清腺方治疗儿童腺样体肥大的临床研究
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摘要
儿童腺样体肥大(CAH)是儿科的常见性疾病,长期反复容易影响患儿的生长发育、智力发育、甚至会诱发心血管系统出现早期的病理性改变。同时,会引发诸多的并发症如分泌性中耳炎、慢性鼻窦炎、鼻炎等诸多疾病。临床上甚至会影响外观性改变,造成“腺样体面容”。
本课题将分为文献综述、徐荣谦教授治疗CAH的临床经验总结及清腺方治疗儿童腺样体肥大临床研究等三部分。在文献综述方面首先介绍了中医对CAH的病名归属、病因病机及治疗进展。其次,对CAH的现代医学研究进展也进行总结与探索,其中包括免疫调节、变态反应、临床治疗等。由于CAH并发症较为复杂,所以对CAH与全身疾病的关系进行了分析,以便对CAH有总体性的了解。
临床研究方面将针对徐荣谦教授治疗CAH的临床经验进行整理。另外,观察徐荣谦教授自拟清腺方的临床疗效,选择86例CAH患儿进行临床研究观察,其中包括数据采集、统计、结果分析与讨论等。深入探讨了中医药对CAH的临床认识及研究进展,为中药新药开发奠定临床基础。
1.文献综述
历经大量的文献资料整理及检索,阐明了CAH的中医病名归属、病因病机、中医治疗、辨证论治的规律。以及对现代医学的临床研究进行较为深入的探索,其中包括免疫研究进展、病原学研究、气道阻塞评估、临床诊断的最新进展及西医疗法。
2.徐荣谦教授治疗儿童腺样体肥大临床经验整理
目的
总结徐荣谦治疗腺样体肥大患儿的临床经验
方法
探讨出CAH患儿的中医病因病机,临证思路,治疗原则。总结三期论治CAH的临证经验。
结果
(I)CAH主要的基本病机为“邪羁、气滞、血瘀、痰结”；基本治则为“祛邪、理气、化瘀、祛痰、散结”为主要治则。
(2)首创三期论治：徐荣谦教授提出CAH初期为风热郁结证,治疗以疏散风热、化痰散结为主。方用银翘散进行加减；中期为痰瘀互结证,治法宜活血祛瘀,化痰散结。方用清腺方加减；后期为肺肾阴虚证,治法以补肺养阴,填精益髓为基准。方用六味地黄丸加减。
3.清腺方治疗儿童腺样体肥大的临床研究
目的
观察清腺方治疗CAH患儿的临床疗效。
方法
纳入符合标准共86例CAH痰瘀互结证患儿,观察性别、年龄、病程及临床症状等一般资料进行分析,其中治疗组44例,对照组42例。分别给于清腺方免煎颗粒及辅舒良鼻喷剂共治疗3个疗程。对治疗前后的临床症状,中医证候积分、生活质量(OSA-18)及腺样体体积疗效进行总结,所得数据利用SPSS16.0统计软件进行处理。
结果
(1)本次86例CAH痰瘀互结证患儿中,男67例(77.91%),女19例(22.09%)。提示出CAH患儿男性高发于女性。
(2)发病年龄中7-12岁共61例,占70.93%,13-18岁共25例,占29.06%。提示7-12岁是CAH发病率较高的年龄段。
(3)86例的腺样体肥大情况统计出以Ⅲ度肥大占的百分比较高为44.73%,其次为Ⅳ度肥大23.68%。说明临床上以Ⅲ度、Ⅳ度腺样体肥大最为常见,共占68.42%。
(4)86例CAH的临床症状进行统计分析,打鼾达81.39%；张口呼吸达76.74%；鼻塞达72.09%,显示出打鼾、张口呼吸、鼻塞是临床上最为常见的3大主要症状。
(5)86例CAH患儿在临床症状改善比较：鼻塞、打鼾、张口呼吸症状方面,鼻塞在治疗1个月后P值两组均<0.001。打鼾及张口呼吸治疗3个月后,治疗组与对照组比较P<0.05,有明显差异,提示治疗组比对照组治疗3个月后疗效显著。
(6)腺样体体积疗效比较,两组经治疗后体积积分比较具有显著性差异P<0.05,说明治疗组疗效优于对照组。
(7)生活质量评估(OSA-18),经治疗后两组比较P<0.001,差异显著,说明治疗组疗效比对照组好。
Children with adenoid hypertrophy (CAH) is a common disease in pediatrics. Recurrence of the disease on a long-term basis will easily affect children's growth and development, intellectual development, and may even induce the occurrence of early pathological change of the cardiovascular system. It will concurrently lead to many complications, such as secretory otitis media, chronic nasosinusitis, nasitis, etc. And it may also affect the appearance clinically, resulting in "adenoid face".
