Efficacy ofβ2-adrenergic receptor agonist combined with corticosteroid in the treatment of children with cough variant asthma

BACKGROUND Cough variant asthma(CVA)is one of the most common respiratory diseases in children,which has a serious impact on the quality of life and daily activities of children.For severe CVA,immunomodulatory drugs are needed.AIM To evaluate the efficacy of salmeterol combined with budesonide in the treatment of pediatric CVA.METHODS 130 children with CVA from January 2020 to December 2022 were prospectively selected and randomly divided into an observation group(salmeterol combined with budesonide)and a control group(budesonide combined with a placebo).Compare the clinical efficacy of two groups before and after intervention.The evaluation parameters include cough frequency score,nocturnal cough arousal,and lung function indicators.Serum inflammatory markers,immune function markers and airway anatomical indicators were also measured.RESULTS After the intervention,the total effective rate of the observation group was significantly higher than that of the control group,and the cough frequency score and the night cough wake rate of the observation group were lower than that of the control group,with a statistically significant difference.In addition,the changes of lung function indicators,serum markers and immune function markers in the observation group were better than those in the control group.CONCLUSION The clinical efficacy of salmeterol combined with Budesonide in the treatment of CVA is better than that of Budesonide alone.

Experimental study on the regulation effect of Qiaoqin Qingfei agent on cough variant asthma based on airway neurogenic inflammation

Objective:To investigate the mechanism of regulation of airway neurogenic inflammation by Qiaoqin Qingfei agent in rats with cough variant asthma(CVA).Methods:48 SD rats were randomly divided into blank group,model group,montelukast sodium group(1.05 mg/kg)and high,medium and low dose groups(26,13,6.5 g/kg),with 8 rats in each group.The rat CVA model was established by the method of ovalbumin(OVA)combined with aluminum hydroxide(Al(OH)3)sensitization and repeated stimulation.From the second day of sensitization,the rat CVA model was given by gavage for 28 days.The pathological changes of lung tissue were observed under microscope by HE staining.The content changes of nerve growth factor(NGF)and substance P(SP)in alveolar lavage fluid(BALF)were determined by double-antibody sandwich ABC-ELISA,and the protein expression levels of NGF and SP in lung tissue were detected by immunohistochemistry.Results:Pathological findings showed significant inflammatory manifestations in the model group,and the inflammatory infiltration in the high-dose,medium-dose and low-dose groups of Qiaoqin Qingfei agent and montelukast sodium groups were alleviated to varying degrees.Compared with blank group,the protein expression levels of NGF and SP in lung tissue of model group were significantly increased(P<0.01).Compared with model group,the protein expression levels of NGF and SP in lung tissue and the contents of NGF and SP in alveolar lavage fluid in high-dose,medium-dose and low-dose groups and montelukast sodium group were significantly decreased(P<0.05).Conclusion:Qiaoqin Qingfei agent may reduce airway inflammation and relieve cough variant asthma by regulating the protein expression levels of NGF and SP in airway neurogenic inflammation.

Effect of glycyrrhetinic acid on Th1/Th2 balance in cough variant asthma mice

Objective:To evaluate the therapeutic effect of Glycyrrhetinic Acid on cough variant asthma(CVA)mice and to investigate the possible mechanism in reducing lung inflammation.Methods:48 young female Balb/c mice were divided into Control,CVA,Prednisone Acetate,Glycyrrhetinic Acid high-dose,Glycyrrhetinic Acid middle-dose and Glycyrrhetinic Acid lowdose groups randomly,with 8 mice in each group.The CVA mice model was established by ovalbumin(OVA)sensitization and OVA challenge,the animal asthma behavior was observed after drug administration,and the index of the lung of mice were recorded.The level of OVAsIgE in the bronchoalveolar lavage fluid(BALF)was tested by ELISA.The pathological changes of the lung tissue were observed by Hematoxylin and Eosin(H&E)staining.The protein expressions of T-bet,IFN-γ,Gata3,IL-4 and IL-13 in the lung tissue were determined by Western blot.Results:Compared with the CVA group,the index of lung of mice,the OVA-sIgE level in BALF and expression levels of Th2-related factor in the lung tissue of mice in Prednisone Acetate and Glycyrrhetinic Acid groups were significantly decreased(P<0.05 or P<0.01),the infiltration of inflammatory cells in the lung tissue was reduced,while expressions of Th1-related factor in the lung tissue was significantly increased(P<0.05 or P<0.01).Conclusion:Glycyrrhetinic acid has therapeutic effect on CVA mice,the underlying mechanism of Glycyrrhetinic acid alleviating lung impairment and airway inflammation may be associated with mediating the Th1/Th2 imbalance in the lung tissue.

