健脾熄风汤治疗脾虚风动型儿童抽动障碍疗效及对血清神经递质、T淋巴细胞亚群水平的影响

Clinical value of Jianpi Xifeng Decoction combined with tiapride tablet in treatment of children with tic disorder and its influence on serum neurotransmitter and T lymphocyte subsets

目的 探讨健脾熄风汤治疗脾虚风动型儿童抽动障碍的临床疗效及对神经递质、T淋巴细胞亚群水平的影响。方法 回顾性选取大庆市中医医院2021年1月至2022年1月收治的80例脾虚风动型抽动障碍患儿作为研究对象,根据治疗方案的不同将其分为对照组和观察组,每组40例。对照组给予硫必利片进行治疗,观察组采用健脾熄风汤联合硫必利片进行治疗,两组均连续治疗8周。比较两组耶鲁综合抽动严重程度量表(YGTSS)评分和临床疗效;比较两组治疗前、后中医证候评分及血清神经递质[多巴胺(DA)、去甲肾上腺素(NE)、5-羟色胺(5-HT)]、T淋巴细胞亚群(CD3^(+)T淋巴细胞、CD4^(+)T淋巴细胞、CD4^(+)T淋巴细胞/CD8^(+)T淋巴细胞)比值水平,统计两组不良反应发生情况。结果 治疗后,两组患儿的运动抽动评分、发声抽动评分、社会受损程度评分和YGTSS总分均低于治疗前,且观察组明显低于对照组,差异均有统计学意义(P<0.05)。观察组治疗总有效率为97.50%,明显高于对照组的85.00%(P<0.05)。治疗后,观察组各项中医证候评分均低于对照组(P<0.05)。重复测量方差分析结果显示,两组DA、NE水平及CD4^(+)T淋巴细胞百分比、CD8^(+)T淋巴细胞百分比、CD4^(+)T淋巴细胞/CD8^(+)T淋巴细胞比值均存在交互效应、时间效应和组间效应(P<0.05),5-HT、CD3^(+)T淋巴细胞水平存在时间效应和组间效应(P<0.05)。进一步进行单独效应分析发现,观察组治疗后第4周、第8周CD4^(+)T淋巴细胞百分比和CD4^(+)/CD8^(+)T淋巴细胞比例高于对照组,血清DA、NE水平及CD8^(+)T淋巴细胞百分比均低于对照组,差异均有统计学意义(P<0.05);两组治疗后第8周后血清DA、NE水平及CD8^(+)T淋巴细胞百分比明显低于治疗后第4周,CD4^(+)T淋巴细胞百分比和CD4^(+)T淋巴细胞/CD8^(+)T淋巴细胞比值均高于治疗后第4周,差异均有统计学意义(P<0.05)。治疗期间,两组均未出现明显不良反应。结论 健脾熄风汤治疗脾虚风动型儿童抽动障碍疗效明确,可显著改善患儿各项临床症状,可能与抑制DA、NE分泌水平及调节机体免疫功能有关。

Objective To investigate the clinical efficacy of Jianpi Xifeng Decoction in the treatment of spleen deficiency and wind-induced tic disorder in children and its influence on the levels of serum neurotransmitter and T lymphocyte subsets.Methods Retrospective analysis was performed on 80 children with spleen deficiency and wind-induced tic disorder in Daqing Hospital of Traditional Chinese Medicine from January 2021 to January 2022,who were divided into control group and observation group according to the difference of the treatment programs,with 40 cases in each group.The control group was given tiapride tablets for treatment,while the observation group was treated with Jianpi Xifeng Decoction combined with tiapride tablet,and both groups were treated continuously for 8 weeks.The Yale General Tic Severity Scale(YGTSS)scores and clinical efficacy were compared between the two groups.The TCM syndrome scores and serum neurotransmitter[dopamine(DA),norepinephrine(NE),5-hydroxytryptamine(5-HT)]and T lymphocyte subsets(CD3^(+),CD4^(+),CD4^(+)/CD8^(+))were compared between the two groups before and after treatment,and the occurrence of the adverse reactions were analyzed between the two group.Results After treatment,the motor tic scores,vocal tic scores,social impairment scores and YGTSS total scores of the children in both groups were lower than those before treatment,and which in the observation group were significantly lower than those in the control group,with statistically significant differences(P<0.05).After treatment,the total effective rate of the observation group was 97.50%,which was significantly higher than 85.00%of the control group(P<0.05).After treatment,the scores of all Chinese syndromes in the observation group were lower than those in the control group(P<0.05).The results of repeated-measures ANOVA showed that there were interaction effect,time effect and intergroup effect for DA,NE,CD4^(+),CD8^(+)levels and CD4^(+)/CD8^(+)ratios in the two groups(P<0.05),and time effect and intergroup effect for 5-HT and CD3^(+)levels(P<0.05).Further analysis of individual effects found that CD4^(+)levels and CD4^(+)/CD8^(+)ratios in the observation group on 4th week and 8th week after treatment were higher than those in the control group,while the serum levels of DA,NE,CD8^(+)were lower than those in the control group,with statistically significant differences(P<0.05).The serum levels of DA,NE,CD8^(+)in both group on 8th week after treatment were lower than those on 4th week after treatment,while the CD4^(+)level and CD4^(+)/CD8^(+)ratio were higher than those on 4th week after treatment,with statistically significant differences(P<0.05).During treatment,no obvious adverse reactions occurred in both groups.Conclusion Jianpi Xifeng Decoction has clear curative effect on tic disorder of spleen deficiency and wind-induced children,and it can significantly improve the clinical symptoms of children,which may be related to inhibiting the secretion of dopamine and norepinephrine and regulating the immune function of the body.