摘要
目的观察咳喘合剂辅助治疗儿童支气管哮喘(BA)急性发作期热哮证的临床疗效,并探讨其对2型固有淋巴样细胞(ILC2)、Th1/Th2细胞因子的影响。方法选取2023年1月至2024年1月在浙江省中西医结合医院儿科确诊为BA急性发作期热哮证患儿60例,采用随机数字表法分为对照组和治疗组,各30例。对照组给予吸入用布地奈德雾化剂治疗,治疗组在对照组治疗方法的基础上联合咳喘合剂治疗,2组均连续治疗7 d后统计临床疗效,并比较治疗前后肺功能用力肺活量(FVC)、第1秒用力呼气容积(FEV_(1))、第1秒用力呼气率(FEV_(1)/FVC)水平变化、痰液炎症细胞数目、外周血ILC2水平、痰液细胞因子白细胞介素(IL)-4、IL-5、IL-13、IL-33、γ-干扰素(IFN-γ)水平,并对细胞因子与ILC2水平进行相关性分析。结果治疗组总有效率为90.00%(27/30),显著高于对照组的86.67%(26/30),2组比较,差异有统计学意义(P<0.05)。治疗前2组肺功能指标FVC、FEV_(1)、FEV_(1)/FVC比较,差异无统计学意义(P>0.05),具有可比性;治疗后2组上述指标值水平均显著升高,与同组治疗前比较,差异有统计学意义(P<0.05或P<0.01),且治疗组FVC、FEV_(1)升高更显著(P<0.05)。治疗前2组痰液炎症细胞巨噬细胞、嗜酸性粒细胞、淋巴细胞、中性粒细胞数目比较,差异无统计学意义(P>0.05),具有可比性;治疗后2组巨噬细胞、嗜酸性粒细胞数目显著下降(P<0.01),淋巴细胞、中性粒细胞数目显著升高(P<0.01),与同组治疗前比较,差异有统计学意义(P<0.01),且治疗组淋巴细胞数目升高更显著(P<0.01)。治疗前2组痰液IL-4、IL-5、IL-13、IFN-γ、IL-33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IL-4、IL-5、IL-13、IL-33水平均显著降低(P<0.01),IFN-γ水平均显著升高(P<0.01),与同组治疗前比较,差异有统计学意义(P<0.01),且治疗组下降或升高更显著(P<0.01)。治疗前2组外周血中ILC2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ILC2水平均显著下降,与同组治疗前比较,差异有统计学意义(P<0.01),且治疗组下降更显著(P<0.01)。2组痰液Th2细胞因子IL-4、IL-5、IL-13水平的降低与外周血ILC2具有强相关性(P<0.01)。结论咳喘合剂可提高儿童BA急性发作期热哮证的临床疗效,改善患儿肺功能指标,减轻炎症反应,作用机制可能与其能够通过抑制ILC2细胞激活、降低Th2型细胞因子IL-4、IL-5、IL-13水平、升高Th1型细胞因子IFN-γ水平、纠正Th1/Th2细胞因子失衡相关。
Objective:To evaluate the clinical efficacy of Kechuan Heji(咳喘合剂)in treating children with bronchial asthma(BA)of heat-wheezing pattern in the acute attack phase as an adjuvant therapy and explore its effects on innate lymphoid cells type 2(ILC2)and Th1/Th2 cytokines.Methods Sixty children diagnosed with BA of heat-wheezing pattern in acute attack phase,at Zhejiang Integrated Traditional Chinese and Western Medicine Hospital from January 2023 to January 2024 were randomly divided into a control group(n=30)and a treatment group(n=30).The control group received inhaled budesonide suspension,while the treatment group received Kechuan Heji in addition to the control treatment.Both groups were treated for 7 days.Clinical efficacy,pulmonary function(FVC,FEV_(1),FEV_(1),/FVC),inflammatory cell counts in sputum,peripheral blood ILC2 levels,and cytokine levels(IL-4,IL-5,IL-13,IL-33,IFN-γ)in sputum were measured before and after treatment.Correlation analysis was performed between cytokines and ILC2 levels.Results The total effective rate of the treatment group was 90.00%(27/30),significantly higher than the control group's 86.67%(26/30).The difference between the two groups was statistically significant(P<0.05).There was no statistically significant difference(P>0.05)in the lung function indicators FVC,FEV_(1),and FEV_(1)/FVC between the two groups before treatment,indicating comparability.After treatment,the levels of the above indicators in both groups significantly increased,and compared with the same group before treatment,the difference was statistically significant(P<0.05 or P<0.01),and the FVC and FEV_(1) in the treatment group increased more significantly(P<0.01).There was no statistically significant difference(P>0.05)in the number of inflammatory cells,macrophages,eosinophils,lymphocytes,and neutrophils in the sputum between the two groups before treatment,indicating comparability;After treatment,the number of macrophages and eosinophils in both groups significantly decreased(P<0.01),while the number of lymphocytes and neutrophils significantly increased(P<0.01).Compared with the same group before treatment,the difference was statistically significant(P<0.01),and the number of lymphocytes in the treatment group increased more significantly(P<0.01).There was no statistically significant difference(P>0.05)in the levels of IL-4,IL-5,IL-13,IFN-γ,and IL-33 in sputum between the two groups before treatment,indicating comparability;After treatment,the levels of IL-4,IL-5,IL-13,and IL-33 in both groups were significantly reduced(P<0.01),while the average level of IFN-γ was significantly increased(P<0.01).Compared with the same group before treatment,the difference was statistically significant(P<0.01),and the decrease or increase in the treatment group was more significant(P<0.01).The comparison of ILC2 levels in peripheral blood between the two groups before treatment showed no statistically significant difference(P>0.05),indicating comparability.After treatment,the levels of ILC2 in both groups significantly decreased,and the difference was statistically significant compared with the same group before treatment(P<0.01),with the treatment group showing a more significant decrease(P<0.01).The decrease in levels of Th2 cytokines IL-4,IL-5,and IL-13 in two groups of sputum was strongly correlated with peripheral blood ILC2(P<0.01).Conclusion Kechuan Heji improves clinical efficacy,pulmonary function,and inflammatory responses in children with BA of heat-wheezing pattern in the acute attack phase.Its mechanism may involve suppressing ILC2 activation,reducing Th2 cytokines(IL-4,IL-5,IL-13),increasing Th1 cytokine(IFN-γ),and restoring Th1/Th2 balance.
作者
沈丹
沈东霞
樊雅丽
林隆
SHEN Dan;SHEN Dongxia;FAN Yali;LIN Long(Department of Pediatrics,Zhejiang Integrated Traditional Chinese and Western Medicine Hospital,Hangzhou,Zhejiang 310000,China;Department of Traditional Chinese Medicine Pediatrics,Quzhou Maternal and Child Health Hospital,Quzhou,Zhejiang 324003,China)
出处
《中医儿科杂志》
2025年第4期50-55,共6页
Journal of Pediatrics of Traditional Chinese Medicine
基金
浙江省中医药科技计划项目(2023ZL116)。
关键词
支气管哮喘
儿童
急性发作期
热哮证
咳喘合剂
临床观察
bronchial asthma
children
acute attack phase
heat-wheezing pattern
Kechuan Heji(咳喘合剂)
clinical observation