Clinical Analysis of Dispelling Wind,Eliminating Lung and Relieving Cough Combined with Western Medicine in the Treatment of Cough Variant Asthma in Children

Objective:This study mainly explores the clinical effect of dispelling wind,eliminating lung and relieving cough combined with western medicine in the treatment of cough variant asthma.Methods:80 children with cough variant asthma accepted by our hospital from January 2018 to December 2020 were randomly selected for the study and divided into two groups.One group was the reference group(40 cases)treated with procaterol hydrochloride tablets and montelukast sodium,and the other group was the research group(40 cases)・The method of eliminating wind,eliminating lung and relieving cough was combined with procaterol hydrochloride tablets and montelukast sodium to observe and compare the curative effects of the two groups.Results:There was no significant difference in TCM symptom score and eosinophil(EOS)count between the two groups before treatment(P>0.05);After treatment,the TCM symptom scores of coughs,pharyngeal itching,expectoration,nasal congestion and nasal itching in the research group were lower than those in the reference group,and the EOS count was lower than that in the reference group(P<0.05);The effective rate of research group was higher than that of reference group(P<0.05).Conclusions:For children with cough variant asthma,Qufeng Sufei cough relieving method combined with procaterol hydrochloride and montelukast sodium can improve children's symptoms and reduce eosinophil count.

Effects of Huaiqihuang Granule on immunoglobulin, T lymphocyte subsets and cytokines in children with cough variant asthma

Objective:To observe the effect of Huaiqihuang granule on immunoglobulin, T lymphocyte subsets and cytokines in children with cough variant asthma (CVA). Methods:80 cases of children with CVA were enrolled in our hospital from June 2015 to June 2016, and were randomly divided into study group and control group. Two groups were both given salbutamol aerosol powder. On this basis, the control group was given Montelukast Sodium Chewable Tablets, while the study group was treated with Huaiqihuang granules. The interleukin 4 (IL-4), interferon-γ(IFN-γ), IgA, IgG and IgE levels and CD4+, CD8+T lymphocyte ratio analyze in children after 3 months of treatment. Results:There were no significant differences between the two groups before treatment (P>0.05). Both IgA and IgG were significantly higher in the two groups after treatment, while IgE was significantly lower (P<0.05). Compared with the control group, the IgA and IgG in the study group were significantly higher than those in the control group (P<0.05), while IgE was significantly lower (P<0.05). After treatment, compared with the control group, the proportion of CD4+ and CD4+/CD8+ in the study group were significantly lower than that of the control group, and the CD8+ratio increased more significantly (P<0.05). After treatment, IL-4 decreased significantly, while IFN-γand IFN-γ/IL-4 were significantly increased (P<0.05), IL-4 level of the study group decreased significantly compared with the control group, and IFN-γincreased significantly compared with the control group, and the level of IFN-γ/IL-4 after treatment was significantly higher than that of the control group (P<0.05). Conclusions: Huaiqihuang granule can improve humoral immunity and cellular immunity of children with CVA, and can adjust the immune cells balance of Th1/Th2, and improve the immune function and prognosis of children with CVA.

