基于集束化策略探讨参芪固本汤干预缓解期哮喘患儿的临床疗效及作用机制  

Clinical Effect and Mechanism of Shenqi Guben Decoction Combined with Bundles of Care on Children with Asthma in Remission Stage

作　　者：徐妍[1] 鲍丽娟 黄洪[1] 刘成全[1] XU Yan;BAO li-juan;HUANG Hong;LIU Cheng-quan(Department of TCM Pediatrics,Huai'an Matemal and Child Health Care Center,Huai'an Jiangsu 223001)

机构地区：[1]江苏省淮安市妇幼保健院中医儿科,江苏淮安223001

出　　处：《世界中西医结合杂志》2023年第12期2467-2472,2477,共7页World Journal of Integrated Traditional and Western Medicine

基　　金：江苏省中医药管理局科技项目(YB2020076)。

摘　　要：目的探讨通过集束化管理策略使用参芪固本汤对缓解期哮喘患儿的干预效果。方法选取2021年1月—2022年1月期间江苏省淮安市妇幼保健院收治的缓解期肺脾气虚证哮喘患儿120例,按随机数字表法分为集束化组、集束化对照组、常规组、常规对照组,每组各30例。集束化组采用集束化管理策略+常规西药+参芪固本汤治疗,集束化对照组采用集束化管理策略+常规西药治疗;常规组采用常规管理+常规西药+参芪固本汤治疗,常规对照组采用常规管理+常规西药治疗。观察比较4组患儿哮喘控制效果、中医证候评分、血清炎症因子、T细胞水平等变化。结果治疗后4组患者中医证候评分比较,显示集束化组<常规组<集束化对照组<常规对照组,且组间两两比较,差异均有统计学意义(P<0.05)。治疗后4组患者血清IL-10、IL-17水平降低,IL-2水平升高(P<0.05),组间比较显示IL-10、IL-17呈集束化组<常规组<集束化对照组<常规对照组,IL-2呈集束化组>常规组>集束化对照组>常规对照组,差异均有统计学意义(P<0.05)。治疗后4组患者Th1及Th1/Th2表达升高、Th2表达降低,差异有统计学意义(P<0.05),Th1和Th1/Th2表达显示集束化组<常规组<集束化对照组<常规对照组,Th2表达显示集束化组>常规组>集束化对照组>常规对照组,差异有统计学意义(P<0.05)。治疗后4组患者Th17/CD4^(+)、FeNO水平降低,Treg/CD4^(+)、PEF%pred、FEV1%pred水平升高,差异有统计学意义(P<0.05),集束化组的Th17/CD4^(+)、FeNO水平明显低于其他3组,Treg/CD4^(+)、PEF%pred、FEV1%pred水平明显高于其他3组,差异有统计学意义(P<0.05),常规组的Th17/CD4^(+)、FeNO水平明显低于集束化对照组和常规对照组,Treg/CD4^(+)、PEF%pred、FEV1%pred水平明显高于集束化对照组和常规对照组,差异有统计学意义(P<0.05)。治疗后集束化组总有效率93.33%(28/30)明显高于常规组80.00%(24/30)、集束化对照组70.00%Objective To explore the therapeutic effect of Shenqi Guben Decoction combined with bundles of care on children with asthma in the remission stage.Methods A total of 120 children with asthma in the remission stage and syndrome of lung-spleen qi deficiency treated in the Huai′an Maternal and Child Health Care Center in Jiangsu province from January 2021 to January 2022 were selected and assigned by the random number table method into 4 groups(n=30):A(bundles of care+Western medicine+Shenqi Guben Decoction),B(bundles of care+Western medicine),C(conventional management+Western medicine+Shenqi Guben Decoction),and D(conventional management+Western medicine).The control effect on asthma,TCM syndrome score,serum levels of inflammatory cytokines,and T cell subsets were compared between the four groups.Results After treatment,the TCM syndrome score followed the trend of group Agroup C>group B>group D,with statistically significant differences between groups(P<0.05).After treatment,the levels of Th17/CD4^(+)and FeNO decreased,while the levels of Treg/CD4^(+),PEF%pred,and FEV1%pred increased(P<0.05).Group A had lower levels of Th17/CD4^(+)and FeNO and higher levels of Treg/CD4^(+),PEF%pred,and FEV1%pred than the other three groups(P<0.05).Group C had lower levels of Th17/CD4^(+)and FeNO and higher levels of Treg/CD4^(+),PEF%pred,and FEV1%pred than groups B and D(P<0.05).The total response rate in group A was 93.33%(28/30),which was higher than those in groups B(70.00%,21/30),C(80.00%,24/30),and D(56.67%,17/30)(P<0.05).The total response rate in other three groups followed a descending order of group C>group B>group D,with significant differences between groups(P<0.05).Conclusion Shenqi Guben Decoction combined with bundles of care can reduce the asthma attacks and respiratory tract infections in children with asthma in the remission stage,demonstrating an improved effect of asthma control.Specifically,the bundles of care can improve the medication compliance of children,and Shenqi Guben Decoction can reduce inflammation,

关 键 词：哮喘 参芪固本汤 集束化管理 肺脾气虚证 细胞免疫 

分 类 号：R256.12[医药卫生—中医内科学]