清消防感颗粒对儿童反复呼吸道感染及TNF-α影响的研究

发布时间：2018-08-16 13:14

【摘要】：目的本文从中西医角度,分别论述小儿反复呼吸道感染的研究进展。对反复呼吸道感染患儿进行深入探讨,针对临床反复呼吸道感染常见滞热型体质患儿,运用“清消防感颗粒”方药并配合饮食指导,观察其临床疗效,并通过对复感儿血清TNF-α影响的研究,初步探讨作用机制,为滞热型体质复感儿寻求一种安全、有效的药物。方法临床观察病例来源于北京中医药大学东方医院儿科及首都医科大学附属复兴医院,为2010年1月-2011年9月门诊3-14岁滞热型体质反复呼吸道感染患儿。纳入70例,剔除2例,脱落8例,最后60例,采用单纯随机、阳性药平行对照的方法,分为治疗组32例和对照组28例。中药治疗组给予口服清消防感颗粒并配合饮食指导,西药对照组给予口服核酪口服液,疗程均为8周,分别于治疗前,治疗后2周、4周、8周、24周记录滞热型体质症状改善情况、再感染次数及症状表现；并观察清消防感颗粒对复感儿血清TNF-α水平的影响。结果 (1)两组患儿疾病总疗效：显效率治疗组为62.5%,对照组为35.71%,治疗组与对照组相比差异具有统计学意义(P0.01),认为治疗组显效率高于对照组。两种治疗方法均能很好地减少呼吸道感染次数(P0.01),两组在减少反复呼吸道感染次数上无明显差异(P0.05),但两种治法在改善患儿病种、病程情况方面有显著差异(P0.05)。 (3)两组患儿中医证候总疗效：总有效率治疗组93.75%,对照组为71.42%；愈显率治疗组62.5%,对照组28.57%,治疗组与对照组比较差异有统计学意义(P0.01),认为治疗组改善滞热型体质中医证候总有效率及愈显率均高于对照组,认为治疗组在改善滞热型体质症状方面有明显优势。 (4)清消防感颗粒改善滞热型体质单个症状方面：治疗组和对照组均能明显改善滞热型体质症状,尤其治疗组在治疗咽红、口臭、大便干燥、手足心热症状时,症状的改善明显优于对照组(P0.01)；在改善口渴症状方面,治疗组亦优于对照组(P0.05)；在改善烦急症状方面,治疗组较对照组无明显差异(P0.05)。 (5)清消防感颗粒改善再次呼吸道感染症状：在服药2周、4周、8周、24周后对照组再感染患儿例数均多于治疗组；在服药4周、8周、24周后,治疗组和对照组再感染时症状积分均有明显差异(P0.05),提示治疗组在减轻再感染症状方面优于对照组。 (6)两种药物均能明显减少TNF-α的表达(P0.05),治疗后两组间TNF-α比较无明显差异(P0.05)。结论：本研究对清消防感颗粒的疗效分别从临床方面及对肿瘤坏死因子-α的影响两方面进行了验证。结果表明：清消防感颗粒对滞热型体质反复呼吸道感染患儿确有较好疗效,能有效地减少呼吸道感染次数,改善滞热型体质临床症状,降低复感儿血清TNF-α水平,抑制气道炎症反应,使机体免疫达到平衡,疗效可靠,值得临床应用。
[Abstract]:Objective to discuss the research progress of recurrent respiratory tract infection in children from the perspective of traditional Chinese and western medicine. In this paper, the children with recurrent respiratory tract infection (RRTI) were studied, and the clinical curative effect was observed by using the prescription of "Qingfanggan granule" and dietary guidance for the children with common heat-stagnation type of recurrent respiratory tract infection (RRTI). The effect of TNF- 伪 on serum TNF- 伪 was studied in order to find a safe and effective drug. Methods Clinical observation cases were collected from Pediatrics Department of Oriental Hospital of Beijing University of traditional Chinese Medicine and Fuxing Hospital affiliated to Capital Medical University. They were children with recurrent respiratory tract infection aged 3-14 years old from January 2010 to September 2011. 70 cases were included, 2 cases were excluded, 8 cases were removed, and 60 cases were left off. The patients were divided into treatment group (n = 32) and control group (n = 28). The traditional Chinese medicine treatment group was given oral Qingfanggan granule and diet guidance, while the western medicine control group was given the oral hedonia oral liquid for 8 weeks. The improvement of the physical symptoms of heat stagnation type was recorded before and after 2 weeks and 2 weeks and 8 weeks and 24 weeks after treatment, respectively. The effect of Qingfanggan granule on serum TNF- 伪 level in children with reinfection was observed. Results (1) the total curative effect of the two groups: the effective rate was 62.5 in the treatment group and 35.71 in the control group. The difference between the treatment group and the control group was statistically significant (P0.01). It was considered that the effective rate of the treatment group was higher than that of the control group. The two treatment methods can reduce the number of respiratory tract infections (P0.01), there is no significant difference in reducing the number of recurrent respiratory infections between the two groups (P0.05), but the two treatment methods can improve the disease types of children. There was significant difference in course of disease (P0.05). (3). The total effective rate of TCM syndromes was 93.75 in the treatment group and 71.42 in the control group. There was significant difference between the treatment group and the control group (P0.01). It was considered that the total effective rate and the more obvious rate of improving the TCM syndrome of the heat stagnation type in the treatment group were higher than those in the control group. It is believed that the treatment group has obvious advantages in improving the physical symptoms of the heat stagnation type. (4) Qingfanggan granule can improve the single symptom of the heat stagnation type constitution: both the treatment group and the control group can obviously improve the physical symptoms of the heat stagnation type. Especially in the treatment of red pharynx, bad breath, dry stool, hot hands and feet, the improvement of symptoms in the treatment group was significantly better than that in the control group (P0.01); in improving the symptoms of thirst, the treatment group was also better than the control group (P0.05); in improving the symptoms of irritation, the treatment group was also superior to the control group (P0.05). There was no significant difference between the treatment group and the control group (P0.05). (5). Qingfanggan granule improved the symptoms of re-respiratory tract infection: after 2 weeks, 4 weeks, 8 weeks and 24 weeks, the number of children in the control group was more than that in the treatment group, and after 4 weeks, 8 weeks and 24 weeks, the number of children in the control group was higher than that in the treatment group. There were significant differences in symptom scores between the treatment group and the control group (P0.05), which suggested that the treatment group was superior to the control group in alleviating the symptoms of reinfection. (6) both drugs could significantly reduce the expression of TNF- 伪 (P0.05), and after treatment, the TNF- 伪 expression was significantly reduced between the two groups. There was no significant difference (P0.05). Conclusion: the effect of Qingfanggan granule on tumor necrosis factor-伪 (TNF-伪) was verified in clinical and clinical aspects. The results showed that QFGG had a good effect on children with recurrent respiratory tract infection, which could effectively reduce the number of respiratory tract infections, improve the clinical symptoms of heat-stagnation constitution, and lower the level of TNF- 伪 in serum. Inhibition of airway inflammation, so that the body immune balance, the efficacy is reliable, worthy of clinical application.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R272

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