DRUGS FOR RELIEVING COUGH AND ASTHMA——Selected from A Practical English——Chinese Library of Traditional Chinese Medicine

Drugs of this category have the effectsof nourishing the lung to relieve cough andlowering the adverse flow of q(?) to relieveasthma.They are indicated for syndrome ofcough and dyspnea which is very complicat-ed and may be manifested as cough withoutsputum,cough with watery thin sputum orwith yellow thick sputum,cough withdyspnea due to affection by exopathogens,or cough with dyspnea due to consumptivediseases.Appropriate drugs should be chos-en with regard to the different syndromes,

The influence of vitamin D3 on airway inflammation and osteopontin expression in cough variant asthma rats

Objective:To observe the effect of vitaminD3 on airway inflammation and osteopontin(OPN)expression on cough variant asthma(CVA)models.Methods:SD rats were randomly divided into blank group,model group and treatment group,each group with 10 rats.The CVA model was induced by intraperitoneal injection combined with aerosolized ovalbumin(OVA),the treatment group was given 100 mg/ml of vitaminD330 minutes before challenge by administered orally.Airway hyperreaction were measured by airway resistance after inhalation of acetylcholine(Ach).Wright-Gimsa staining was used to observe the inflammatory cells in bronchoalveolar lavage fluid(BALF).HE and PAS were used to observe the morphological changes of lung tissue.OPN expression was detected by immunohistochemistry.Results:1)Airway hyperreaction:airway resistance after inhalation Ach in model group and treatment group were significantly higher than that in blank group(P<0.01),airway resistance in treatment group were lower than that in model group(P<0.01);2)Classification of inflammatory cells:The percentage of macrophages,lymphocytes,neutrophils,and eosinophils in the BALF of the model group and the treatment group were increased compared with the blank group(P<0.01),furthermore,the number of treatment group were lower than the model group(P<0.05);3)Morphological changes of lung tissue:a large amount of inflammatory cells and goblet cell proliferation were observed in the lung tissue of the model group,and these changes were slight in treatment group compared with model group;OPN expression in lung tissue:The expression of OPN in model and treatment group were increased compared with blank group(P<0.05),and the treatment group was lower than that of model group(P<0.05).The OPN content was positively correlated with the percentage of inflammatory cells in BALF(P<0.05).Conclusions:Vitamin D3 can reduce airway hyperreaction and airway inflammation in CVA rats.The mechanism may be related to the intervention of OPN expression in lung tissue.

Effect of inhalant combined with Dingchuan Zhike decoction therapy on the airway remodeling, inflammation and PARC/CCL-18 pathways in patients with cough variant asthma

Objective:To study the effect of inhalant combined with Dingchuan Zhike decoction therapy on the airway remodeling, inflammation and PARC/CCL-18 pathways in patients with cough variant asthma.Methods: A total of 60 patients with cough variant asthma who were treated in our hospital between January 2014 and May 2016 were collected and divided into the control group (n=30) who received conventional inhalant treatment and the observation group (n=30) who received inhalant combined with Dingchuan Zhike decoction treatment according to single-blind randomized controlled method, and the treatment lasted for 6 months. Before treatment and after 6 months of treatment, high-resolution CT was used to determine the airway remodeling index levels, RIA method was used to detect the peripheral blood airway remodeling index contents, and enzyme-linked immunosorbent assay (ELISA) was used to detect the contents of inflammatory mediators in induced sputum and the PARC/CCL-18 in serum.Results: Before treatment, the differences in the airway remodeling degree as well as the contents of inflammatory mediators and PARC/CCL-18 were not statistically significant between the two groups. After 6 months of treatment, CT airway remodeling indexes LA and TA levels of observation group were higher than those of control group while WA level was lower than that of control group, and peripheral blood airway remodeling indexes CTGF, YKL-39, MMP-9 and TIMP-1 contents were lower tha=n those of control group;inflammatory mediators IL-5, IL-6 and IL-8 contents in induced sputum of observation group were lower than those of control group, and serum PARC/CCL-18 content was lower than that of control group.Conclusion:Inhalant combined with Dingchuan Zhike decoction can inhibit the airway remodeling and reduce the airway inflammation in patients with cough variant asthma.

