摘要
目的:评价加减旋覆夏麻芍草汤治疗小儿咳嗽变异性哮喘(cough variant asthma,CVA)的临床疗效。方法:采用随机、阳性药平行对照的前瞻性研究方法,选择符合纳入标准的CVA患儿60例,随机分为治疗组与对照组,每组30例。治疗组采用加减旋覆夏麻芍草汤治疗,对照组采用布地奈德粉吸入剂+孟鲁司特钠咀嚼片治疗,疗程均为3个月。评价两组患儿的临床疗效与中医证候疗效,比较两组的临床症状、体征改善情况;采用荧光酶免疫分析法(FEIA)检测患儿的血清嗜酸性粒细胞阳离子蛋白(ECP)水平,采用酶联免疫吸附试验(ELISA)检测患儿的尿白三烯(LTE4)水平。治疗期间,记录两组患儿的合并用药情况及不良反应发生情况;治疗结束后随访6个月,比较两组有效病例的复发情况。结果:1临床疗效:治疗后,治疗组的总有效率为89.3%,对照组为85.2%,两组临床疗效比较,差异无统计学意义(P>0.05)。2中医证候疗效:治疗后,治疗组的总有效率为85.7%,对照组为81.5%,两组中医证候疗效比较,差异无统计学意义(P>0.05)。3主要临床症状、体征:治疗组在改善患儿咯痰、咳呕、多汗、舌象异常、下眼睑发青等症状或体征方面,其疗效明显优于对照组(P<0.01)。4实验室指标:治疗后,两组患儿的尿LTE4、血ECP水平均显著降低(P<0.01),且治疗组患儿的血ECP水平明显低于对照组(P<0.01)。5合并用药与不良反应发生情况:治疗组的合并用药患儿例数少于对照组(P≤0.05);治疗期间,两组均未发生严重不良反应事件。6复发情况:治疗组的复发率为8.0%,对照组为30.4%,但两组复发情况比较,差异无统计学意义(P>0.05)。结论:加减旋覆夏麻芍草汤是治疗小儿CVA的有效方剂,且有一定的疗效持续性,能有效改善患儿的临床症状与体征,无不良反应。其下调CVA患儿异常的LTE4和ECP水平可能是起效的机制之一。
Objective： To evaluate the clinical efficacy of ＂ Modified Xuanfu Xiama Shaocao Decoction＂ in treating children with cough variant asthma （CVA）. Methods： A randomized and positive parallel-controlled clinical trial was designed. Sixty children with CVA who met the inclusion criteria were selected and randomly divided into the treatment group and the control group, 30 cases in each group. The children in the treatment group were treated with ＂Modified Xuanfu Xiama Shaocao Decoction＂ and the children in the control group were treated with budesonide powder inhalation and montelukast sodium chewable tablets, with a course of 3 months. The clinical effect and Chinese medical syndrome effect were evaluated and the improvement of the main symptoms and signs was compared. The levels of serum eosinophil cationic protein （ECP） and urinary leukotriene E4 （LTFA） were detected by FEIA and ELISA methods respectively. In the course of treatment, the drug combination and adverse reactions were recorded. Follow-up for 6 months after treatment, the recurrence rate in effective cases was compared. Results： （1）Clinical effect： After treatment, the total effective rates of the treatment group and the control group were 89.3% and 85.2% respectively, with no statistical difference between the two groups （ P 〉 0.05 ）. （2）The efficacy of Chinese medical syndrome ： After treatment, the total effective rates Of the treatment group and the control group were 85.7% and 81.5 % respectively, with no statistical difference between the two groups （P 〉 0.05 ）. （3）The main symptoms and signs： The improvement of symptoms and signs such as expectoration, cough-vomiting, sweating, abnormal tongue and blue lower eyelids in the treatment group were superior to that in the control group （ P 〈 0.01 ）. （4）The experimental indexes： After treatment, the levels of serum ECP and urinary LTFA in both groups were significantly decreased （ P 〈 0.01 ） and the level of serum ECP in the treatment group was significantly lower than that in the control group （P 〈0.01 ）. （5）Drug combination and adverse reactions ： The number of the cases with drug combination in the treatment group were less than that in the control group （P〈0.05） ; during the treatment, there were no severe adverse reactions in both groups. （6）Recurrence rate： The recurrence rates of the treatment group and the control group were 8.0% and 30.4% respectively, with no statistical difference between the two groups （ P 〉 0.05 ）. Conclusion： ＂Modified Xuanfu Xiama Shaocao Decoction＂ is an effective prescription in treating children with CVA and has some durability of the efficacy, which can improve the clinical symptoms and signs with no adverse reactions. One of its effective mechanisms may be down-regulating the abnormal levels of LTE4 and ECP in children with CVA.
出处
《上海中医药大学学报》
CAS
2017年第1期24-29,共6页
Academic Journal of Shanghai University of Traditional Chinese Medicine
基金
国家中医药管理局中医大师传承人才培养项目(国中医药函[2008]185)
上海市进一步加快中医药事业发展三年行动计划项目(ZY3-RCPY-3-1010)
关键词
咳嗽变异性哮喘
旋覆夏麻芍草汤
儿童
cough variant asthma
＂Xuanfu Xiama Shaocao Decoction＂
child
