免疫调节联合推拿治疗脑瘫伴反复呼吸道感染患儿的临床效果

Clinical effect of immunomodulatory therapy combined with massage on treatment of cerebral palsy children complicated with recurrent respiratory tract infection

目的探讨免疫调节联合推拿治疗脑性瘫痪(简称脑瘫)伴反复呼吸道感染患儿的临床治疗价值.方法回顾性收集2017年1月-2019年4月河北省中医院收治的96例脑瘫伴反复呼吸系统感染患儿的临床资料,按治疗方式分为联合组51例,在康复训练和对症处理基础上采用免疫调节药物和推拿治疗;推拿组45例,在康复训练和对症处理基础上采用推拿治疗,比较两组患儿呼吸道感染症状消失时间,分析两组患儿治疗前、治疗1个月后免疫球蛋白A(IgA)、IgG、IgM及T淋巴细胞亚群(CD_(4)^(+)、CD_(8)^(+)、CD_(4)^(+)/CD_(8)^(+))水平变化;比较治疗前和治疗1周白细胞计数(WBC)、白细胞介素(IL)-6、IL-1β、超敏C-反应蛋白(hs-CRP)等炎症因子水平变化;比较两组治疗前后肺功能的变化及治疗不良反应发生情况;统计随访3个月、6个月再次呼吸道感染发生率.结果联合组发热消退、咳嗽消失、肺部啰音消失、扁桃体肿大改善时间分别为(2.75±0.67)d、(4.53±1.25)d、(4.65±1.45)d、(3.25±1.02)d均短于推拿组(P<0.05);治疗后,两组IgA、IgG、IgM、CD_(4)^(+)、CD_(4)^(+)/CD_(8)^(+)均上升,CD_(8)^(+)均降低(P<0.05),联合组IgA、IgG、IgM、CD_(4)^(+)、CD_(4)^(+)/CD_(8)^(+)高于推拿组(P<0.05),CD_(8)^(+)低于推拿组(P<0.05);治疗后,两组WBC、IL-6、IL-1β、hs-CRP均降低(P<0.05),联合组WBC、IL-6、IL-1β、hs-CRP低于推拿组(P<0.05);治疗后两组1秒用力呼气容积(FEV1)、用力肺活量(FVC)、最大呼气流量(PEF)均上升(P<0.05),联合组FVC、FEV1、PEF高于推拿组(P<0.05);随访3、6个月,联合组再次感染率(7.84%、19.61%)低于推拿组(22.22%、44.44%),比较差异有统计学意义(P<0.05).结论泛福舒免疫调节治疗联合推拿较单用推拿更能改善脑瘫伴反复呼吸道感染患儿机体免疫,降低炎症因子水平及再次感染率,改善肺功能.

OBJECTIVE To explore the clinical value of immunomodulatory therapy combined with massage in treatment of cerebral palsy children complicated with recurrent respiratory tract infection.METHODS A total of 96 cerebral palsy children complicated with recurrent respiratory tract infection who were treated in the Hebei Hospital of Traditional Chinese Medicine from Jan 2017 to Apr 2019 were enrolled in the study and divided into the combined group with 51 cases and the massage group with 45 cases according to the treatment mode,the clinical data of the children were retrospectively analyzed.The combined group was treated with immunomodulatory therapy combined with massage on basis of rehabilitation training and symptomatic treatment,and the massage group was given massage on basis of rehabilitation training and symptomatic treatment.The time of disappearance of respiratory tract infection symptoms was compared between the two groups of children,the levels of immunoglobulin A(IgA),immunoglobulin G(IgG),immunoglobulin M(IgM)and T lymphocyte subsets(CD_(4)^(+),CD_(8)^(+),CD_(4)^(+)/CD_(8)^(+))were observed before the treatment and after the treatment for 1 month;the levels of inflammatory factors such as white blood cell(WBC),interleukin-6(IL-6),interleukin-1β(IL-1β)and high-sensitivity C-reactive protein(hs-CRP)were compared before the treatment and after the treatment for 1 week;the lung function indexes and incidence of adverse reactions were compared between the two groups before and after the treatment,and the incidence rates of recurrent respiratory tract infection were statistically analyzed after the follow-up for 3 and 6 months.RESULTS The time of recovery from fever,disappearance of cough,disappearance of pulmonary rales and improvement of swelling of tonsil of the combined group were respectively(2.75±0.67)d,(4.53±1.25)d,(4.65±1.45)d and(3.25±1.02)d,significantly shorter than those of the massage group(P<0.05).The levels of IgA,IgG,IgM,CD_(4)^(+)and CD_(4)^(+)/CD_(8)^(+)of the two groups were significantly elevated after the treatment,while the CD_(8)^(+)level was reduced significantly(P<0.05);the levels of IgA,IgG,IgM,CD_(4)^(+)and CD_(4)^(+)/CD_(8)^(+)of the combined group were significantly higher than those of the massage group(P<0.05),while the CD_(8)^(+)level of the combined group was significantly lower than that of the massage group(P<0.05).The levels of WBC,IL-6,IL-1βand hs-CRP of the two groups were significantly reduced after the treatment(P<0.05),and the levels of WBC,IL-6,IL-1βand hs-CRP of the combined group were significantly lower than those of the massage group(P<0.05).The forced expiratory volume in one second(FEV1),forced vital capacity(FVC)and peak expiratory flow(PEF)of the two groups were increased after the treatment(P<0.05),and the FVC,FEV1 and PEF of the combined group were significantly higher than those of the massage group(P<0.05).After the follow-up for 3 and 6 months,the incidence rates of recurrent infection were respectively 7.84%and 19.61%in the combined group,significantly lower than 22.22%and 44.44%in the massage group(P<0.05).CONCLUSION As compared with single use of massage,Broncho-Vaxom immunomodulatory therapy combined with massage can boost the body immunity of the cerebral palsy children complicated with recurrent respiratory tract infection more effectively,reduce the levels of inflammatory factors and incidence of recurrent infection,and improve the lung function.