The effectiveness and safety of HuangQiXiXin decoction for cough variant asthma:protocol for a systematic review

Objective:A comprehensive and updated systematic review is needed to evaluate the effectiveness and safety of HuangQiXiXin decoction(HQXXD)for cough variant asthma(CVA).The aim of this systematic review protocol is to comprehensively assess the effectiveness and safety of HQXXD for CVA.Methods:An overall search for studies in main English and Chinese electronic databases from their inception to January 2021 will be performed.Randomized controlled trials regarding HQXXD for CVA will be included.We will use RevMan 5.3 software to perform statistical analysis and meta-analysis.Results:The findings of this systematic review will be disseminated through peer-reviewed publications.Conclusion:The systematic review will provide more evidence regarding the effectiveness and safety of HQXXD for CVA.

Meta-analysis of the efficacy and safety of Ding-Chuan Tang in the treatment of pediatric cough variant asthma

Objective:To systematically evaluate the clinical efficacy and safety of Ding-Chuan Tang in the treatment of pediatric cough variant asthma(CVA).Methods:Randomized controlled trials on the treatment of pediatric CVA with Ding-Chuan Tang were searched by computer through the China Journal Full Text Database(CNKI),WanFang Digital Journal Full Text Database(WanFang Data),Vipe Chinese Science and Technology Journal Database(VIP),Pubmed Database,Ovid Database,Embase Database,etc.The search time was from database establishment to April 1,2021.Based on the inclusion and exclusion criteria,the Executive editor:Nuo-Xi Pi.Received:10 September 2021;Accepted:13 January 2022;Available online:19 January 2022.©2022 By Author(s).Published by TMR Publishing Group Limited.This is an open access article under the CC-BY license.(http://creativecommons.Org/licenses/BY/4.0/)two researchers independently screened the literature,extracted information,and assessed the methodological quality evaluation of the literature,and Meta-analysis was performed by RevMan 5.4 software.Results:The final number of RCTs was included 17,including cases of affected 1308 children.According to the results of the Meta-analysis:the test group was significantly better than the control group in terms of clinical efficiency,percentage of first second force expiratory volume(FEV1%),percentage of peak expiratory flow rate(PEF%),time to treatment onset,time to the disappearance of symptoms,Chinese medicine symptom score,and recurrence rate;the difference in the incidence of adverse reactions between the two groups was not statistically significant.Conclusion:The clinical treatment of pediatric CVA with Ding-Chuan Tang is effective and does not increase the incidence of adverse reactions.However,the methodological and reporting quality of existing small-sample randomized controlled trials(RCTs)is low,so evidence of efficacy must be confirmed by rigorously designed large-sample clinical trials.

