摘要
目的 探讨盐酸丙卡特罗联合消咳喘胶囊治疗儿童咳嗽变异性哮喘(CVA)的临床效果及对患儿血清学指标、气道功能的影响.方法 选择2019年3月至2022年4月自贡市第一人民医院收治的124例CVA患儿为研究对象.采用随机数字表法将患儿分为对照组和观察组,每组62例.对照组患儿给予盐酸丙卡特罗治疗,观察组患儿给予盐酸丙卡特罗联合消咳喘胶囊治疗,均治疗2周.比较2组患儿治疗后的临床疗效;分别于治疗前、治疗2周后评估2组患儿的日间和夜间咳嗽积分;分别于治疗前、治疗2周后采用酶联免疫吸附法检测2组患儿血清高迁移率族蛋白B1(HMGB1)、Toll样受体4(TLR4)、核因子κB(NF-κB)、白细胞介素-4(IL-4)、γ-干扰素(INF-γ)水平,并计算INF-γ/IL-4;应用肺功能检测仪测定2组患儿治疗前、治疗2周后的呼出25％肺活量时流速(MEF25)、呼出50％肺活量时流速(MEF50)和呼出75％肺活量时流速(MEF75);记录2组患儿治疗期间不良反应发生情况.结果 对照组和观察组患儿的治疗总有效率分别为82.26％(51/62)、95.16％(59/62);观察组患儿治疗总有效率显著高于对照组(P＜0.05).治疗前2组患儿日间和夜间咳嗽积分比较差异无统计学意义(P＞0.05);2组患儿治疗后日间和夜间咳嗽积分均显著低于治疗前(P＜0.05);治疗后,观察组患儿日间和夜间咳嗽积分均显著低于对照组(P＜0.05).治疗前2组患儿血清HMGB1、TLR4、NF-κB水平比较差异无统计学意义(P＞0.05);2组患儿治疗后血清HMGB1、TLR4、NF-κB水平显著低于治疗前(P＜0.05);治疗后,观察组患儿血清HMGB1、TLR4、NF-κB水平显著低于对照组(P＜0.05).治疗前2组患儿MEF25、MEF50、MEF75比较差异无统计学意义(P＞0.05);2组患儿治疗后MEF25、MEF50、MEF75显著高于治疗前(P＜0.05);治疗后,观察组患儿MEF25、MEF50、MEF75显著高于对照组(P＜0.05).治疗前2组患儿血清IL-4、INF-γ水平及INF-γ/IL-4比较差异无统计学意义(P＞0.05);2组患儿治疗后血清IL-4水平显著低于治疗前,INF-γ水平及INF-γ/IL-4显著高于治疗前(P＜0.05);治疗后,观察组患儿血清IL-4显著低于对照组,INF-γ水平及INF-γ/IL-4显著高于对照组(P＜0.05).所有患儿治疗期间的药物耐受情况良好,未出现明显药物不良反应.结论 消咳喘胶囊联合盐酸丙卡特罗治疗小儿CVA疗效显著,其作用机制可能与调控HMGB1-TLR4-NF-KB信号通路有关.
Abstract
Objective To explore the clinical effect of procaterol hydrochloride combined with Xiaokechuan capsule in the treatment of cough variant asthma(CVA)and its impact on serological indicators,airway function of children.Methods A total of 124 children with CVA admitted to the Zigong First People's Hospital from March 2019 to April 2022 were selected as the research subjects.The children were divided into control group and observation group according to random number table method,with 62 cases in each group.The children in the control group were treated with procaterol hydrochloride,and the children in the observation group were treated with procaterol hydrochloride and Xiaokechuan capsule for two weeks.The clinical efficacy of children was compared between the two groups after treatment.The cough scores during the day and night of children were evaluated in the two groups before and 2 weeks after treatment.The serum high mobility group protein B1(HMGB1),Toll like receptor 4(TLR4),nuclear factor-κB(NF-κB),interleukin-4(IL-4),interferon-γ(INF-γ)levels of children in the two groups were measured by enzyme linked immunosorbent assay before and 2 weeks after treatment,and the ratio of INF-γ/IL-was calculated.The 25％maximal expiratory flow-volume(MEF25),50％maximal expiratory flow-volume(MEF50),75％maximal expiratory flow-volume(MEF75)of children in the two groups were measured by lung function detector before and 2 weeks after treatment.The adverse reactions of children in the two groups were recorded during treatment.Results The total effective rate of children in the control group and observation group was 82.26％(51/62)and 95.16％(59/62),respectively;the total effective rate of children in the observation group was significantly higher than that in the control group(P＜0.05).There was no significant difference in cough scores during the day and night of children between the two groups before treatment(P＞0.05);the cough scores during the day and night of children after treatment were significantly lower than those before treatment in the two groups(P＜0.05);after treatment,the cough scores during the day and night of children in the observation group were significantly lower than those in the control group(P＜0.05).There was no significant difference in serum HMGB1,TLR4,NF-κB levels of children between the two groups before treatment(P＞0.05);the serum HMGB1,TLR4,NF-κB levels of children after treatment were significantly lower than those before treatment in the two groups(P＜0.05);after treatment,the serum levels of HMGB1,TLR4,and NF-κB of children in the observation group were significantly lower than those in the control group(P＜0.05).There was no significant difference in MEF25,MEF50,and MEF75 of children between the two groups before treatment(P＞0.05);the MEF25,MEF50,and MEF75 of children after treatment were significantly higher than those before treatment in the two groups(P＜0.05);after treatment,the MEF25,MEF50,and MEF75 of children in the observation group were significantly higher than those in the control group(P＜0.05).There was no significant difference in serum IL-4,INF-γ levels and the ratio of INF-γ/IL-4 of children between the two groups before treatment(P＞0.05);the serum IL-4 level of children after treatment were significantly lower than those before treatment,the INF-γ level and the ratio of INF-γ/IL-4 were significantly higher than those before treatment in the two groups(P＜0.05);after treatment,the serum IL-4 level of children in the observation group was significantly lower than that in the control group,the INF-γ level and the ratio of INF-γ/IL-4 were significantly higher than those in the control group(P＜0.05).All children had good drug tolerance during the treatment period,and no significant adverse drug reactions were observed.Conclusion The combination of Xiaokechuan capsules and procaterol hydrochloride has a significant therapeutic effect for pediatric CVA,and its mechanism of action may be related to the regulation of HMGB1-TLR4-NF-κB signal pathway.
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