The thesis will be divided into three parts, namely literature review, clinical experience summary of Professor Xu Rongqian in the treatment of CAH and clinical research of Qingxianfang in the treatment of CAH. In the first part of literature review, it introduces the name of the disease attributed by TCM, etiology and pathogenesis and progress of treatment. Secondly, summary and exploration have also been carried out on the progress of modern medical research on CAH, including immunoregulation, allergic reaction, clinical treatment, etc. Since the complications of CAH are complex, the analysis has also been made to the relationship between CAH and systemic disease to have a general understanding of CAH.
The thesis will conclude the clinical experience of Professor Xu Rongqian in the treatment of CAH in the part of clinic research. Moreover, it carries out clinic research in terms of the cur at ive effect of Professor Xu Rongqian's treatment of Qingxianfang, and explores studies about86cases of children with CAH, including data col lect ion, statistics, result analysis and discussion, etc. The thesis also investigates in-depth the clinical recognization and progress of research of TCM to CAH so as to lay a sound clinical foundation for the development of TCM and new drugs of TCM in the future.
1. Literature Review
After conclusion and retrieval of huge amount of literature and data, the thesis clarifies the name of the disease attributed by TCM, etiology and pathogenesis, TCM treatment, and the rules of treatment according to syndrome differentiation. In addition, it carries out in-depth exploration in terms of the clinical research of modern medicine, including the progress of Imnunological study, the research on etiology, the evaluation of airway obstruction, the latest progress of clinical diagnosis and western medicine therapy.
2. Conclusion of Clinical Experience of Professor Xu Rongqian in the treatment of CAH
Objective:
To summarize the clinic experience of Professor Xu Rongqian in the treatment of CAH
Method:
To explore and find out the etiology and pathogenesis of TCM, clinical ideas, therapeutic principles and to summarize the clinical experience of three-stage theory in the treatment of CAH.
Results:
(1) The basic pathogenesis of CAH is "pathogenic heat lingering, stagnation of the circulation of vital energy, blood stasis, stubborn phlegm"; the basic principle of treatment is "heat removal, regulating the f low of vi tal energy and remove obstruct ion toit, blood stasis removal, phlegm removal, stasis removal".
(2) The initiation of the three-stage treatment:Professor Xu Rongqian puts forward the notion that CAH is heat stagnation syndrome in the early stage, the treatment of which should be mainly focus on dispelling wind and heat and reducing phlegm and resolving masses; it turns into syndrome of intermingled phlegm and blood stasis in the middle stage, the treatment of which should be focus on activating blood and eliminating stasis and reducing phlegm and resolving masses, using Qingxianf ang to achieve the appropr iate curat ive effect. In the late stage, it turns into syndrome of yin deficiency of lung and kidney, the treatment of which should be focus on nourishing the lung and replenishing vital essence and tonifying the Bone marrow, using Liuweidihuang pills to achieve the appropriate curative effect.
