截敏汤联合脱敏煎治疗小儿咳嗽变异性哮喘的临床疗效

Clinical efficacy of Jiemin decoction combined with Tuomin decoctum in treatment of children with cough variant asthma

目的分析截敏汤联合脱敏煎治疗小儿咳嗽变异性哮喘(CVA)的临床疗效.方法选取2018年1月-2020年1月浙江大学医学院附属儿童医院儿科收治的86例CVA患儿,随机分为对照组与观察组,每组43例.对照组给予孟鲁司特钠咀嚼片治疗,观察组在上述用药基础上给予截敏汤联合脱敏煎治疗,两组均连续治疗3个月.比较两组肺功能、中医症候积分、细胞免疫功能、随访成功率及复发率.结果观察组治疗总有效率为90.70%,显著高于对照组的72.09%,差异有统计学意义(χ^(2)=4.074,P=0.044).治疗后,观察组用力肺活量(FVC)、第1秒用力呼气容积与FVC比(FEV_(1)/FVC)及最大呼气峰流速(PEF)分别为(1.98±0.35)L、(87.38±7.66)%及(3.15±0.68)L/s,对照组FVC、FEV_(1)/FVC及PEF分别为(1.80±0.31)L、(78.35±7.20)%及(2.84±0.54)L/s.两组治疗后FVC、FEV_(1)/FVC及PEF比较差异均有统计学意义(t=2.252,P=0.014;t=5.633,P=0.000;t=2.341,P=0.022).治疗后,观察组咽红、咳痰、咽痒、咳嗽积分及总积分分别为(0.58±0.24)分、(0.55±0.18)分、(0.51±0.20)分、(0.31±0.10)分及(1.89±0.46)分,对照组咽红、咳痰、咽痒、咳嗽积分及总积分分别为(0.78±0.27)分、(0.73±0.20)分、(0.71±0.23)分、(0.69±0.14)分及(3.67±0.54)分.两组治疗后咽红、咳痰、咽痒、咳嗽积分及总积分比较差异均有统计学意义(t=4.356,P=0.000;=4.387,P=0.000;t=4.303,P=0.000;t=14.483,P=0.000;t=16.454,P=0.000).治疗后,观察组血清IgA、IgM、IgG及IgE水平分别为(1.70±0.25)g/L、(4.05±0.77)g/L、(15.35±2.88)g/L及(108.46±22.20)kU/L,对照组血清IgA、IgM、IgG及IgE水平分别为(1.43±0.22)g/L、(3.31±0.65)g/L、(12.77±2.40)g/L及(143.58±24.26)kU/L.两组治疗后血清IgA、IgM、IgG及IgE水平比较差异均有统计学意义(t=5.317,P=0.000;t=4.816,P=0.000;t=4.513,P=0.000;t=7.003,P=0.000).随访6个月,观察组复发2例,复发率为4.88%,对照组复发8例,复发率为20.51%,两组复发率比较差异有统计学意义(χ^(2)=4.467,P=0.035).结论截敏汤联合脱敏煎治疗小儿CVA疗效确切,可显著改善患儿临床症状和肺功能,调节细胞免疫因子水平,降低复发率.

Objective To analyze the clinical efficacy of Jiemin decoction combined with Tuomin decoctum in treatment of children with cough variant asthma(CVA).Methods From January 2018 to January 2020,86 children with CVA treated in Department of Pediatrics in Children’s Hospital,Zhejiang University School of Medicine were selected and randomly divided into control group and observation group,43 children in each group.The children in control group were treated with montelukast sodium chewable tablets,while the children in observation group were treated with montelukast sodium chewable tablets,Jiemin decoction,and Tuomin decoctum.The children in the two groups were treated for three months continuously.Pulmonary function parameters,TCM syndrome scores,cellular immune function parameters,successful rates of follow-up,and recurrence rates in the two groups were compared.Results The total effective rate of treatment in observation group was 90.70%,which was statistically significantly higher than that in control group(72.09%)(χ^(2)=4.074,P=0.044).After treatment,forced vital capacity(FVC),forced expiratory volume in one second/FVC(FEV_(1)/FVC),and peak expiratory flow(PEF)in observation group were(1.98±0.35)L,(87.38±7.66)%,and(3.15±0.68)L/s,respectively;FVC,FEV_(1)/FVC,and PEF in control group were(1.80±0.31)L,(78.35±7.20)%,and(2.84±0.54)L/s,respectively.After treatment,there were statistically significant differences in FVC,FEV_(1)/FVC,and PEF between the two groups(t=2.252,P=0.014;t=5.633,P=0.000;t=2.341,P=0.022).After treatment,the scores of red throat,sputum,pharyngeal itching,cough,and total score in observation group were(0.58±0.24),(0.55±0.18),(0.51±0.20),(0.31±0.10),and(1.89±0.46),respectively;the scores of red throat,sputum,pharyngeal itching,cough,and total score in control group were(0.78±0.27),(0.73±0.20),(0.71±0.23),(0.69±0.14),and(3.67±0.54),respectively.After treatment,there were statistically significant differences in the scores of red throat,sputum,pharyngeal itching,cough,and total score between the two groups(t=4.356,P=0.000;t=4.387,P=0.000;t=4.303,P=0.000;t=14.483,P=0.000;t=16.454,P=0.000).After treatment,the levels of serum Ig A,Ig M,Ig G,and Ig E in observation group were(1.70±0.25)g/L,(4.05±0.77)g/L,(15.35±2.88)g/L,and(108.46±22.20)k U/L,respectively;the levels of serum Ig A,Ig M,Ig G,and Ig E in control group were(1.43±0.22)g/L,(3.31±0.65)g/L,(12.77±2.40)g/L,and(143.58±24.26)kU/L,respectively.After treatment,there were statistically significant differences in the levels of serum IgA,IgM,IgG,and IgE between the two groups(t=5.317,P=0.000;t=4.816,P=0.000;t=4.513,P=0.000;t=7.003,P=0.000).After follow-up for six months,the recurrence rates in observation group and control group were 4.88%(2 children)and 20.51%(8 children),respectively,there was statistically significant difference between the two groups(χ^(2)=4.467,P=0.035).Conclusion The clinical efficacy of Jiemin decoction combined with Tuomin decoctum in treatment of children with CVA is significant,the therapy can significantly improve clinical symptoms and pulmonary function,regulate the levels of cellular immune factors,and reduce recurrence rate.