清解散结汤辨证辅助治疗儿童传染性单核细胞增多症的临床研究

Clinical Study of Qingjie Sanjie Decoction(清解散结汤)in Syndrome Differentiation and Treatment of Infectious Mononucleosis in Children

目的探讨清解散结汤辨证辅助治疗儿童传染性单核细胞增多症(IM)的临床疗效。方法选取诊治的IM患儿80例,随机分为对照组与观察组,每组40例,常规采取卧床休息、退热、护肝、营养支持等综合措施治疗,观察组患儿同时给予清解散结汤辨证辅助治疗,观察治疗前后中医证候积分变化,症状及体征消退时间,天门冬氨酸氨基转移酶(AST)及丙氨酸氨基转移酶(ALT)及外周血T细胞亚群CD_(3)^(+)、CD_(4)^(+)、CD_(8)^(+)及CD_(4)^(+)/CD_(8)^(+)值变化,EBV-DNA转阴率。结果两组患儿中医证候积分治疗后较治疗前下降(P<0.001),且观察组低于对照组(P<0.001);观察组完全热退时间、颈部淋巴结肿大消退时间、咽峡炎消失时间、肝肿大消退时间、脾肿大消退时间、异常淋巴细胞恢复时间短于对照组(P<0.001);两组患儿ALT及AST水平治疗后较治疗前下降(P<0.001),且观察组低于对照组(P<0.001);两组患儿治疗后CD_(3)^(+)、CD_(8)^(+)较治疗前下降(P<0.001),且观察组低于对照组(P<0.001),CD_(4)^(+)、CD_(4)^(+)/CD_(8)^(+)较治疗前升高(P<0.001),且观察组高于对照组(P<0.001);观察组EBV-DNA转阴率为60.00%(24/40),高于对照组(37.50%,15/40)(P<0.05);观察组治疗总有效率为85.00%(34/40),高于对照组(62.50%,25/40)(P<0.05)。结论清解散结汤辨证辅助治疗儿童传染性单核细胞增多症能有助于缓解临床症状及体征,改善肝功能及免疫功能,促进EBV-DNA的转阴,提高治疗疗效。

Objective To discuss the clinical efficacy of Qingjie Sanjie Decoction(清解散结汤)in syndrome differentiation and treatment of infectious mononucleosis(IM)in children.s Methods We collected 80 cases of children with IM.They were ran-domly divided into control group and observation group with 40 cases in each group.Routine treatment included bed rest,antipy-retic therapy,liver protection and nutritional support in the two groups.They were routinely taken for treatment bed rest,antipy-retic,liver protection,nutritional support and other comprehensive measures.The observation group was treated with Qingjie Sanjie Decoction at the same time.The changes of TCM syndromes scores,the time for the disappearance of symptoms and signs before and after treatment,aspartate aminotransferase(AST),alanine aminotransferase(ALT)and CD_(3)^(+),CD_(4)^(+),CD_(8)^(+) and CD_(4)^(+)/CD_(8)^(+) in peripheral blood T cell subsets,and EBV DNA-negative conversion ratio were observed.s Results The scores of TCM syndromes in both groups were decreased after treatment compared with those before treatment(P<0.001)and the observation group’s score was lower than that of the control group(P<0.001).The complete fever regression time,neck lymph node en-largement regression time,angina disappearance time,hepatomegaly regression time,splenomegaly regression time and abnormal lymphocyte recovery time of the observation group were shorter than those of the control group(P<0.001).Levels of ALT and AST in both groups were decreased after treatment compared with those before treatment(P<0.001),and the observation group’s levels were lower than those of the control group(P<0.001).Levels of CD_(3)^(+) and CD_(8)^(+) in both groups were decreased after treatment compared with those before treatment(P<0.001),and the observation group’s levels were lower than those of the con-trol group(P<0.001).Levels of CD3 and CD_(4)^(+)/CD_(8)^(+) in both groups were elevated after treatment compared with those before treatment(P<0.001)and the observation group’s levels were higher than those of the control group(P<0.001).The EBV DNA-negative conversion ratio(60.00%,24/40)in the observation group was higher than that of the control group(37.50%,15/40)(P<0.05).n Conclusion The syndrome differentiation and treatment of infectious mononucleosis in children by Qingjie Sanjie Decoction can alleviate clinical symptoms and signs,improve liver function and immune function,promote EBV DNA-negative conversion ratio and improve the therapeutic effect.