【作者】 李梅；

【导师】 王丽清；

【作者基本信息】 广州中医药大学 ， 中医学， 2010， 硕士

【摘要】 目的运用前瞻性的临床研究方法,观察清肺化痰平喘方治疗小儿哮喘发作期痰热壅肺型的临床疗效,同时进行血清总IgE及外周血EOS的测定,初步探讨血清总IgE及EOS变化与该中医症候改善情况的相关性。方法依照前瞻性简单随机试验收集符合研究标准的小儿痰热壅肺型哮喘发作期的患儿共40例,其中治疗组与对照组各20例。对照组采用常规治疗,治疗组用常规治疗加用清肺化痰平喘方,治疗5天后,观察两组治疗前后中医症候积分及疗效改善情况,同时在治疗前后进行血清总IgE及外周血EOS的测定。运用SPSS11.5及Excel统计软件分析观察结果。结果1.一般情况分析：本次研究共收集符合纳入标准病例40例,男2l例,女19例,最大年龄8岁,最小年龄3岁,其中治疗组患儿20例,男11例,女9例,平均年龄4.23±1.28岁；对照组患儿20例,男10例,女10例,平均年龄为4.28±1.40岁。两组在性别年龄上均无显著性差异(P>0.05),具有可比性。2.清肺化痰平喘方对小儿哮喘急性发作期痰热壅肺型疗效的影响：治疗前两组患儿症状及体征总积分比较,无显著性差异(P>0.05),具有可比性。治疗后,治疗组与对照组间症状及体征总积分相比,有显著性差异(P<0.05),说明清肺化痰平喘方在改善小儿哮喘痰热壅肺型症状体征方面明显优于对照组。经过相同疗程的治疗后,治疗组临床痊愈1例,显效18例,有效l例；对照组临床痊愈1例,显效10例,有效9例,两组间相比,具有显著性差异(P<0.05),说明治疗组的总疗效明显优于对照组。3.小儿哮喘急性发作期痰热壅肺型治疗前后血清总IgE的变化：治疗前,两组患儿血清总IgE无显著性差异(P>0.05),具有可比性。治疗组治疗后血清总IgE稍下降,但与治疗前无明显差异(P>0.05),对照组治疗后血清总IgE呈上升趋势,治疗前后无显著差异(P>0.05)。且两组患儿在治疗后比较亦无显著差异(P>0.05)。4.治疗前,治疗组与对照组外周血EOS无显著性差异(P>0.05),具有可比性。治疗组与对照组治疗后EOS均下降,治疗前后组内比较均具有明显差异性(P<0.05),两组间比较,治疗组EOS数值下降较对照组明显,治疗后两组对比具有差异性(P<0.05),且运用清肺化痰平喘方加常规西药组降低EOS更明显。亦说明外周血EOS与小儿痰热壅肺型哮喘症候改善情况成一定的相关性。结论1.清肺化痰平喘方能明显改善小儿痰热壅肺型哮喘症状及体征积分数。2.运用中西医结合治疗方法能明显改善小儿哮喘痰热壅肺型的症状及体征。3.治疗前后治疗组与对照组血清总IgE数值无明显变化。4.初步探讨小儿哮喘痰热壅肺型之症候变化与血清总IgE变化无明显相关性。5.治疗前后治疗组与对照组外周血嗜酸性粒细胞数值均有所下降,且治疗组有优势。6.初步发现小儿哮喘痰热壅肺型症候变化与外周血EOS呈一定的相关性。嗜酸性粒细胞与西医中“痰液”密切相关,治疗组EOS下降更明显,且症状及体征亦明显改善,初步推测清肺化痰平喘方联合西医治疗通过抑制气道炎症细胞如嗜酸性粒细胞,减少“痰液”等渗出,减轻气道炎症,改善痰热壅肺型哮喘的症状及体征。更多还原