FeNO联合TSLP对儿童咳嗽变异性哮喘与感染后咳嗽的鉴别价值及与小气道功能的关系

目的探究呼出气一氧化氮(FeNO)联合胸腺基质淋巴细胞生成素(TSLP)对儿童咳嗽变异性哮喘(CVA)与感染后咳嗽(PIC)的鉴别价值,并分析FeNO、TSLP与CVA病情、小气道功能的关系,为临床诊疗提供有利依据。方法选取2021年6月至2023年4月郑州大学第一附属医院儿科诊治收治的90例CVA患儿作为CVA组,另选取同期90例PIC患儿作为PIC组。比较两组患儿的临床资料和FeNO、TSLP水平,绘制受试者工作特征(ROC)曲线及曲线下面积(AUC)分析FeNO联合TSLP对CVA与PIC的鉴别价值;比较CVA不同病情严重程度和病情阶段患儿的小气道功能[FEF25(%)、FEF50(%)、FEF75(%)、FEF25~75(%)]和FeNO、TSLP水平,采用Spearman和Pearson相关系数法分析FeNO、TSLP与CVA小气道功能、病情阶段、病情严重程度的相关性。结果CVA组患儿的FeNO、TSLP水平明显高于PIC组,差异均有统计学意义(P<0.05);ROC分析结果显示,FeNO联合TSLP鉴别CVA与PIC的AUC最大(0.934),敏感度、特异度为87.78%、82.22%,明显高于各指标单独诊断(P<0.05);轻度组患儿的FEF25、FEF50、FEF75和FEF25~75>中度组>重度组,差异均有统计学意义(P<0.05);轻度组患儿的FeNO、TSLP水平<中度组<重度组,差异均有统计学意义(P<0.05);临床缓解期组患儿的FEF25、FEF50、FEF75、FEF25~75明显高于急性发作期组,FeNO、TSLP水平明显低于急性发作期组,差异均有统计学意义(P<0.05);Pearson相关系数法分析结果显示,FeNO、TSLP与FEF25、FEF50、FEF75、FEF25~75均呈负相关(P<0.05);Spearman相关系数法分析结果显示,FeNO、TSLP与病情阶段、病情严重程度均呈正相关(P<0.05)。结论与PIC患儿比较,CVA患儿FeNO、TSLP水平异常升高,其联合鉴别诊断CVA与PIC具有较高价值,且FeNO、TSLP水平与患儿病情、小气道功能密切相关。

孟鲁司特钠单用、布地奈德/福莫特罗单用及两者联用治疗对儿童咳嗽变异型哮喘的疗效比较

目的本研究旨在比较孟鲁司特钠(Mon)单用、布地奈德/福莫特罗(BF)单用及两者联用治疗儿童咳嗽变异型哮喘(CVA)的疗效。方法选取2021年6月至2023年6月北京市海淀医院诊治的CVA患儿为研究对象。根据治疗方案,将CVA患儿分为Mon组、BF组和联合组。观察治疗8周后的治疗总有效率(TER)、不良反应发生率(TAER)、咳嗽症状评分[日间咳嗽症状评分(DCSS)和夜间咳嗽症状评分(NCSS)]、免疫功能[肿瘤坏死因子-α(TNF-α)、白细胞介素-4(IL-4)和免疫球蛋白E(IgE)]、肺功能[第1秒用力呼出气体容量(FEV_(1))、肺活量(FVC)和呼气峰值流速(PEF)]和血清嗜酸性粒细胞计数(EOS)。结果共选取180例CVA患儿,Mon组62例,BF组60例,联合组58例。治疗后,3组TER、TAER、DCSS、NCSS、血清TNF-α、血清IL-4和血清IgE水平差异无统计学意义(P>0.05)。联合组患儿FEV_(1)、FVC和PEF显著高于Mon组和BF组(P<0.05),EOS显著低于Mon组和BF组(P<0.05);而Mon组和BF组FEV1、FVC、PEF和EOS学差异无统计学意义(P>0.05)。结论Mon或BF可有效改善CVA患儿咳嗽症状和免疫功能,其镇咳作用和抗炎作用同Mon和BF联用相似。此外,Mon和BF联用可进一步改善CVA患儿肺功能,减少血清EOS水平。

