小儿推拿疗法在小儿支气管哮喘慢性持续期的作用机制和治疗效果研究

摘要

目的：探讨小儿推拿疗法在小儿支气管哮喘（哮喘）慢性持续期的相应作用机制和临床治疗效果。方法选取2010年1月—2012年12月到河北联合大学附属医院、广州医科大学附属第五医院、江苏省无锡市第三人民医院及黑龙江中医药大学附属医院就诊且符合本研究纳入及排除标准的慢性持续期哮喘患儿160例，以入选病例随机分组方法将其分为治疗组和对照组各80例。对照组采用常规雾化治疗方法，治疗组在常规雾化治疗方法的基础上应用小儿推拿疗法，各治疗3个月。分别记录两组患儿治疗前后的哮喘发作次数、呼吸道感染次数、儿童哮喘控制测试（C _ ACT）评分及最大呼气流量（PEF）；取两组患儿治疗前后的外周静脉血，记录巨噬细胞 Toll 样受体（Toll _ like receptors，TLR）中 TLR1、TLR2和 TLR4的表达强度。结果治疗后，治疗组患儿的哮喘发作次数和呼吸道感染次数低于对照组患儿，C _ ACT 评分和 PEF%（PEF%= PEF 实测值/ PEF 预计值×100%）高于对照组患儿，差异有统计学意义（p <0.05）；治疗后，两组患儿的临床疗效比较，差异有统计学意义（p <0.05）；治疗后，治疗组患儿外周静脉血巨噬细胞 TLR1、TLR2和 TLR4的表达荧光强度高于对照组，差异有统计学意义（p <0.05）。结论小儿推拿疗法在小儿哮喘慢性持续期有一定的临床治疗效果，其可能是通过上调巨噬细胞 TLR1、TLR2和 TLR4的表达水平来改善小儿哮喘的临床症状。%[AbstraCt] ObjeCtive To investigate the therapeutic effect and mechanism of massage on Pediatric asthma during chronic duration. Methods From January,2010 to December,2012,160 asthmatic children according to the diagnostic criteria were recruited from the Affiliated Hospital,Hebei Associated University and the First Affiliated Hospital,Guangzhou Medical University and the Third Peopleˊs Hospital,Wuxi,Jiangsu province and the Affiliated Hospital,Chinese Medicine University of Heilongjiang and were randomly divided into the control group who were treated by conventional atomization and the treatment group who were treated by traditional techniques of pediatric massage and conventional atomization,both for 3 months. Time of attack of asthma,the incidence of respiratory infection,C _ ACT score and maximal expiratory flow(PEF)were recorded both before and after treatment;peripheral venous blood samples were collected to detect the expression intensity of TLR1,TLR2 and TLR4 in Toll _ like receptors,TLR. Results After treatment,compared with those in control group,time of attack of asthma and the incidence of respiratory infection in trial group were lower while C _ ACT score and PEF% were higher,with significant differences(p < 0. 05);the therapeutic efficacy between the two groups was statistically significant( p < 0. 05);the ANG expression levels(ANG fluorescence intensity)of TLR1,TLR2 and TLR4 in macrophagocyte were stronger in trial group than those in control group,with significance( p < 0. 05). ConClusion Massage has a certain clinical effectiveness on pediatric asthma during chronic duration. It may improve the clinical symptoms by up _ regulating the expression level of TLR1,TLR2 and TLR4 in macrophagocyte.