三伏灸配合肠内营养治疗儿童咳嗽变异性哮喘的效应与机制研究

摘要

Objective: To observe the clinical efficacy of application in canicular days plus enteral nutrition in treating cough variant asthma (CVA) in kids, and to explore its action mechanism. Methods:Following a randomized controlled single-blind parallel-group design, 138 eligible kids with CVA were randomized into an observation group, a canicular-day application group, and an enteral nutrition group, 46 kids in each group. The canicular-day application group was intervened by application in canicular days, the enteral nutrition group was by enteral feeding, and the observation group was by both canicular-day application and enteral feeding. The therapeutic efficacies were evaluated after a treatment course. Results: The recovery rate and total effective rate were respectively 50.0% and 98.0% in the observation group, versus 23.9% and 91.3% in the canicular-day application group, and 13.0% and 78.6% in the enteral nutrition group. The observation group was significantly superior to the other two groups (bothP<0.05). In comparing the global symptom score, peak expiratory flow (PEF), forced expiratory volume in one second (FEV1), CD3+, CD4+, CD4+/CD8+, CD8+, hemoglobin (Hb), total protein (TP), albumin (ALB), eosinophil cationic protein (ECP), lipid peroxide (LPO), leukotriene (LT), body weight (BW), triceps skin-fold (TSF), and arm muscle circumference (AMC), the observation group was significantly better than the other two groups (bothP<0.05). Conclusion:Application in canicular days plus enteral nutrition can significantly improve the pulmonary function and symptoms in children’s CVA, and the effect is possibly produced by regulating cellular immune system, enhancing Hb, TP, ALB, BW, TSF, AMC, and inhibiting the production of ECP, LPO, and LT.%目的：观察三伏灸配合肠内营养治疗儿童咳嗽变异性哮喘(cough variant asthma, CVA)的临床疗效,并探讨其作用机制。方法：采用随机、单盲、平行对照的原则将符合纳入标准的138例CVA患儿分为观察组、三伏灸组和肠内营养组,每组46例。三伏灸组给与三伏灸治疗,肠内营养组给与肠内营养治疗,观察组给与三伏灸配合肠内营养治疗。治疗1个疗程后进行疗效评定。结果：观察组治愈率50.0%,总有效率为98.0%；三伏灸组治愈率为23.9%,总有效率为91.3%；肠内营养组治愈率为13.0%,总有效率为78.6%；观察组均明显优于其他两组,差异均有统计学意义(均P＜0.05)。在症状总积分、最大呼气流量(peak expiratory flow, PEF)、一秒用力呼气容积(forced expiratory volume in one second, FEV1)、CD3+、CD4+、CD4+/CD8+和CD8+、血红蛋白(hemoglobin, Hb)、血清总蛋白(total protein, TP)、清蛋白(albumin, ALB)、嗜酸细胞阳离子蛋白(eosinophil cationic protein, ECP)、过氧化脂质(lipid peroxide, LPO)、白三烯(leukotriene, LT)、体质量、肱三头肌皮皱厚度和上臂肌围上,观察组均优于其他两组,差异均有统计学意义(均 P＜0.05)。结论：三伏灸配合肠内营养能明显改善小儿 CVA 患者的肺功能和临床症状,可能通过调节细胞免疫,提高患者的 Hb、TP、ALB、体质量、肱三头肌皮皱厚度和上臂肌围等营养状况,抑制ECP、LPO和LT的分泌等机制发挥治疗作用。