自拟平喘汤联合特布他林雾化吸入治疗急性发作期儿童支气管哮喘的疗效分析

Effect of self-made Pingchuan decoction combined with terbutaline nebulized inhalation on the treatment of bronchial asthma in children

摘要:

目的 评价自拟平喘汤联合特布他林雾化吸入治疗儿童支气管哮喘的疗效。方法 该研究为前瞻性随机对照试验。选取2020年2月—2021年2月就诊于河北省儿童医院、河北中医药科学院的124例支气管哮喘患儿，按随机数字表法分为对照组和观察组，每组62例。所有患儿均接受对症支持治疗，对照组接受特布他林雾化吸入治疗，观察组在对照组基础上加用自拟平喘汤治疗，共治疗7 d。比较两组疗效、临床症状体征消失时间；通过酶联免疫吸附试验（ELISA）检测两组患儿的转化生长因子-β₁（TGF-β₁）、骨桥蛋白（OPN）、核因子-κB（NF-κB）、基质金属蛋白酶-9（MMP-9）、环氧化酶-2（COX-2）、趋化素样因子1（CKLF-1）、γ干扰素（IFN-γ）、白三烯B4（LTB4）水平；采用东芝TSV-302A80排CT测量患儿支气管总面积（TA）、管壁面积（WA）、管腔面积（LA）；通过比色法检测患儿的谷胱甘肽过氧化物酶（GSH）、总氧化能力（TAC）、丙二醛（MDA）、超氧化物歧化酶（SOD）水平；观察治疗后不良反应。结果 观察组治疗总有效率（91.94%）比对照组（77.42%）高（P <0.05），气促、喘息、哮鸣音、胸闷消失时间均比对照组短（P <0.05）；两组治疗前后TGF-β₁、OPN、NF-κB及MMP-9差值比较，观察组大于对照组（P <0.05）；两组治疗前后TA、WA、LA差值比较，观察组大于对照组（P <0.05）；两组治疗前后COX-2、CKLF-1、IFN-γ、LTB4差值比较，观察组大于对照组（P <0.05）。两组治疗前后GSH、TAC、MDA、SOD差值比较，观察组大于对照组（P <0.05）。观察组不良反应总发生率（4.84%）与对照组（6.45%）比较，差异无统计学意义（P >0.05）。结论 自拟平喘汤联合特布他林雾化吸入治疗儿童支气管哮喘效果明显，有助于快速缓解临床症状，改善气道重塑，降低炎症应激反应，且用药安全性高。

Abstract:

Objective To evaluate the therapeutic effect of self-made Pingchuan decoction combined with terbutaline aerosol inhalation on children asthma.Methods This study is a prospective randomized controlled trial. 124 children with bronchial asthma who were admitted to Hebei Children's Hospital and Hebei Academy of Traditional Chinese Medicine from February 2020 to February 2021 were selected and divided into two groups according to the principle of randomized control. All children had received symptomatic and supportive treatment for a total of 7 days, the control group received terbutaline nebulized inhalation therapy, and the study group was treated with self-made Pingchuan decoction on the basis of the control group. The curative effect and the time of disappearance of clinical symptoms and signs were compared between the two groups. The levels of transforming growth factor beta 1 (TGF-β₁), osteopontin (OPN), nuclear factor-κB (NF-κB), matrix metallo proteinase 9 (MMP-9), Cyclooxygenase 2 (COX-2), chemokine-like factor 1 (CKLF-1), IFN-γ, and leukotriene B4 (LTB4) were measured by Elisa. The total bronchial area (TA), wall area (WA), and lumen area (LA) were measured by Philips Brilliance 256-slice spiral CT scanner. The levels of Glutathione peroxidase, total oxidation capacity (TAC), malondialdehyde (MDA), and superoxide dismutase were measured by colorimetry.Results The total effective rate (91.94%) of the study group was higher than that of the control group (77.42%) (P < 0.05), and the disappearance time of shortness of breath, puffing, wheezing, and chest tightness was shorter than that of the control group (P < 0.05). The difference of TGF-β₁, OPN, NF-κB, and MMP-9 levels before and after treatment in the observation group was higher than that in the control group (P < 0.05). The difference of COX-2, CKLF-1, IFN-γ, and LTB4 before and after treatment in the observation group was higher than that in the control group (P < 0.05). The difference of TA, WA, and LA between the two groups before and after treatment was higher in the observation group than in the control group (P < 0.05). The difference of GSH, TAC, MDA, and SOD between the two groups before and after treatment was higher in the observation group than in the control group (P < 0.05). There was no significant difference in the occurrence of adverse reaction between the observation group (4.84%) and the control group (6.45%) (P > 0.05).Conclusions Self-made Pingchuan decoction combined with terbutaline aerosol inhalation is effective in treating childre's asthma, which is helpful to quickly relieve clinical symptoms, improve airway remodeling, reduce inflammatory stress reaction, with high safety.