推拿联合自拟健脾调肝方治疗小儿厌食临床研究

Clinical study on the treatment of anorexia in children by Tui Na therapy combined with self-made Jianpi-Tiaogan Decoction

目的评价推拿联合自拟健脾调肝方治疗小儿厌食的疗效。方法将符合入选标准的2018年1月-2019年6月本院92例厌食患儿按随机数字表法分为2组,每组46例。对照组采用捏脊摩腹推脾为主的推拿法治疗,治疗组在对照组基础上加服自拟健脾调肝方。2组均连续治疗4周。分别于治疗前后进行中医证候评分,采用双抗体夹心ELISA法测定血清瘦素、促人生长激素释放肽(Ghrelin)水平,采用放射免疫法测定血清神经肽Y,采用火焰原子吸收光谱法、蛋白印迹法检测血锌、唾液淀粉酶含量,并进行D-木糖吸收试验,评价临床疗效。结果治疗组总有效率为91.3%(42/46)、对照组为73.9%(34/46),2组比较差异有统计学意义(χ^2=4.821,P=0.028)。治疗组治疗后食欲不振、拒食、烦躁易怒、兴奋躁动、呃逆嗳气、胸胁胀满、形态偏瘦、夜寐难安评分及总分均低于对照组(t值分别为6.782、7.524、9.100、5.643、4.796、6.066、4.069、3.197、5.073,P值均<0.01)。治疗后,治疗组血清神经肽Y[(133.7±12.4)ng/L比(105.6±10.8)ng/L,t=11.589]、Ghrelin[(329.6±26.1)ng/L比(275.4±25.0)ng/L,t=12.211]水平高于对照组(P<0.01);瘦素[(21.7±4.0)g/L比(25.2±4.3)g/L,t=4.042]水平低于对照组(P<0.01);血锌[(9.9±2.5)mol/L比(8.7±2.3)mol/L,t=2.396]、唾液淀粉酶[(23.5±4.2)U/L比(17.9±3.6)U/L,t=6.866]、D-木糖[(0.9±0.4)ng/L比(0.7±0.3)ng/L,t=2.713]含量均高于对照组(P<0.05或P<0.01)。结论推拿联合自拟健脾调肝方可改善厌食患儿的中医证候,调节神经肽Y、瘦素、Ghrelin水平,提高临床疗效。

Objective To evaluate the efficacy of Tui Na therapy combined with self-made Jianpi-Tiaogan Decoction in the treatment of anorexia in children.Methods A total of 92 patients with pediatric anorexia in our hospital from January 2018 to June 2019 who met the inclusion criteria were divided into 2 groups by random number table method,with 46 patients in each group.The control group was treated with the Tui Na therapy mainly by manipulating on the abdomen and pushing the spleen,and the treatment group was given the self-made Jianpi-Tiaogan Decoction on the basis of the treatment of the control group.Both groups were treated for 4 weeks.The TCM syndrome scores were performed,serum Leptin and Ghrelin levels were measures by enzyme linked immunosorbent assay,serum neuropeptide Y(NPY)was measured by radioimmunoassay,contents of blood zinc and salivary amylase ptyalase were measured by flame atomic absorption spectrometry and Western blot,and D-xylose absorption test was carried out respectively before and after treatment.And the clinical efficacy was evaluated.Results The total effective rate was 91.3%(42/46)in the treatment group and 73.9%(34/46)in the control group.The difference between the two groups was statistically significant(χ^2=4.821,P=0.028).After treatment,the scores of anorexia,antifeedance,irritability,agitation,hiccup and belching,fullness of chest and flank,thin shape,sleep difficulty and total score in the treatment group were significantly lower than those in the control group(t values were 6.782,7.524,9.100,5.643,4.796,6.066,4.069,3.197,5.073,respectively,all Ps<0.01).After treatment,the serum NPY(133.7±12.4 ng/L vs.105.6±10.8 ng/L,t=11.589)and Ghrelin(329.6±26.1 ng/L vs.275.4±25.0 ng/L,t=12.211)levels in the treatment group were significantly higher than those in the control group(P<0.01),but Leptin(21.7±4.0 g/L vs.25.2±4.3 g/L,t=4.042)was significantly lower than that of the control group(P<0.01).After treatment,blood zinc(9.9±2.5 mol/L vs.8.7±2.3 mol/L,t=2.396),salivary amylase ptyalase content(23.5±4.2 U/L vs.17.9±3.6 U/L,t=6.866),D-xylose absorption test(0.9±0.4 ng/L vs.0.7±0.3 ng/L,t=2.713)were significantly higher than those in the control group(P<0.05 or P<0.01).Conclusions Tui Na therapy combined with self-made Jianpi-Tiaogan Decoction can improve TCM syndromes of children,regulate the levels of NPY,Leptin and Ghrelin,and improve clinical efficacy.