清腺通络方治疗儿童腺样体肥大临床研究

Clinical Study on Qingxian Tongluo Prescription for Adenoid Hypertrophy in Children

摘要:

目的：观察清腺通络方治疗儿童腺样体肥大（AH） 的临床疗效。方法：将杭州师范大学附属萧山医院儿科2023年1月—2024年12月收治的80例AH患儿，按随机数字表法分为对照组与研究组各40例。对照组给予口服孟鲁司特钠咀嚼片治疗；研究组给予清腺通络方治疗。治疗12周后观察疗效。剔除后最终对照组完成研究38例，研究组完成研究36例。比较治疗前后2组临床疗效、中医证候积分、鼻咽侧位影像学指标［腺样体厚度（A值）、鼻咽腔宽度（N值）、腺样体厚度/鼻咽腔宽度（A/N）］、免疫功能（T淋巴细胞亚群CD3+ 、CD4+ 、CD8+ 、CD4+/CD8+ 比值） 及炎性因子［过敏原特异性免疫球蛋白E （sIgE）、嗜酸性粒细胞（EOS）、白三烯C4（LTC4）］，并统计2组治疗期间不良反应发生率。结果：治疗12周及随访12个月后，2组中医证候主症积分、次症积分及总积分均较治疗前降低，差异均有统计学意义（P＜0.05），研究组上述各项积分均低于对照组，差异均有统计学意义（P＜0.05）。治疗12周后，2组A值、N值、A/N值均较治疗前降低，差异均有统计学意义（P＜0.05），研究组各指标值均低于对照组，差异均有统计学意义（P＜0.05）。治疗12周后，研究组CD3+、CD4+、CD4+/CD8+水平水平均较治疗前及同期对照组提高，差异均有统计学意义（P＜0.05），CD8+水平均较治疗前及同期对照组降低，差异均有统计学意义（P＜0.05）；对照组CD3+、CD4+、CD8+、CD4+/CD8水平与治疗前比较，差异均无统学意义（P＞0.05）。治疗12周后，2组sIgE、EOS、LTC4水平均较治疗前下降（P＜0.05），研究组上述各指标水平均低于对照组，差异均有统计学意义（P＜0.05）。治疗12周后，临床疗效总有效率研究组94.44%（34/36），对照组76.32%（29/38），2组比较，差异有统计学意义（P＜0.05）。不良反应发生率研究组8.33%（3/36），对照组28.95%（11/38），2组比较，差异有统计学意义（P＜0.05）。结论：清腺通络方治疗儿童AH疗效突出，对缓解临床症状、缩小腺样体体积、改善机体免疫功能、减轻机体炎症反应及降低不良反应发生率均有效果。

Abstract:

Abstract： Objective： To observe the clinical efficacy of Qingxian Tongluo Prescription in treating adenoid hypertrophy （AH） in children. Methods：A total of 80 children with AH admitted to the Department of Pediatrics of Xiaoshan Hospital Affiliated to Hangzhou Normal University from January 2023 to December 2024 were randomly divided into a control group and a study group using a random number table method，with 40 cases in each group. The control group received Montelukast Sodium Chewable Tablets， while the study group received Qingxian Tongluo Prescription. After 12 weeks of treatment，efficacy was evaluated. After exclusion，38 cases in the control group and 36 cases in the study group completed the study. Clinical efficacy， traditional Chinese medicine syndrome scores， lateral nasopharyngeal imaging indicators [adenoid thickness （A value），nasopharyngeal width （N value），A/N ratio]， immune function （T lymphocyte subsets CD3⁺，CD4⁺，CD8⁺，CD4⁺/CD8⁺ ratio），and inflammatory factors [allergenspecific immunoglobulin E （sIgE）， eosinophils （EOS）， leukotriene C4 （LTC4）] were compared between the two groups before and after treatment. The incidence of adverse reactions during treatment was also recorded. Results： After 12 weeks of treatment and at the 12-month follow-up， the primary and secondary traditional Chinese medicine syndrome scores and total scores decreased in both groups compared to before treatment， with statistically significant differences （P＜0.05）. The study group had lower scores than the control group， with statistically significant differences （P＜0.05）. After 12 weeks of treatment， the A value， N value， and A/N ratio decreased in both groups compared to before treatment， with statistically significant differences （P＜0.05）. The study group had lower values than the control group，with statistically significant differences （P＜0.05）. After 12 weeks of treatment，the levels of CD3⁺，CD4⁺，and the CD4⁺/CD8⁺ ratio in the study group increased compared to before treatment and to the control group at the same time point， with statistically significant differences （P＜0.05）， while the CD8⁺ level decreased compared to before treatment and to the control group，with statistically significant differences （P＜0.05）. In the control group，there were no statistically significant differences in CD3⁺，CD4⁺，CD8⁺ levels，or CD4⁺/CD8⁺ ratio compared to before treatment（ P＞0.05）. After 12 weeks of treatment，the levels of sIgE，EOS，and LTC4 decreased in both groups compared to before treatment （P＜0.05），and the study group had lower levels than the control group （P＜0.05）. After 12 weeks of treatment，the total clinical efficacy rate was 94.44% （34/36） in the study group and 76.32% （29/38） in the control group，with a statistically significant difference between the two groups （P＜0.05）. The incidence of adverse reactions was 8.33% （3/36） in the study group and 28.95% （11/38） in the control group，with a statistically significant difference between the two groups （P＜0.05）. Conclusion： Qingxian Tongluo Prescription has a certain efficacy in treating AH in children. It effectively alleviates clinical symptoms，reduces adenoid size，improves immune function， alleviates inflammatory responses，and lowers the incidence of adverse reactions.