3. Clinical Research of Qingxianfang in the Treatment of CAH
Objective:
To observe the clinical therapeutic effect of Qingxianfang in the treatment of CAH
Method:
86cases of children with syndrome of intermingled phlegm and blood stasis who meet the criteria requirement are brought into the research, including44cases in treatment group and42cases in the control group. They are treated respectively with Qingxianfang and fushuliang nasal spray for3courses. Observation and analysis should be made in terms of
the gender and age of children, courses of disease and clinical symptoms, etc. Then conclusions will be made to the clinical symptoms pre and post treatment, integral of syndrome of TCM, qual i ty of life (OSA-18), and curative effect of adenoid volume, the data resulted from which will be processed by SPSSS16.0statistical software.
Results:
(1) Among86cases of syndrome of intermingled phlegm and blood stasis patients, male patients are67cases (77.91%) and female patients are19cases (22.09%), which demonstrates that males are of higher percentage to catch the disease than females.
(2) The patients aged from seven years old to twelve years old account for61cases, taking up70.93%whi le the patients aged from thirteen years old to eighteen years old account for25cases, taking up29.06%, which demonstrates children aged group from seven to twelve years old are of high percentage to catch the disease.
(3) The statistics of the adenoid hypertrophy situation among86cases show that hypertrophy of the third degree reaches a relatively high percentage of44.73%, followed by the fifth degree of23.68%. It demonstrates that the hypertrophies of the third and fifth degree are the most common types clinically, accounting for68.42%.
(4) The statistical analysis of clinical symptoms among86cases shows that snoring reaches81.39%, buccal respiration reaches76.74%and nasal obstruction reaches72.09%. It demonstrates that snoring, buccal
(5) The Improve of clinical symptoms among86cases respiration and nasal obstruction are the three major symptoms clinically. After treatment for1month,P values of two groups are both<0.001for nasal obstruction, with obvious curative effect clinically for two groups. After treatment for3months,P value are<0.05, comparing treatment group with control group, with obvious difference, which demonstrates that the treatment group has more obvious curative effect than the control group after treatment for3months.
(6) In the aspect of the adenoid volume in clinical efficacy, there is obvious different between the two groups after treatment in terms of the volume integral with P<0.05. It demonstrates that the treatment group has better curative effect than the control group.
(7) The evaluation of quality of life (OSA-18). The comparison of the two groups after treatment,P values are<0.001, with obvious difference. It demonstrations that the treatment group has better curative effect than the control group.
本课题将分为文献综述、徐荣谦教授治疗CAH的临床经验总结及清腺方治疗儿童腺样体肥大临床研究等三部分。在文献综述方面首先介绍了中医对CAH的病名归属、病因病机及治疗进展。其次,对CAH的现代医学研究进展也进行总结与探索,其中包括免疫调节、变态反应、临床治疗等。由于CAH并发症较为复杂,所以对CAH与全身疾病的关系进行了分析,以便对CAH有总体性的了解。
临床研究方面将针对徐荣谦教授治疗CAH的临床经验进行整理。另外,观察徐荣谦教授自拟清腺方的临床疗效,选择86例CAH患儿进行临床研究观察,其中包括数据采集、统计、结果分析与讨论等。深入探讨了中医药对CAH的临床认识及研究进展,为中药新药开发奠定临床基础。
1.文献综述
历经大量的文献资料整理及检索,阐明了CAH的中医病名归属、病因病机、中医治疗、辨证论治的规律。以及对现代医学的临床研究进行较为深入的探索,其中包括免疫研究进展、病原学研究、气道阻塞评估、临床诊断的最新进展及西医疗法。
