平喘通窍方协同小剂量激素雾化治疗小儿咳嗽变异性哮喘合并鼻炎

Clinical study of Pingchuan Tongqiao decoction combined with low-dose ICS in the treatment of cough variant asthma complicated with rhinitis in children

目的观察平喘通窍方联合小剂量吸入用糖皮质激素治疗小儿咳嗽变异性哮喘合并鼻炎的疗效。方法将84例咳嗽变异性哮喘合并鼻炎的患儿随机分为治疗组与对照组各42例,治疗组予以平喘通窍方口服联合小剂量布地奈德(每次0.5 mg,每日2次)雾化治疗,对照组予以常规剂量布地奈德(每次1.0 mg,每日2次)+特布他林雾化,联合氯雷他定口服治疗,治疗4周后观察疗效,检测实验室指标外周血嗜酸粒细胞百分比(EOS%)、血清总免疫球蛋白E(总IgE),以及测试肺功能及呼出气一氧化氮(FeNO)、安全性指标。结果2组临床疗效,治疗组优于对照组(P<0.05)。日间及夜间咳嗽程度,治疗组优于对照组(P<0.05)。2组治疗后中医主要证候积分均具有统计学意义(P<0.01)。次要证候积分(咳痰、睡眠、饮食、大便),中医证候总积分,2组治疗后均较治疗前有显著改善(P<0.01),且治疗后,治疗组显著优于对照组(P<0.01)。2组治疗后血清EOS%、总Ig E均较治疗前显著改善(P<0.01),对照组在EOS%改善上,优于治疗组(P<0.05)。治疗前后,对照组及治疗组对FEV1、FVC、PEF、FEF50、FEF75有显著改善作用(P<0.01),对FEV1/FVC有改善作用(P<0.05),2组治疗后总体肺功能改善相当(P>0.05)。治疗后Fe NO的改善,治疗组优于对照组(P<0.05)。2组均无安全性指标异常。结论平喘通窍方协同小剂量布地奈德雾化,对小儿咳嗽变异性哮喘合并鼻炎具有良好的临床疗效,能改善咳嗽及鼻部症状,改善饮食、大便、睡眠等生活质量,其机制可能是通过抑制气道炎性物质,改善小气道阻塞性病变来实现的。研究发现患儿对于FeNO检查的配合度高,值得推广。该方案能够减少激素的使用,减少西药口服药物的使用,具有较出色的协同作用,且安全性良好。

Objective To observe the efficacy of Pingchuan Tongqiao decoction combined with low-dose inhaled corticosteroid(ICS)in the treatment of children with cough variant asthma(CVA)complicated with allergic rhinitis(AR).Methods A total of 84 children with CVA complicated with AR were randomly divided into a treatment group and a control group,with 42 cases in each group.The treatment group was treated with Pingchuan Tongqiao decoction combined with a low-dose budesonide(0.5mg/time,twice a day)atomization,while the control group was treated with conventional dose budesonide(1.0mg/time,twice a day)+terbutaline atomization combined with a loratadine oral treatment.After 4 weeks of treatment,the curative effect was observed and the percentage of eosinophils in peripheral blood(EOS%),serum total immunoglobulin E(total IgE),pulmonary function,fractional exhaled nitric oxide(FeNO)as well as safety indicators were measured.Results The clinical efficacy was better in the treatment group than that in the control group(P<0.05).The degree of cough during the day and at night was different between the two groups after treatment,and the treatment group was significantly better than the control group(P<0.05).The scores of primary TCM syndromes in the two groups were significantly improved after treatment(P<0.01),and the treatment group was better than the control group(P<0.05).The scores of secondary syndromes(expectoration,sleep,diet,stool)and the total scores of TCM syndromes in the two groups were significantly improved after treatment(P<0.01),and the treatment group was significantly better than the control group(P<0.01).After treatment,the levels of serum EOS%and total IgE in the two groups were significantly improved compared with those before treatment(P<0.01),and the improvement of EOS%in the control group was better than that in the treatment group(P<0.05).Before and after treatment,the levels of FEV_(1),FVC,PEF,FEF50 and FEF75 were significantly improved in both the control group and the treatment group(P<0.01),and the level of FEV_(1)/FVC was improved(P<0.05),while the overall improvement of pulmonary function after treatment was similar in the two groups(P>0.05).The improvement of FeNO was better in the treatment group than that in the control group(P<0.05).There were no abnormal safety indexes in both groups.Conclusion Pingchuan Tongqiao decoction combined with a low-dose budesonide atomization has a good clinical effect on children with CVA complicated with AR,which can improve the cough and nasal symptoms,improve the quality of life such as diet,stool,sleep,possibly by inhibiting airway inflammatory substances and improving small airway obstructive lesions.The study finds that children have a high degree of cooperation with FeNO examination,which is worthy of promotion.The scheme can reduce the use of ICS and oral drugs,with an excellent synergistic effect and a good safety.