基于网络药理学探讨紫苏子—杏仁药对治疗咳嗽变异性哮喘的作用机制

目的 基于网络药理学探讨紫苏子—杏仁药对治疗咳嗽变异性哮喘(CVA)的潜在分子作用靶点及机制。方法 采用中药系统药理学数据库和分析平台(TCMSP)数据库对紫苏子—杏仁药对的有效活性成分进行筛选,并采用SwissTargetPrediction网站进行靶点预测。采用GeneCards数据库检索CVA相关靶点,借助Venny 2.1.0获取交集靶点,对交集靶点分别运用Cytoscape 3.9.1软件和STRING数据库构建主要活性成分—潜在治疗靶基因网络图和PPI蛋白互作网络,并筛选出关键有效活性成分和核心靶蛋白,通过DAVID数据库对交集靶点进行GO功能及KEGG通路的富集分析。结果 筛选出紫苏子—杏仁药对有效成分19个,与CVA相关靶点224个,核心靶点为AKT1、IL-6、TP53、SRC、MAPK3、EGFR、JUN、PTGS2、HSP90AA1、ESR1。GO功能富集分析显示分子功能165个、细胞组分79个、生物过程630个。KEGG通路富集分析显示得到信号通路155条,主要涉及cAMP信号通路、PI3K-Akt信号通路、癌症通路、化学致癌—受体激活通路、神经活性配体—受体相互作用等。结论 紫苏子—杏仁药对可通过多成分、多靶点、多通路的协同作用抗CVA。

小儿咳嗽变异性哮喘标准治疗后停药1年复发的影响因素及其交互效应

目的研究咳嗽变异性哮喘(CVA)患儿标准治疗后停药一年复发的影响因素及其交互效应。方法回顾性分析2018年1月-2020年1月玉林市红十字会医院收治的167例CVA患儿的临床资料,所有患儿均接受吸入性糖皮质激素(ICS)规范治疗(疗程≥6个月),停药后随访观察≥2年,按照患儿2年的随访结果,将CVA标准治疗后停药1年复发的98例患儿纳为CVA复发组,69例未复发纳为CVA未复发组,进行对照研究,分析CVA复发影响因素及其交互效应。结果单因素分析得出两组患儿反复呼吸道感染病史、变应性鼻炎、过敏性皮炎及停药时呼出气一氧化氮(FeNO)比较,差异有统计学意义(P<0.05)。多因素分析得出,有反复呼吸道感染病史(OR=4.543,P=0.001)、有变应性鼻炎(OR=7.146,P<0.001)、FeNO>20.00 ppb(OR=3.770,P=0.001)为CVA标准治疗后停药一年复发独立危险因素。反复呼吸道感染病史与变应性鼻炎、反复呼吸道感染病史与FeNO、变应性鼻炎与FeNO的交互作用指数S分别为2.152、1.527、1.397。结论有反复呼吸道感染、变应性鼻炎和FeNO>20.00ppb均是影响CVA标准治疗后停药1年复发的影响因素,且两两因素间有正向交互作用。

标准化分级药学监护服务在慢性气道疾病住院患者中的多维价值分析

目的 为构建慢性气道疾病住院患者科学、合理的药学服务新模式提供参考。方法 选取2023年10月-2024年3月在河北省人民医院呼吸科住院并接受药学监护(PC)服务的慢性阻塞性肺疾病及哮喘急性加重的患者250例,采用随机数字表法将其分成对照组(125例)和观察组(125例)。对照组患者住院期间全程给予一般药学服务,观察组患者住院期间全程给予标准化分级PC服务。比较不同PC服务模式在患者临床价值指标、人文价值指标及质量管理指标间的差异。结果 在临床价值评价指标中,观察组患者的疾病治疗目标达成率、吸入装置正确使用得分、药品不良反应发生率、解决药物相关问题数量均显著优于对照组(P<0.05)。在人文价值评价指标中,观察组的患者用药依从性得分、药师干预成功率、患者满意度均显著高于对照组(P<0.05)。在质量管理评价指标中,观察组患者的药品费用占比、静脉用药占比、抗菌药物使用率、抗菌药物使用强度均显著优于对照组(P<0.05);观察组药事服务例数也多于对照组,但两组间各项药事服务例数占比的差异无统计学意义(P>0.05)。结论 标准化分级PC服务可帮助药师识别更需要关注和管理的高危患者,提高药师工作效率,提升患者就医体验,是值得推广的新型药学服务模式。

