加减舒中化痰汤替代激素治疗慢性鼻-鼻窦炎合并腺样体肥大患儿术后的临床疗效

Effect of Modified Shuzhong Huatantang Replace Hormone on Children with Chronic Rhinosinusitis and Adenoid Hypertrophy due to Spleen Deficiency and Phlegm Obstruction After Operation

目的:观察加减舒中化痰汤替代激素治疗慢性鼻-鼻窦炎合并腺样体肥大脾虚痰阻证患儿术后的临床疗效。方法:80例患儿随机分为对照组和观察组,各40例。对照组在鼻内窥镜术后给予糠酸莫米松,观察组在鼻内窥镜术后给予加减舒中化痰汤内服和局部冲洗,疗程均为6周。分别于治疗前及术后6,24,48周观察两组鼻内窥镜检查评分量表(Lund-Kennedy),腺样体占所在位置的比值(A/N),鼻鼽中医辨证脾虚痰阻证(中医证状)。治疗前及术后6周分别检测两组血清及鼻分泌液中免疫球蛋白E(IgE),嗜酸性粒细胞阳离子蛋白(ECP),嗜酸性粒细胞(EOS),肿瘤坏死因子-α(TNF-α),白细胞介素-1β(IL-1β),白细胞介素-17(IL-17)的含量。比较两组临床疗效、并发症及术后48周复发情况。结果:研究期间对照组脱落3例,观察组脱落1例。术后6周,观察组总控制率94.9%,高于对照组的75.7%(χ^(2)=6.972,P<0.05)。术后48周,观察组复发率2.6%,低于对照组的18.9%(χ^(2)=4.137,P<0.05)。与对照组术后6,24,48周比较,观察组同期Lund-Kennedy,A/N和中医证状降低(P<0.05)。与对照组术后6周比较,观察组血清及鼻分泌液中IgE,ECP,EOS,TNF-α,IL-1β,IL-17降低(P<0.05)。观察组不良反应发生率2.7%,低于对照组的29.7%(χ^(2)=8.943,P<0.05)。结论:加减舒中化痰汤可明显改善慢性鼻-鼻窦炎合并腺样体肥大脾虚痰阻证患儿术后临床症状,复发率低。

Objective: To observe the effect of modified Shuzhong Huatantang replace hormone on children with rhinosinusitis and adenoid hypertrophy due to spleen deficiency and phlegm obstruction after operation. Method: Eighty cases were randomly divided into control group and observation group,40 cases in each group. After nasal endoscopy,the control group was given mometasone furoate,and the observation group was given modified Shuzhong Huatantang for 6 week. The nasal situation Lund-Kennedy assessment scal(LundKennedy),adenoid thickness/nasopharyngeal cavity width(A/N),TCM syndrome were observed for before treatment,6,24,and 48 weeks after operation. The contents of immunoglobulin E(IgE),eosinophilic cationic protein(ECP),eosinophilic granulocyte(EOS),tumor necrosis factor-alpha(TNF-α),interleukin-1β(IL-1β),interleukin-17(IL-17)in serum and nasal secretions were detected before and 48 weeks after operation. The clinical efficacy,complications,recurrence 48 weeks after operation were compared between the two groups.Result: Three cases of abscission in the control group and one case in the observation group during the study period. The total control rate was 94.9% in the observation group higher than that 75.7% in the control group six weeks after the operation(χ~2=6.972,P<0.05). The recurrence rate was 2.6% in the observation group lower than that 18.9% in the control group 48 weeks after operation(χ~2=4.137,P<0.05). To compared with the control group at 6,24 and 48 weeks after operation,Lund-Kennedy,A/N,TCM syndromes in the observation group decrease in the same period(P<0.05). To compared with the control group 48 weeks after operation,The TNF-α,IL-1β,IL-17,IgE,ECP,EOS in serum and nasal secretions in the observation group were reduced(P<0.05). The incidence of adverse reactions was 2.7% in the observation group lower than that 29.7% in the control group. Conclusion:Modified Shuzhong Huatantang can significantly improve the postoperative clinical symptoms with chronic rhinosinusitis and adenoid hypertrophy due to spleen deficiency and phlegm obstruction,and the recurrence rate is lower.