小青龙汤对小儿哮喘激素干预的增效作用及免疫调节观察

目的 研究小青龙汤对小儿哮喘激素干预的增效作用及免疫调节作用。方法 选择我院满足诊断标准的69例小儿哮喘者为研究样本，以随机数字表法分为观察组（n=35例）与对照组（n=34），两组均行舒利迭雾化吸入治疗，观察组另给予小青龙汤治疗，1周为1个疗程，采用中医证候积分评价两组治疗疗效，同时观察1个疗程后肺功能指标用力肺活量（FVC）、1s用力呼气容积（FEV1）、最大通气量（MVV）变化，比较两组免疫指标免疫球蛋白A（IgA）、免疫球蛋白E（IgE）、免疫球蛋白G（IgG），同时观察T淋巴细胞CD₄⁺、CD₈⁺、CD₄⁺/CD₈⁺治疗前后差异，比较两组治疗期间不良反应发生率，同时建立CD₄⁺/CD₈⁺对治疗疗效的评估模型。结果 观察组中医证候总有效率为97.1%，显著高于对照组82.4%（P<0.05）；两组治疗后FVC、FEV1、MVV均高于治疗前（P<0.05），观察组FVC、FEV1、MVV高于对照组，其中FEV1与对照组比较差异有统计学意义（P<0.05）；观察组治疗后IgA、IgG较治疗前及对照组显著升高，IgE较治疗前及对照组降低，差异有统计学意义（P<0.05），对照组治疗前后免疫指标均无显著变化（P>0.05）；治疗后两组CD₄⁺较治疗前降低（P<0.05），观察组CD₄⁺低于对照组，CD₈⁺高于对照组，CD₄⁺/CD₈⁺低于对照组，差异有统计学意义（P<0.05）；两组均未见严重不良反应，不良反应发生率对照组5.88%（2/34）与观察组8.57%（3/35）比较差异无统计学意义（P>0.05）；治疗后无效患儿CD₄⁺/CD₈⁺较高，CD₄⁺/CD₈⁺值达2.17时，患儿无效率较高。结论 小青龙汤联合激素治疗小儿轻中度急性哮喘有良好的协同作用，用药无明显不良反应，对中医证候及肺功能的改善优于单一西药治疗，其机制考虑与增强患儿免疫力有关。

The Synergistic and Immunoregulation Effects of Xiaoqinglong Decoction on Pediatric Asthma PatientsTreated by Glucocorticoid

Objective To explore the effect of Xiaoqinglong decoction on the improvement of pediatric asthma treated by glucocorticoid. Methods Totally 69 cases of infantile asthma were randomly divided into the observation group (n=35) and control group (n=34). Patients in the two groups were treated with seretide inhalation, and the observation group was additionally treated with Xiaoqinglong decoction, one course for one week.The clinical effect was assessed based on Traditional Chinese Medicine (TCM) syndrome score. The pulmonary function parameters including forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and maximal voluntary ventilation (MVV) were measured after the first course of treatment. Immune indices included immunoglobulin A(IgA), immunoglobulin E(IgE) and immunoglobulin G(IgG)were compared between the two groups. The differences in CD4+, CD8+, and CD4+/CD8+ T lymphocyte were observed before and after the treatment, and the the prediction model of CD4+/CD8+ for the therapeutic effect was built at the same time. Results The total effective rate based on TCM snydrome score was 97.1% in the observation group and was significantly higher than that in the control group (82.4%)(P<0.05). The FVC, FEV1 and MVV in the two groups were significantly higher after treatment(P<0.05), and FVC, FEV1 and MVV in the observation group were higher than that in the control group, with a significant difference in FEV1(P<0.050). The IgA and IgG in the observation group were significantly higher than those before treatment and in the control group, while IgE was significantly lower than that before treatment and in the control group (P<0.05). The level of CD4+ in the two groups significantly decreased after the treatment (P<0.05). The level of CD8+ and CD4+/CD8+ in the observation group were significantly lower than that in the control group, while the CD8+ was higher than that in the control group (P<0.05). No serve adverse effect was found in both groups. Conclusion The therapy of Xiaoqinglong decoction combined with glucocorticoid in the treatment of children with mild or moderate asthma shows good synergistic effect without obvious adverse reaction. It is better than the single application of Western medicine in the improvement of TCM snydrome and pulmonary functions, which may through strengthening patient''s immunity.