2.徐荣谦教授治疗儿童腺样体肥大临床经验整理
目的
总结徐荣谦治疗腺样体肥大患儿的临床经验
方法
探讨出CAH患儿的中医病因病机,临证思路,治疗原则。总结三期论治CAH的临证经验。
结果
(I)CAH主要的基本病机为“邪羁、气滞、血瘀、痰结”；基本治则为“祛邪、理气、化瘀、祛痰、散结”为主要治则。
(2)首创三期论治：徐荣谦教授提出CAH初期为风热郁结证,治疗以疏散风热、化痰散结为主。方用银翘散进行加减；中期为痰瘀互结证,治法宜活血祛瘀,化痰散结。方用清腺方加减；后期为肺肾阴虚证,治法以补肺养阴,填精益髓为基准。方用六味地黄丸加减。
3.清腺方治疗儿童腺样体肥大的临床研究
目的
观察清腺方治疗CAH患儿的临床疗效。
方法
纳入符合标准共86例CAH痰瘀互结证患儿,观察性别、年龄、病程及临床症状等一般资料进行分析,其中治疗组44例,对照组42例。分别给于清腺方免煎颗粒及辅舒良鼻喷剂共治疗3个疗程。对治疗前后的临床症状,中医证候积分、生活质量(OSA-18)及腺样体体积疗效进行总结,所得数据利用SPSS16.0统计软件进行处理。
结果
(1)本次86例CAH痰瘀互结证患儿中,男67例(77.91%),女19例(22.09%)。提示出CAH患儿男性高发于女性。
(2)发病年龄中7-12岁共61例,占70.93%,13-18岁共25例,占29.06%。提示7-12岁是CAH发病率较高的年龄段。
(3)86例的腺样体肥大情况统计出以Ⅲ度肥大占的百分比较高为44.73%,其次为Ⅳ度肥大23.68%。说明临床上以Ⅲ度、Ⅳ度腺样体肥大最为常见,共占68.42%。
(4)86例CAH的临床症状进行统计分析,打鼾达81.39%；张口呼吸达76.74%；鼻塞达72.09%,显示出打鼾、张口呼吸、鼻塞是临床上最为常见的3大主要症状。
(5)86例CAH患儿在临床症状改善比较：鼻塞、打鼾、张口呼吸症状方面,鼻塞在治疗1个月后P值两组均<0.001。打鼾及张口呼吸治疗3个月后,治疗组与对照组比较P<0.05,有明显差异,提示治疗组比对照组治疗3个月后疗效显著。
(6)腺样体体积疗效比较,两组经治疗后体积积分比较具有显著性差异P<0.05,说明治疗组疗效优于对照组。
(7)生活质量评估(OSA-18),经治疗后两组比较P<0.001,差异显著,说明治疗组疗效比对照组好。
Children with adenoid hypertrophy (CAH) is a common disease in pediatrics. Recurrence of the disease on a long-term basis will easily affect children's growth and development, intellectual development, and may even induce the occurrence of early pathological change of the cardiovascular system. It will concurrently lead to many complications, such as secretory otitis media, chronic nasosinusitis, nasitis, etc. And it may also affect the appearance clinically, resulting in "adenoid face".
The thesis will be divided into three parts, namely literature review, clinical experience summary of Professor Xu Rongqian in the treatment of CAH and clinical research of Qingxianfang in the treatment of CAH. In the first part of literature review, it introduces the name of the disease attributed by TCM, etiology and pathogenesis and progress of treatment. Secondly, summary and exploration have also been carried out on the progress of modern medical research on CAH, including immunoregulation, allergic reaction, clinical treatment, etc. Since the complications of CAH are complex, the analysis has also been made to the relationship between CAH and systemic disease to have a general understanding of CAH.
The thesis will conclude the clinical experience of Professor Xu Rongqian in the treatment of CAH in the part of clinic research. Moreover, it carries out clinic research in terms of the cur at ive effect of Professor Xu Rongqian's treatment of Qingxianfang, and explores studies about86cases of children with CAH, including data col lect ion, statistics, result analysis and discussion, etc. The thesis also investigates in-depth the clinical recognization and progress of research of TCM to CAH so as to lay a sound clinical foundation for the development of TCM and new drugs of TCM in the future.
1. Literature Review
After conclusion and retrieval of huge amount of literature and data, the thesis clarifies the name of the disease attributed by TCM, etiology and pathogenesis, TCM treatment, and the rules of treatment according to syndrome differentiation. In addition, it carries out in-depth exploration in terms of the clinical research of modern medicine, including the progress of Imnunological study, the research on etiology, the evaluation of airway obstruction, the latest progress of clinical diagnosis and western medicine therapy.
