五虎汤合清金降火汤加减治疗小儿社区获得性肺炎痰热闭肺证及其机制

王艳; 郑义雪; 霍开明; 翁海美

doi:10.13422/j.cnki.syfjx.20200433

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五虎汤合清金降火汤加减治疗小儿社区获得性肺炎痰热闭肺证及其机制

临床 | 更新时间：2020-09-09

- 五虎汤合清金降火汤加减治疗小儿社区获得性肺炎痰热闭肺证及其机制
- Clinical Effect of Addition and Subtraction Therapy of Wuhutang Combined with Qingjin Jianghuotang to Community Acquired Pneumonia in Children with Syndrome of Phlegm Heat Closing Lung
- 中国实验方剂学杂志 2020年26卷第14期页码：123-128
- 作者机构：
  
  1.三亚市中医院，海南三亚 572000
  2.海南医学院第二附属医院，海口 570216
  3.海南省人民医院，海口 570311
- 作者简介：
  
  王艳，主治医师，从事儿科呼吸系统的临床工作，E-mail：447059094@qq.com
  霍开明，博士，主任医师，从事儿科疾病的诊治工作，E-mail：haikou2016@139.com
- 基金信息：
  
  海南省卫生计生行业科研项目(13A210284)
- DOI：10.13422/j.cnki.syfjx.20200433
  中图分类号： R24;R56;R563;R563.1
- 网络出版日期：2020-01-17，
  
  纸质出版日期：2020-07-20
- 稿件说明：
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王艳,郑义雪,霍开明等.五虎汤合清金降火汤加减治疗小儿社区获得性肺炎痰热闭肺证及其机制[J].中国实验方剂学杂志,2020,26(14):123-128.

WANG Yan,ZHEN Yi-xue,HUO Kai-ming,et al.Clinical Effect of Addition and Subtraction Therapy of Wuhutang Combined with Qingjin Jianghuotang to Community Acquired Pneumonia in Children with Syndrome of Phlegm Heat Closing Lung[J].Chinese Journal of Experimental Traditional Medical Formulae,2020,26(14):123-128.
王艳,郑义雪,霍开明等.五虎汤合清金降火汤加减治疗小儿社区获得性肺炎痰热闭肺证及其机制[J].中国实验方剂学杂志,2020,26(14):123-128. DOI： 10.13422/j.cnki.syfjx.20200433.

WANG Yan,ZHEN Yi-xue,HUO Kai-ming,et al.Clinical Effect of Addition and Subtraction Therapy of Wuhutang Combined with Qingjin Jianghuotang to Community Acquired Pneumonia in Children with Syndrome of Phlegm Heat Closing Lung[J].Chinese Journal of Experimental Traditional Medical Formulae,2020,26(14):123-128. DOI： 10.13422/j.cnki.syfjx.20200433.

摘要

目的

观察五虎汤合清金降火汤加减治疗小儿社区获得性肺炎（CAP）痰热闭肺证的临床疗效及对炎症因子的影响。

方法

将140例CAP患儿随机按数字表法分为对照组69例和观察组71例。两组患儿给予抗感染、退热、祛痰、平喘及呼吸支持等治疗。对照组口服羚羊清肺颗粒，1 g/次，3次/d；观察组内服五虎汤合清金降火汤加减，1剂/d。两组疗程均为连续治疗7 d。监测体温，记录退热起效时间和完全退热时间和治疗后7 d的完全退热率；记录咳嗽、咯痰缓解时间及消失时间，记录肺部湿啰音消失时间；记录治疗失败情况；进行治疗前后痰热闭肺证评分；检测治疗前后血清超敏C反应蛋白（hs-CRP），降钙素原(PCT)，肿瘤坏死因子-

(TNF-

)和白细胞介素-6(IL-6)水平。

结果

采用秩和检验分析两组患儿的临床疾病疗效，观察组优于对照组（

＝2.106，

0.05）；采用秩和检验分析两组患儿中医证候疗效，观察组优于对照组（

＝2.119，

0.05）；观察组患儿的退热起效和完全退热时间均短于对照组（

0.01）；观察组患儿咳嗽、咯痰缓解时间及消失时间和肺部湿啰音消失时间均短于对照组（

0.01）；观察组治疗后7 d的完全退热率96.92%（63/65），高于对照组的82.81%（53/64）（

=7.085，

0.01）；观察组患儿治疗失败率为9.23%（6/65），低于对照组的23.44%（15/64）（

=4.775，

0.05）；观察组痰热闭肺证各主要症状、体征评分、次要症状评分和总积分均低于对照组（

0.01）；观察组hs-CRP，PCT，TNF-

和IL-6水平均明显低于对照组（

0.01）。

结论

在常规抗感染等综合治疗的基础上，给予五虎汤合清金降火汤加减内服治疗CAP（痰热闭肺证）患儿，可进一步控制临床症状，具有起效快、症状消退快、病程短的优点，并可减轻炎症反应，控制疾病进展，完全退热率，提高临床疾病疗效和中医证候的疗效。

Abstract

Objective

To discuss clinical effect of addition and subtraction therapy of Wuhutang combined with Qingjin Jianghuotang to community acquired pneumonia (CAP) in children with syndrome of phlegm heat closing lung

and to study the influence to inflammatory factors.

Method

One hundred and forty patients were randomly divided into control group (69 cases) and observation group (71 cases) by random number table. Patients in two group of chidren got comprehensive symptomatic treatment measures of anti-infection

antipyretic

expectorant

antiasthmatic and respiratory support of inflammatory factors. The control group was treated with Lingyang Qingfei granules.1 g/time

3 time/day. Patients in observation group added addition and subtraction therapy of Wuhutang combined with Qingjin Jianghuotang

1 dose/day. The courses of treatment in two groups were 7 days. And temperature

time of antipyretic

time of complete antipyretic and rate of complete antipyretic at the 7

day after treatment were recorded. And release time and disappearance time of cough

expectoration

disappearance time of pulmonary rales and treatment failure were also recorded. And before and after treatment

scores of syndrome of phlegm heat closing lung were graded

and levels of serum high sensitive C-reactive protein (hs-CRP)

procalcitonin (PCT)

tumor necrosis factor-

(TNF-

) and interleukin-6 (IL-6) were detected.

Result

Analyzed by rank sum test

effect in observation group was better than that in control group (

=2.106

0.05)

and curative effect of traditional Chinese medicine (TCM) syndrome was also better than that in control group (

=2.119

0.05). Time of antipyretic

time of complete antipyretic

release time and disappearance time of cough and expectoration and disappearance time of pulmonary rales were all shorter than those in control group (

0.01). Rate of complete antipyretic at the 7

day after treatment in observation group was 96.92%（63/65） higher than 82.81%（53/64） in control group (

=7.085

0.05). Failure rate of treatment was 9.23%（6/65） lower than 23.44%（15/64） in control group (

=4.775

0.05). And major symptom

physical sign score

minor symptom score

the total score of syndrome of phlegm heat closing lung and levels of hs-CRP

PCT

TNF-

and IL-6 were all lower than those in control group (

0.01).

Conclusion

On the basis of comprehensive anti-infection treatment

addition and subtraction therapy of Wuhutang combined with Qingjin Jianghuotang can control the clinical symptoms

and the advantages of rapid onset

rapid symptom regression

short course of disease can be found

and it can also reduce the inflammatory reaction

control the progress of the disease. The complete antipyretic rate

disease efficacy and TCM syndrome efficacy are better.

关键词

Keywords

references

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