滋肾润肺平喘汤治疗哮喘缓解期疗效及对儿童Th17/Treg影响研究

目的:观察儿童哮喘缓解期口服滋肾润肺平喘汤对辅助性T细胞17/调节T细胞(Th17/Treg)及临床疗效的影响。方法:选取86例哮喘患儿纳入此项研究,按随机法划分为西药组与联合组,西药组给予布地奈德福莫特罗粉吸入治疗,联合组在西药组治疗的同时联合给予滋肾润肺平喘汤口服; 1个治疗后,评估全部患儿疗效,观察疗程前后中医症候积分、肺功能、Th17计数、Treg计数、Th17/Treg及白细胞介素-17(IL-17)、白细胞介素-10(IL-10)、转化生长因子-β(TGF-β)水平的变化; 统计治疗期间不良反应发生情况; 随访6个月,比较患儿哮喘发作频率的变化。结果:1个治疗后,两组患儿主症:喉中哮鸣音、气喘、畏寒肢冷,次症:咳嗽、咳痰、发育迟缓、面色苍白积分均较本组治疗前降低(均P<0.05),联合组均低于西药组(均P<0.05); 两组患儿FEV₁、FEV₁/FVC、PEF均较本组治疗前提高(均P<0.05),联合组均高于西药组(均P<0.05); 两组患儿Th17计数均有下降(P<0.05)、Treg计数均有升高(P<0.05)、Th17/Treg均较本组治疗前降低(P<0.05),联合组Th17计数高于西药组(P<0.05)、Treg计数与Th17/Treg均高于西药组(P<0.05); 两组患儿血清IL-17、TGF-β水平均较本组治疗前改善(均P<0.05),联合组均优于西药组(均P<0.05); 两组治疗期间均未见严重不良反应; 随访6个月,两组患儿哮喘发作频率与每次发作时间均较本组治疗前减少,联合组均少于西药组(均P<0.05)。结论:儿童哮喘口服滋肾润肺平喘汤可通过改善患儿Th17、Treg相关血清因子表达水平,发挥辅助调节Th17/Treg平衡,降低哮喘发作频率的作用。

Effect of Zishen Runfei Pingchuan decoction on Th17/Treg and its clinical curative effect in children with asthma in remission stage

Objective:To observe the effect of Zishen Runfei Pingchuan decoction on the T cells 17/Regulatory T cells(Th17/Treg)and its clinical curative effect in children with asthma in remission stage.Methods:The objects of study were 86 children with asthma,and enrolled children were divided into western medicine group and combined group according to the randomization method.Children in western medicine group were given Budesonide and formoterol powder for inhalation,and those in the combined group were provided with Zishen Runfei Pingchuan decoction simultaneously on the basis of therapeutic approach in western medicine group.After 1 course of treatment,the curative effect of all the children was evaluated,and the changes of traditional Chinese medicine(TCM)syndrome score,lung function,Th17 count,Treg count,Th17/Treg and serum factors including interleukin-17(IL-17),interleukin-10(IL-10)and transforming growth factor-β(TGF-β)levels were observed before and after the treatment of all the children.Furthermore,the incidence of adverse reactions during treatment was counted.The children were followed up for 6 months to compare the frequency of asthma attacks.Results:After one course of treatment,the main symptoms of the children in the two groups were wheezing rales in the throat,asthma,chilly sensation and the cold limbs,while the secondary symptoms included cough,expectoration,growth retardation,pale complexion;all the above scores were lower than those before the course of treatment in the two groups(all P<0.05),and scores in the combined group were all lower than the western medicine group(all P<0.05).FEV 1,FEV 1/FVC and PEF of the two groups were all improved compared with those before treatment during intra-group comparison(all P<0.05),and those of the combined group were higher than those of the western medicine group(all P<0.05).Th17 count in both groups were decreased(all P<0.05)while Treg count increased(P<0.05)in both groups,and Th17/Treg count were both decreased(all P<0.05)compared with that before treatment during intra-group comparison.Furthermore,Th17 count in the combined group was higher than that in the western medicine group(P<0.05),while Treg count and Th17/Treg count were both higher than that in the western medicine group(all P<0.05).The serum levels of IL-17 and TGF-βwithin both groups were improved after treatment compared with those before treatment(all P<0.05),and the combined group was superior to the western medicine group(all P<0.05).No serious adverse reactions were observed during treatment in both groups.Follow-up for 6 months showed that the frequency and duration of asthma attacks in the two groups were both lower than that before the course of treatment during intra-group comparison,and the combined group was lower than that in the western medicine group(P<0.05).Conclusion:Zishen Ru nfei Pingchuan decoction can help to improve the expression levels of Th17 and Treg-related serum factors in children with asthma,which plays a role in assisting the regulation of Th17/Treg balance and reducing the frequency of asthma attacks.