桂枝麻黄各半汤联合苏子降气汤及依巴斯汀治疗急性荨麻疹伴呼吸困难临床研究

Clinical study on the treatment of acute urticaria with dyspnea by Guizhi Mahuang Geban Decoction combined with Suzi Jiangqi Decoction and ebastine

目的探讨桂枝麻黄各半汤联合苏子降气汤及依巴斯汀治疗急性荨麻疹伴呼吸困难的效果及其机制。方法随机将衡水市中医医院皮肤科2020年10月至2023年6月收治的急性荨麻疹伴呼吸困难患者110例均分为2组,对照组55例给予依巴斯汀+维生素C治疗,观察组55例在对照组基础上给予桂枝麻黄各半汤联合苏子降气汤治疗,7 d为1个疗程,均治疗2个疗程。比较2组临床疗效及治疗前后皮损严重程度相关症状积分、呼吸困难视觉模拟量表(visual analogue scale,VAS)评分、变态反应指标[总免疫球蛋白E(total immunoglobulin E,TIgE)、白三烯(leukotriene,LT)、白细胞介素(interleukin,IL)-4、IL-35]、免疫功能[补体C3、补体C4、免疫球蛋白A(immunoglobulin A,IgA)、免疫球蛋白G(immunoglobulin G,IgG)]及肠道菌群(乳酸杆菌、普拉梭菌、双歧杆菌、柔嫩梭菌)丰度。结果观察组治疗总有效率(98.18%)高于对照组(83.64%)(P<0.05)。与治疗前比较,治疗后2组皮损严重程度相关症状积分及VAS评分均降低(P<0.05),且观察组低于对照组(P<0.05);TIgE、LT、IL-4水平均降低(P<0.05),且观察组低于对照组(P<0.05),IL-35水平均升高(P<0.05),且观察组高于对照组(P<0.05);补体C3、IgA、IgG水平均升高(P<0.05),且观察组高于对照组(P<0.05),补体C4水平差异无统计学意义(P>0.05);乳酸杆菌、普拉梭菌、柔嫩梭菌水平均升高(P<0.05),且观察组高于对照组(P<0.05),双歧杆菌水平差异无统计学意义(P>0.05)。结论桂枝麻黄各半汤联合苏子降气汤及依巴斯汀治疗急性荨麻疹伴呼吸困难疗效相较于单纯西药治疗疗效更好,能减轻变态反应,调节机体免疫功能及肠道菌群,从而有效改善患者临床症状。

Objective To explore the effects and mechanism of Guizhi Mahuang Geban Decoction(GZMHGBD)combined with Suzi Jiangqi Decoction(SZJQD)and ebastin in the treatment of acute urticaria with dyspnea.Methods A total of 110 patients with acute urticaria accompanied by dyspnea,admitted to the Dermatology Department of Hengshui Chinese Medicine Hospital from October 2020 to June 2023 were equally randomized into two groups.The control group(n=55)was treated with ebastine and vitamin C,while the observation group(n=55)was treated with GZMHGBD combined with SZJQD in addition to the control group's treatment.Each treatment course lasted seven days,with a total of two courses.Clinical efficacy,as well as the symptom scores related to the severity of skin lesions,visual analogue scale(VAS)scores for dyspnea,allergic reaction indicators[total immunoglobulin E(TIgE),leukotriene(LT),interleukin(IL)-4,IL-35],immune function[complement C3,complement C4,immunoglobulin A(IgA),immunoglobulin G(IgG)]and intestinal flora(lactobacillus,Faecalibacterium prausnitzii,bifidobacterium,and Clostridium leptum)abundance before and after treatment were compared between the two groups.Results The total effective rate of the observation group was 98.18%,which was higher than that of the control group(83.64%)(P<0.05).Compared with before treatment,the symptom scores related to the severity of skin lesions and VAS scores decreased in both groups after treatment(P<0.05),with the observation group showing lower scores than the control group(P<0.05);levels of TIgE,LT,and IL-4 all decreased(P<0.05),with the observation group showing lower levels than the control group(P<0.05);the level of IL-35 of both groups increased,with the observation group showing a higher level than the control group(P<0.05);levels of complement C3,IgA,and IgG all increased(P<0.05),with the observation group showing higher levels than the control group(P<0.05);there was no statistically significant difference in the level of complement C4 before and after treatment(P>0.05).After treatment,levels of lactobacilli,Faecalibacteria prausnitzii,and Clostridium leptum all increased(P<0.05),with the observation group showing higher levels than the control group(P<0.05),while there was no significant difference in the level of bifidobacteria(P>0.05).Conclusion The combination of GZMHGBD,SZJQD,and ebastine shows better efficacy than monotherapy with western medicine alone in treating acute urticaria with dyspnea.It can alleviate allergic reaction,regulate the immune function and intestinal flora,thereby relieving the clinical symptoms of the patients effectively.