清热利湿方治疗小儿急性细菌性下尿路感染膀胱湿热证的疗效及机制  

Efficacy and Mechanism of Qingre Lishi Prescription in Treating Children with Acute Bacterial Lower Urinary Tract Infection of Bladder Damp-heat Syndrome

作　　者：张新瑶 刘健[2] 纪宁 冯金花[2] 王婉琦 蒋锴[2] ZHANG Xin-yao;LIU Jian;JI Ning;FENG Jin-hua;WANG Wan-qi;JIANG Kai(Changchun University of Chinese Medicine,Changchun 130117,China;Affiliated Hospital of Changchun University of Chinese Medicine,Changchun 130021,China)

机构地区：[1]长春中医药大学,长春130117 [2]长春中医药大学附属医院,长春130021

出　　处：《中国实验方剂学杂志》2021年第10期51-57,共7页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：国家重点研发计划项目(2017YFC1703204);国家中医药管理局中医药循证能力建设项目(2019XZZX-EK002)。

摘　　要：目的:观察清热利湿方治疗小儿急性细菌性下尿路感染膀胱湿热证疗效,并探讨其作用机制。方法:将长春中医药大学附属医院收治的80例急性细菌性下尿路感染膀胱湿热证患儿分对照组和观察组,各40例。在常规治疗基础上,对照组给予八正散口服治疗,观察组给予清热利湿方内服加外洗治疗。治疗两周后,比较两组患儿的临床和病原学疗效、中医证候评分,退热时间和尿菌转阴时间、不良反应发生情况,尿液病原菌(大肠埃希菌、粪肠球菌、奇异变形杆菌、肺炎克雷伯菌),血清炎症因子指标瘤坏死因子-α(TNF-α),白细胞介素-6(IL-6),白细胞介素-8(IL-8),降钙素原(PCT),白细胞计数(WBC)和血清C反应蛋白(CRP)水平;免疫功能指标T细胞亚群(CD3^(+),CD4^(+),CD8^(+))和补体(C3,C4)水平。结果:观察组临床有效率92.50%(37/40),显著高于对照组的65.00%(26/40)(χ^(2)=9.038,P<0.01);观察组病原学疗效87.50%(35/40)显著高于对照组60.00%(24/40)(χ^(2)=7.813,P<0.01);治疗后,两组患儿发热、尿频、尿急、尿痛、排尿困难、腹痛中医证候评分均明显低于本组治疗前(P<0.05),观察组上述中医证候评分低于对照组(P<0.05);观察组退热时间和尿菌转阴时间明显低于对照组(P<0.05);两组患儿大肠埃希菌、粪肠球菌、奇异变形杆菌、肺炎克雷伯菌检出数均明显低于本组治疗前(P<0.05),观察组大肠埃希菌、粪肠球菌、奇异变形杆菌、肺炎克雷伯菌检出数低于对照组(P<0.05);治疗后两组TNF-α,IL-6,IL-8,PCT,WBC和CRP等炎症因子水平均明显低于本组治疗前(P<0.05),且观察组低于对照组(P<0.05);治疗后两组患儿免疫功能显著提高,观察组CD3^(+),CD4^(+),C3,C4水平高于对照组(P<0.05),CD8^(+)水平低于对照组(P<0.05);观察组不良反应发生率与对照组比较差异无统计学意义。结论:清热利湿方治疗小儿膀胱湿热证急性细菌性下尿路感染具有较好的临床疗效,可改善Objective: To observe the efficacy of Qingre Lishi prescription in treating children with acute bacterial lower urinary tract infection of bladder damp-heat syndrome,and to explore its mechanism of action. Method: Eighty children with acute bacterial lower urinary tract infection of late bladder damp-heat syndrome who were admitted to the Affiliated Hospital of Changchun University of Chinese Medicine were divided into control group and observation group,40 cases in each group. Patients in control group were given Bazhengsan for oral treatment on basis of basic treatment,while patients in observation group were given Qingre Lishi prescription for oral administration plus external washing treatment. After two weeks of treatment,the clinical and etiological effect,traditional Chinese medicine(TCM)syndrome scores,antipyretic time and urinary negative time,adverse reactions,and urine pathogens(Escherichia coli,Enterococcus faecalis,Strange proteus,Klebsiella pneumoniae),serum inflammatory factor indicators [tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),interleukin-8(IL-8),calcium lowering PCT,white blood cell count(WBC)and serum C-reactive protein(CRP)],immune function indicators[T cell subsets(CD3^(+),CD4^(+),CD8^(+))and complement(C3,C4)]were comapred between two groups. Result:The clinical efficacy of observation group was 92.50%(37/40),which was significantly higher than 65.00%(26/40)in control group(χ^(2)=9.038,P<0.01),the etiological efficacy of observation group was 87.50%(35/40),which was significantly higher than 60.00%(24/40)in control group(χ^(2)=7.813,P<0.01). After treatment,the scores of TCM syndromes of the two groups were significantly reduced(P<0.05). The scores of fever,frequent urination,urgent urination,painful urination,difficulty urinating and abdominal pain in two groups were significantly lower than those before treatment(P<0.05),and the TCM syndrome scores in observation group were lower than those in control group(P<0.05),the antipyretic time and urinary bacteria turning negative ti

关 键 词：清热利湿方 小儿尿路感染 膀胱湿热证 炎症因子 细菌 免疫功能 机制 

分 类 号：R22[医药卫生—中医基础理论] R242[医药卫生—中医学]