【Abstract】 ObjectiveProspective clinical research methods used to observe the Treatment of Pediatric Asthma Qingfeihuatanpingchuan decoction obstruct the efficacy of lung-type,while the serum total IgE and peripheral blood EOS determination of serum total IgE and the initial changes in EOS TCM symptoms and improve the situation with the correlation.Methodssimple random testing in accordance with prospective collection of children met the study criteria type of lung phlegm obstruct children with asthma were 40 cases in which the treatment group and control group of 20 cases. Control group with conventional therapy,the treatment group with conventional therapy plus phlegm Qingfei Recipe,5 days after treatment were observed symptom scores before and after treatment and efficacy to improve the situation, and before and after treatment of serum total IgE and peripheral blood Determination of EOS. SPSS11.5 and Excel statistical software using analysis of observations.Results1. General analysis:The study met the inclusion criteria were collected 40 cases,21 males and 19 females, maximum age of 8 years old and the youngest 3 years old,20 cases in which treatment group patients,11 males and 9 females mean age 4.23±1.28 of age; the control group suffered 20 cases,10 males and 10 females, mean age 4.28±1.40-year-old. Gender age groups there was no significant difference between comparable(P> 0.05).2. Qingfeihuatanpingchuan decoction in children with acute asthma side of phlegm obstruct the curative effect of pulmonary type:Before treatment, symptoms and signs in children with total score compared with no significant difference (P> 0.05), comparable. After treatment, the treatment group and control group compared with symptoms and signs total score, there were significant differences (P<0.05), shows Recipe Qingfeihuatanpingchuan decoction obstruct the improvement of the lung in children with asthma symptoms and signs were better than those based the control group. After the same course of treatment, clinical cure one case of treatment group,18 cases markedly effective, effective 1 case; the control group 1 case of clinical cure, effective 10 cases,9 cases, compared to two groups, with significant difference (P<0.05), indicating that the overall efficacy of the treatment group than the control group.3. Acute attack of asthma in children of phlegm obstruct the lung in total serum IgE before and after treatment the change:Before treatment, both groups of serum total IgE in children with no significant difference (P> 0.05), comparable. After treatment, serum total IgE was slightly decreased, but no significant difference before treatment (P> 0.05), the control group after treatment, the rise of serum total IgE, no significant difference before and after treatment (P> 0.05). And two groups of patients after treatment there was no significant difference (P> 0.05).4. Before treatment, the treatment group and control group in peripheral blood EOS were no significant differences (P> 0.05), comparable. Treatment group and control group after treatment EOS decreased, compared before and after treatment group differences were significantly (P<0.05), between the two groups, the treatment group than in the control group EOS values significantly decreased after treatment with the difference between two groups (P<0.05), phlegm and asthma and the use of Qingfei plus conventional western side were decreased more significantly EOS. It also shows that peripheral blood EOS and children phlegm obstruct pulmonary asthma symptoms to improve the situation into a certain correlation.Conclusion1. Qingfeihuatanpingchuan decoction can significantly improve asthma in children phlegm obstruct pulmonary symptoms and signs of number of points.2. The use of Integrated Traditional and Western treatment methods can improve the phlegm obstruct children with asthma symptoms and signs of pulmonary type.3. The treatment group and control group before and after treatment of serum total IgE values no significant change.4. Preliminary study of asthma in children phlegm obstruct pulmonary type of symptom change and changes in serum total IgE was not related.5. The treatment and control groups before and after treatment of eosinophils in peripheral blood values are decreased, and the treatment group has the edge.6. Initial findings of asthma in children phlegm obstruct changes in the lung and peripheral blood EOS-type symptoms was a certain correlation. Eosinophils and Western medicine in "sputum" is closely related to the treatment group EOS was more obvious signs and symptoms and significant improvement was also initially speculated that the joint Western Qingfeihuatanpingchuan decoction and asthma treatment by inhibiting the inflammatory cells such as airway eosinophilic granule cells, reduce the "sputum" and leakage, to reduce airway inflammation, to improve the phlegm obstruct pulmonary symptoms and signs of asthma.更多还原