温润辛金方治疗微寒恋肺型咳嗽变异型哮喘的临床疗效研究

目的:观察温润辛金方治疗微寒恋肺型咳嗽变异型哮喘(CVA)的临床疗效及安全性,为CVA的中医临床治疗提供依据和思路。方法:选取2017年6月~2019年12月期间于某院就诊的60例微寒恋肺型CVA患者,根据随机数字表法分为对照组和观察组,每组30例。对照组给予沙美特罗替卡松吸入粉雾剂,观察组给予温润辛金方,两组均治疗6周。观察两组患者的中医证候疗效以及不良反应,比较两组患者治疗前后呼出气一氧化氮(FeNO)及咳嗽症状积分的变化。结果:对照组和观察组分别脱落2例和4例。两组临床治疗总有效率比较无统计学差异(P>0.05)。治疗后,两组咳嗽症状积分、FeNO均较治疗前下降(P<0.05),且观察组咳嗽症状积分低于对照组(P<0.05),但两组FeNO水平比较无统计学差异(P>0.05)。观察组有2例患者在服药期间出现恶心等胃部不适,嘱其改为饭后服药后症状消失;对照组有2例患者出现轻微不良反应,但不影响后续治疗。结论:温润辛金方可有效改善微寒恋肺型CVA患者的临床症状和咳嗽症状积分,临床疗效较佳且安全性良好。

五虎汤干预咳嗽变异性哮喘自噬的生物信息学研究

目的:五虎汤具有治疗咳嗽变异性哮喘(CVA)的作用,但其具体作用机理仍需进一步探究或阐明。方法:从中药系统药理学数据库与分析平台(TCMSP)、中药分子机制的生物信息学分析工具(BATMAN-TCM)及中医药整合药理学研究平台v2.0(TCMIP)、PubChem、Chemspider、Swiss Target Prediction、GEO、GeneCards等数据库中获取和挖掘五虎汤的活性成分、预测靶点、自噬基因、CVA基因及哮喘的差异表达基因(DEGs),利用线韦恩图交集工具取交集获取关键基因,使用Cytoscape3.8.0软件构建活性成分-关键网络;五虎汤干预CVA自噬靶点与自噬基因的相关性分析;使用STRING数据库、Cytohubba插件构建蛋白互作网络及核心基因筛选。运用R语言Biomanager、ClusterProfiler包进行关键靶点GO、KEGG富集分析,最后进行分子对接。结果:收集并筛选出五虎汤活性成分42个,潜在作用靶点536个,自噬相关基因7 236个,CVA基因1 987个,DEGs 460个,取交集后共获得13个关键靶点,运用Wilcoxon非参数检验验证,发现12个基因差异具有统计学意义。富集分析结果显示,这些靶基因主要通过VEGF信号通路、部分氨基酸代谢通路在细胞自噬中发挥作用。结论:五虎汤通过多成分、多层次、多靶点参与自噬相关过程达到干预CVA的目的,促进了中西医结合治疗CVA思路的发展,为临床新药研发提供了新视角。