2. Conclusion of Clinical Experience of Professor Xu Rongqian in the treatment of CAH
Objective:
To summarize the clinic experience of Professor Xu Rongqian in the treatment of CAH
Method:
To explore and find out the etiology and pathogenesis of TCM, clinical ideas, therapeutic principles and to summarize the clinical experience of three-stage theory in the treatment of CAH.
Results:
(1) The basic pathogenesis of CAH is "pathogenic heat lingering, stagnation of the circulation of vital energy, blood stasis, stubborn phlegm"; the basic principle of treatment is "heat removal, regulating the f low of vi tal energy and remove obstruct ion toit, blood stasis removal, phlegm removal, stasis removal".
(2) The initiation of the three-stage treatment:Professor Xu Rongqian puts forward the notion that CAH is heat stagnation syndrome in the early stage, the treatment of which should be mainly focus on dispelling wind and heat and reducing phlegm and resolving masses; it turns into syndrome of intermingled phlegm and blood stasis in the middle stage, the treatment of which should be focus on activating blood and eliminating stasis and reducing phlegm and resolving masses, using Qingxianf ang to achieve the appropr iate curat ive effect. In the late stage, it turns into syndrome of yin deficiency of lung and kidney, the treatment of which should be focus on nourishing the lung and replenishing vital essence and tonifying the Bone marrow, using Liuweidihuang pills to achieve the appropriate curative effect.
3. Clinical Research of Qingxianfang in the Treatment of CAH
Objective:
To observe the clinical therapeutic effect of Qingxianfang in the treatment of CAH
Method:
86cases of children with syndrome of intermingled phlegm and blood stasis who meet the criteria requirement are brought into the research, including44cases in treatment group and42cases in the control group. They are treated respectively with Qingxianfang and fushuliang nasal spray for3courses. Observation and analysis should be made in terms of
the gender and age of children, courses of disease and clinical symptoms, etc. Then conclusions will be made to the clinical symptoms pre and post treatment, integral of syndrome of TCM, qual i ty of life (OSA-18), and curative effect of adenoid volume, the data resulted from which will be processed by SPSSS16.0statistical software.
Results:
(1) Among86cases of syndrome of intermingled phlegm and blood stasis patients, male patients are67cases (77.91%) and female patients are19cases (22.09%), which demonstrates that males are of higher percentage to catch the disease than females.
(2) The patients aged from seven years old to twelve years old account for61cases, taking up70.93%whi le the patients aged from thirteen years old to eighteen years old account for25cases, taking up29.06%, which demonstrates children aged group from seven to twelve years old are of high percentage to catch the disease.
(3) The statistics of the adenoid hypertrophy situation among86cases show that hypertrophy of the third degree reaches a relatively high percentage of44.73%, followed by the fifth degree of23.68%. It demonstrates that the hypertrophies of the third and fifth degree are the most common types clinically, accounting for68.42%.
(4) The statistical analysis of clinical symptoms among86cases shows that snoring reaches81.39%, buccal respiration reaches76.74%and nasal obstruction reaches72.09%. It demonstrates that snoring, buccal
(5) The Improve of clinical symptoms among86cases respiration and nasal obstruction are the three major symptoms clinically. After treatment for1month,P values of two groups are both<0.001for nasal obstruction, with obvious curative effect clinically for two groups. After treatment for3months,P value are<0.05, comparing treatment group with control group, with obvious difference, which demonstrates that the treatment group has more obvious curative effect than the control group after treatment for3months.
(6) In the aspect of the adenoid volume in clinical efficacy, there is obvious different between the two groups after treatment in terms of the volume integral with P<0.05. It demonstrates that the treatment group has better curative effect than the control group.
(7) The evaluation of quality of life (OSA-18). The comparison of the two groups after treatment,P values are<0.001, with obvious difference. It demonstrations that the treatment group has better curative effect than the control group.
引文
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