小建中汤联合艾灸治疗小儿肠系膜淋巴结炎脾胃虚寒证54例临床观察

Clinical observation on the combination of Xiaojianzhong Tang(小建中汤)and moxibustion in the treatment of 54 cases of pediatric mesenteric lymphadenitis with spleen and stomach deficiency and cold syndrome

目的观察小建中汤联合艾灸治疗小儿肠系膜淋巴结炎脾胃虚寒证的临床疗效。方法选取2018年1月至2021年12月温州市中医院消化科和温州市中西医结合医院中医儿科门诊收治的肠系膜淋巴结炎脾胃虚寒证患儿108例为研究对象,按照随机数字表法分为对照组和治疗组,各54例。对照组口服头孢克洛干混悬剂,腹痛严重者给予消旋山莨菪碱片,疼痛缓解后停止用药。治疗组在对照组治疗方法的基础上口服小建中汤联合艾灸治疗,2组均连续治疗2周后统计临床疗效。结果治疗组总有效率为94.44%(51/54),对照组为74.08%(43/54),2组比较,差异有统计学意义(P<0.05)。治疗前2组中医证候积分、肠系膜淋巴结大小比较,差异无统计学意义(P>0.05),具有可比性;治疗后2组中医证候积分均明显下降,肠系膜淋巴结长径、短径明显缩小,与同组治疗前比较,差异均有统计学意义(P<0.05),且治疗组改善更显著(P<0.05)。治疗前2组免疫功能指标成熟T淋巴细胞(CD3^(+))、辅助性T淋巴细胞(CD4^(+))、杀伤性T淋巴细胞(CD8^(+))及CD4^(+)/CD8^(+)水平比较,差异无统计学意义(P>0.05),具有可比性;治疗后2组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平显著升高,CD8^(+)水平显著下降,与同组治疗前比较,差异均有统计学意义(P<0.05),且治疗组升高或下降更显著(P<0.05)。2组治疗总有效患儿经随访6个月,治疗组复发率为3.92%(2/51),对照组为18.60%(8/43),2组比较,差异有统计学意义(P<0.05)。结论小建中汤联合艾灸治疗小儿肠系膜淋巴结炎脾胃虚寒证,能有效改善患儿临床症状,缩小肿大的肠系膜淋巴结,提高机体免疫力,降低复发风险,效果显著,值得临床推广应用。

Objectivee To explore the clinical efficacy of Xiaojianzhong Tang(小建中汤)combined with moxibustion on children with mesenteric lymphadenitis(ML)of spleen and stomach deficiency andcold syndrome.Methods 108 children with mesenteric lymphadenitis of spleen and stomach deficiency and cold syndrome admited to the gastroenterology clinic of Wenzhou Traditional Chinese Medicine and Wenzhou Integrated Hospital of Traditional Chinese and Western Medicine were selected and divided into the treatment group and the control group(54 cases each)according to the random number table.In the control group,cefaclor dry suspension was given orally,and Racanisodamine Tablets were given to those with severe abdominal pain,and it was stopped after pain relief.The treatment group was treated with Xiaojianzhong Tang combined with moxibustion on the basis of the treatment method of the control group,and the clinical efficacy of both groups was counted after 2 weeks of continuous treatment.Results The total effective rate of the treatment group was 94.44%(51/54),while that of the control group was 74.08%(43/54).The difference between the two groups was statistically significant(P<0.05).There was no statistically significant difference(P>0.05)in the scores of traditional Chinese medicine syndromes and the size of mesenteric lymph nodes between the two groups before treatment,indicating comparability.After treatment,both groups of traditional Chinese medicine syndrome scores significantly decreased,and the long and short diameters of mesenteric lymph nodes were significantly reduced.Compared with the same group before treatment,the differences were statistically significant(P<0.05),and the treatment group showed more significant improvement(P<0.05).Before treatment,there was no statistically significant dfference in the levels of mature T lymphocytes(CD3^(+)),helper T lymphocytes(CD4^(+)),killer T lymphocytes(CD8^(+)),and CD4/CD8^(+)between the two groups of immune function indicators(P>0.05),indicating comparability.After treatment,the levels of CD3^(+),CD4^(+),and CD4^(+)/CD8^(+)in the two groups significantly increased,while the levels of CD8^(+)significantly decreased.Compared with the same group before treatment,the differences were statistically significant(P<0.05),and the treatment group showed a more significant increase or decrease(P<0.05).After 6 months of follow-up,the recurrence rate of the treatment group was 3.92%(2/51),while the control group was 18.60%(8/43).The difference between the two groups was statistically significant(P<0.05).Conclusion Xiaojianzhong Tang combined with moxibustion has a definite therapeutic effect on children with ML,which can improve the clinical symptoms of children,reduce mesenteric lymph nodes,improve the immunity of the body,and reduce the recurrence rate.It is worth popularizing and applying.