咳嗽变异性哮喘患儿血清25(OH)D_(3)、IL-6水平变化与T淋巴细胞免疫平衡的关系及预测预后的价值分析

目的分析咳嗽变异性哮喘(CVA)患儿血清25-羟维生素D_(3)[25(OH)D_(3)]、白介素-6(IL-6)水平变化与T淋巴细胞免疫平衡的关系及预测预后的价值。方法选取98例CVA患儿作为研究组,49例健康儿童作为对照组。比较两组一般资料、血清25(OH)D_(3)、IL-6水平、T淋巴细胞免疫平衡指标,分析研究组血清25(OH)D_(3)、IL-6水平与免疫平衡指标的相关性,比较治疗4周后不同预后患儿治疗前后血清25(OH)D_(3)、IL-6水平及变化值(以△表示治疗前后变化值的绝对值),分析△25(OH)D_(3)、△IL-6与预后的相关性及治疗前血清25(OH)D_(3)、IL-6预测预后的价值。结果研究组血清25(OH)D_(3)水平、外周血CD4^(+)T淋巴细胞百分比低于对照组,血清IL-6水平高于对照组(P<0.05);研究组血清25(OH)D_(3)水平与外周血CD4^(+)T淋巴细胞百分比呈正相关,血清IL-6水平与外周血CD4^(+)T淋巴细胞百分比呈负相关(P<0.05);预后不良患儿治疗前、治疗后血清25(OH)D_(3)水平低于预后良好患儿,IL-6水平高于预后良好患儿,△IL-6小于预后良好患儿(P<0.05);研究组△IL-6与预后呈正相关(P<0.05);治疗前血清25(OH)D_(3)、IL-6单独预测CVA患儿预后不良的曲线下面积(AUC)分别为0.784、0.764,与单独预测比较,联合预测的AUC(0.926)明显增大,NRI、IDI均>0(P<0.05)。结论CVA患儿血清25(OH)D_(3)、IL-6水平变化与T淋巴细胞免疫平衡失调有关,且各指标联合在预测患儿预后方面具有良好应用价值。

小儿肺咳颗粒联合布地奈德对儿童咳嗽变异性哮喘的疗效

目的观察小儿肺咳颗粒联合布地奈德治疗儿童咳嗽变异性哮喘的疗效及对机体免疫力的影响。方法选取73例咳嗽变异性哮喘儿童作为研究对象,用随机数字表法分为联合组(n=36)和对照组(n=37)。对照组给予布地奈德治疗,联合组给予小儿肺咳颗粒联合布地奈德治疗。比较2组的临床疗效、不良反应的发生情况、复发率以及治疗前后咳嗽症状、免疫功能、肺功能和炎症指标的水平。结果联合组的总有效率(94.44%)明显高于对照组(75.68%),P<0.05。治疗后,2组的日间、夜间咳嗽症状评分均明显降低,且联合组低于对照组(P<0.05);2组的CD4+、CD4+/CD8+水平明显降低,CD8+水平明显升高,且联合组的改善程度明显优于对照组(P<0.05);2组的第1秒用力呼气容积(forced expiratory volume in first second,FEV1)、用力肺活量(forced vital capacity,FVC)、第1秒用力呼气容积占用力肺活量百分比(forced expiratory volume in first second/forced vital capacity,FEV1/FVC)均明显升高,且联合组高于对照组(P<0.05);2组的血清肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素-4(interleukin-4,IL-4)水平均明显降低,且联合组低于对照组(P<0.05)。联合组的不良反应发生率(13.89%)与对照组(18.92%)比较差异无统计学意义(P>0.05),联合组的随访期复发率为5.56%,明显低于对照组(27.03%),P<0.05。结论小儿肺咳颗粒联合布地奈德治疗儿童咳嗽变异性哮喘的临床疗效显著,不仅能提高患儿的免疫力,同时能有效缓解患儿的咳嗽症状,降低炎症因子水平,改善肺功能,有效降低复发率。

基于“聚于胃,关于肺”论治小儿咳嗽变异性哮喘

咳嗽变异性哮喘是儿科慢性咳嗽中最常见的疾病之一,“聚于胃,关于肺”是对咳嗽病机的概括,反映了《黄帝内经》在治疗咳嗽病时对肺胃的高度重视。肺胃两脏解剖位置相近,脉络相互贯通,在生理病理方面也相互影响,为临床从肺胃论治咳嗽变异性哮喘提供了充实的理论依据。根据此理论,临床上对于风热犯肺证以桑菊饮为主疏风清热,宣肺止咳;胃阳虚弱,脾虚气滞证者以异功散和或苓桂术甘汤为主温脾和胃,理气止咳;脾虚痰伏,肺热气逆证以加味六安煎为主健中化痰,清肺降气;肺胃阴伤证以麦门冬汤为主养阴生津。以求治咳不离肺,也不拘泥于肺。