祛风蠲饮汤对发作期小儿支气管哮喘风痰阻肺证临床疗效的影响

目的:观察祛风蠲饮汤治疗发作期小儿支气管哮喘(风痰阻肺证)的临床疗效及对辅助性T淋巴细胞17(Th17),调节性T细胞(Treg)和相关因子的调节作用。方法:采用随机按数字表法将130例患儿分为观察组和对照组各65例。对照组脱落、失访1例,违背方案剔除3例,完成61例,观察组脱落、失访2例,最终完成63例。两组患者基础治疗,布地奈德混悬液,1 mg/次,2次/d,经雾化器给药;重度患儿加用硫酸特布他林气雾剂,1~2喷/次,早晚各1次。对照组口服苏黄止咳胶囊,2粒/次,3次/d。观察组采用祛风蠲饮汤辨证内服,1剂/d。两组疗程均为7 d。记录哮喘起效和缓解时间;进行治疗前后肺功能评价,记录呼气流量峰值(PEF)日变异率、第一秒用力呼气容积(FEV₁)占预计值的百分比(FEV₁%)和第一秒用力呼气容积(FEV₁)/用力肺活量(FVC);进行治疗前后风痰阻肺证评分和呼出气一氧化氮(FeNO)测量;治疗后1周进行儿童哮喘控制测试(C-ACT);检测治疗前后Th17,Treg,白细胞介素-17(IL-17),IL-6,IL-10,IL-22和IL-35水平;进行安全性评价。结果:观察组哮喘起效时间和缓解时间均短于对照组(P<0.01);观察组PEF日变异率低于对照组(P<0.01),FEV₁%,FEV₁/FVC均高于对照组(P<0.01);观察组哮喘控制情况好于对照组(Z=2.106,P<0.05);观察组FeNO和风痰阻肺证评分均低于对照组(P<0.01);观察组Th17细胞和Th17/Treg均低于对照组(P<0.01),Treg细胞比例高于对照组(P<0.01);观察组IL-17,IL-6,IL-22水平均低于对照组(P<0.01),IL-10,IL-35水平均高于对照组(P<0.01);观察组疾病疗效总有效率为96.83%(61/63),优于对照组的85.25%(52/61)(χ²=5.141,P<0.05);观察组中医证疗效总有效率为98.41%(62/63),优于对照组的86.89%(53/61)(χ²=4.525,P<0.05)。未发现与使用祛风蠲饮汤相关不良反应。结论:采用祛风蠲饮汤辨证治疗支气管哮喘发作期风痰阻肺证中重度患儿,可缩短病程,改善肺功能,并可调节Th17,Treg及相关因子的表达,促进Th17/Treg免疫平衡,减轻了气道炎症和气道高反应性,能有效控制哮喘的发作情况,有着较好的临床疗效且使用安全。

Clinical Efficacy of Qufeng Juanyin Decoction on Infantile Bronchial Asthma with Wind Phlegm Obstructing Lung Syndrome

Objective:To observe the clinical efficacy of Qufeng Juanyin Decoction on bronchial asthma in children(syndrome of wind phlegm blocking lung)during the stage of attack,and the regulatory effect on T helper cell 17(Th17)/regulatory T cell(Treg)and related factors.Method:One hundred and thirty patients were randomly divided into observation group(65 cases)and control group(65 cases)by random number table.In control group,61 cases completed the treatment,including 1 fell off or lost visit,3 was eliminated because of breach of protocol.And in observation group,63 patients completed the treatment,including 2 cases fell off or lost visit.Both of the groups got Budesonide suspension by atomizer,1 mg/time,2 times/day,and severe children were added with Terbutaline Sulfate Aerosol every morning and evening,2 sprays/time.Patients in control group got Suhuang Zhike capsules,2 grains/time,3 times/day.Patients in observation group got Qufeng Juanyin Decoction,1 dose/day.The course of treatment lasted for 7 days.Onset and mitigation times of asthma were recorded.And before and after treatment,pulmonary function was evaluated,and daily variation rate of peak expiratory flow(PEF),first second expiratory flow as a percentage of expected(FEV₁%)and ratio of first second forced expiratory volume(FEV₁)and forced vital capacity(FVC)were recorded,and scores of syndrome of wind phlegm blocking lung and exhaled nitric oxide were detected.At the first week after the treatment,asthma control test in children(C-ACT)was made.Levels of Th17 cells,Treg cells,interleukin-17(IL-17),IL-6,IL-10,IL-22 and IL-35 were also detected.And the safety was evaluated.Result:Onset and mitigation times of asthma in observation group were shorter those in control group(P<0.01).The daily variation rate of PEF in observation group was lower than that in control group(P<0.01),while levels of FEV1%and FEV₁/FVC were higher than those in control group(P<0.01).Asthma control in observation group was better than that in control group(Z=2.106,P<0.05).FeNO and score of syndrome of wind phlegm blocking lung were lower than those in control group(P<0.01).Levels of Th17,Th17/Treg,IL-17,IL-6 and IL-22 were lower than those in control group(P<0.01),whereas levels of proportion of Treg cells,IL-10 and IL-35 were higher than those in control group(P<0.01).The total effective rate in observation group was 96.83%(61/63),which was better than 85.25%(52/61)in control group(χ²=5.141,P<0.05).And the total effective rate of traditional Chinese medicine(TCM)syndrome was 98.41%(62/63),which was better than 86.89%(53/61)in control group(χ²=4.525,P<0.05).And there was no adverse reaction caused by Qufeng Juanyin Decoction.Conclusion:Qufeng Juanyin Decoction can shorten the course of disease,improve the lung function,regulate the expressions of Th17/Treg cells and related factors,promote the immune balance of Th17/Treg,reduce airway inflammation and airway hyperresponsiveness,and effectively control the attack of asthma,with a good clinical efficacy and safety on bronchial asthma in children(syndrome of wind phlegm blocking lung)during the stage of attack.