小柴胡汤加减方治疗传染性单核细胞增多症患儿的临床观察

Clinical efficacy of modified Xiaochaihu Decoction on children with infectious mononucleosis

目的 观察小柴胡汤加减方治疗传染性单核细胞增多症(IM)患儿的临床疗效。方法 将60例IM患儿按照随机数字表法分为2组,2组均给予对症支持治疗,并根据细菌感染指征酌情予抗生素治疗,西药组30例予注射用更昔洛韦治疗10~14天,中药组30例在西药组治疗的基础上给予小柴胡汤加减方治疗14天。比较2组治疗前后T细胞亚群CD4^(+)、CD8^(+)、CD3^(+)、CD4^(+)/CD8^(+)值变化,天冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、颈淋巴结大小、中医证候积分,记录临床症状、体征及异常淋巴细胞恢复时间,并统计2组疗效。结果 中药组总有效率96.7%(29/30),西药组总有效率73.3%(22/30),中药组临床疗效优于西药组(P<0.05)。2组治疗后CD8^(+)、CD3^(+)均较本组治疗前降低(P<0.05),且中药组均低于西药组(P<0.05);2组治疗后CD4^(+)、CD4^(+)/CD8^(+)均较本组治疗前升高(P<0.05),且中药组均高于西药组(P<0.05)。2组治疗后ALT、AST均较本组治疗前降低(P<0.05),且中药组治疗后均低于西药组(P<0.05)。2组治疗后颈部淋巴结直径均较本组治疗前降低(P<0.05),且中药组治疗后低于西药组(P<0.05)。2组治疗后中医证候积分均较本组治疗前降低(P<0.05),且中药组治疗后低于西药组(P<0.05)。中药组完全热退时间、乏力、咽痛消失时间、肝脾肿大恢复正常时间、异常淋巴细胞恢复正常时间均短于西药组(P<0.05)。结论 小柴胡汤加减方可缩短IM患儿病程,改善免疫功能,提高疗效。

Objective To observe the clinical efficacy of modified Xiaochaihu Decoction on children with infectious mononucleosis(IM).Methods Sixty children with IM were randomly divided into the Western medicine(WM)group and the traditional Chinese medicine(TCM)group,with 30 cases in each group.All patients were managed by symptomatic treatment,and were given antibiotics according to indications of bacterial infection.In addition,the WM group was treated with injectable ganciclovir infusion for 10 to 14 days,and the TCM group was treated with modified Xiaochaihu Decoction for 14 days based on the WM group.T cell subsets(CD4^(+),CD8^(+),CD3^(+),CD4^(+)/CD8^(+)),aspartate aminotransferase(AST),alanine aminopeptidase(ALT),size of cervical lymph,TCM syndrome scores,clinical symptoms,clinical features,recovery time of abnormal lymphocytes were included as comparators.The curative effect was assessed.Results The overall effective rate in the TCM group was better than that in the WM group(96.7%[29/30]vs 73.3%[22/30],[P<0.05],respectively).After treatment,significantly decreased CD8^(+)and CD3^(+),and increased CD4^(+)and CD4^(+)/CD8^(+)were detected in the two groups(all P<0.05),and the TCM group was superior to the WM group for CD8^(+),CD3^(+),CD4^(+),CD4^(+)/CD8^(+)(all P<0.05).ALT and AST in groups were significantly decreased(P<0.05),the decrease in the TCM group was more common than the WM group(P<0.05).The diameter of posterior cervical lymph nodes in groups was significantly decreased(P<0.05),the decrease in the TCM group was more prevalent compared with the WM group(P<0.05).After treatment,TCM symptom scores in groups were significantly decreased(P<0.05),which decreased notably in the TCM group compared with the WM group(P<0.05).The antipyretic time,disappearance time of fatigue and sore throat,recovery time of hepatosplenomegaly and abnormal lymphocytes in the TCM group were significantly shorter than those in the WM group(P<0.05).Conclusion For children with IM,modified Xiaochaihu Decoction can shorten the course of disease,improve immune function and curative effect.