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1.天津中医药大学 第一附属医院,国家中医针灸临床医学研究中心,天津 300193
2.贵州医科大学 第二附属医院,贵州 凯里 556000
3.吉林大学 第二医院,长春 130041
4.洛阳市第二中医院,河南 洛阳 471003
5.迁安市中医院,河北 唐山 064499
6.大庆市人民医院,黑龙江 大庆 163711
7.黔东南苗族侗族自治州中医医院,贵州 凯里 556000
8.河南中医药大学 第一附属医院,郑州 450099
9.安阳市中医院,河南 安阳 455001
10.内蒙古自治区国际蒙医医院,呼和浩特 010020
11.武汉科技大学 附属天佑医院,武汉 430070
祝新璐,硕士,从事中医儿科学研究,E-mail:1961033216@qq.com
* 胡思源,博士,主任医师,从事儿科疾病的中药临床评价研究,E-mail:husiyuan1963@sina.com
收稿日期:2021-07-02,
网络出版日期:2021-10-19,
纸质出版日期:2021-12-05
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祝新璐,胡思源,钟成梁等.龙牡壮骨颗粒治疗小儿反复呼吸道感染肺脾气虚证多中心随机对照临床观察[J].中国实验方剂学杂志,2021,27(23):111-117.
ZHU Xin-lu,HU Si-yuan,ZHONG Cheng-liang,et al.Multicenter Randomized Controlled Clinical Trial of Longmu Zhuanggu Granule in Treatment of Children Recurrent Respiratory Infection with Lung-Spleen Qi Deficiency Syndrome[J].Chinese Journal of Experimental Traditional Medical Formulae,2021,27(23):111-117.
祝新璐,胡思源,钟成梁等.龙牡壮骨颗粒治疗小儿反复呼吸道感染肺脾气虚证多中心随机对照临床观察[J].中国实验方剂学杂志,2021,27(23):111-117. DOI: 10.13422/j.cnki.syfjx.20212392.
ZHU Xin-lu,HU Si-yuan,ZHONG Cheng-liang,et al.Multicenter Randomized Controlled Clinical Trial of Longmu Zhuanggu Granule in Treatment of Children Recurrent Respiratory Infection with Lung-Spleen Qi Deficiency Syndrome[J].Chinese Journal of Experimental Traditional Medical Formulae,2021,27(23):111-117. DOI: 10.13422/j.cnki.syfjx.20212392.
目的
2
评价龙牡壮骨颗粒治疗小儿反复呼吸道感染(肺脾气虚证)的临床疗效及安全性。
方法
2
本研究采用分层区组随机、双盲双模拟、阳性药(匹多莫德颗粒)平行对照、非劣效性检验、多中心临床研究的方法,计划纳入240例患儿,以1∶1比例分为观察组和对照组。疗程8周,随访12个月。观察指标为疾病痊愈率、呼吸道感染次数、平均病程、中医证候疗效、单项症状疗效、免疫指标疗效及安全性指标。
结果
2
本次试验10家研究中心共入选受试者237例,其中,观察组118例,对照组119例。236例进入全分析集(FAS),210例进入符合方案数据集(PPS),236例进入安全性数据集(SS)。两组基线资料差异均无统计学意义,具有可比性。观察组疾病痊愈率为75.21%(88/117),对照组为73.95%(88/119),两组差值的95%置信区间(CI),FAS为1.26%(-9.85%,12.37%),PPS为3.81%(-6.28%,13.90%),在非劣界值为10%的条件下,治疗终点疾病痊愈率的非劣效检验成立,FAS,PPS分析结论一致。上呼吸道感染、支气管炎、肺炎次数及病程的组间比较,差异均无统计学意义。中医证候等级疗效,治疗4周两组间比较,差异无统计学意义,治疗8周两组间比较,差异有统计学意义(
P
<
0.01)。单项症状消失率,治疗4周,各单项症状消失率(面色少华、形体消瘦、少气懒言、气短、食少、纳呆、多汗、大便稀溏)的组间比较,差异均无统计学意义;治疗8周,仅少气懒言、纳呆、多汗的消失率的组间比较,差异均有统计学意义(
P
<
0.05);免疫指标基线及治疗后8周的组间比较,差异均无统计学意义;除观察组的CD8外(
P
<
0.05),其余免疫指标,治疗前后的自身比较,差异均无统计学意义。两组不良反应发生率的组间比较,差异无统计学意义。
结论
2
龙牡壮骨颗粒治疗小儿反复呼吸道感染(肺脾气虚证)改善疾病痊愈率非劣于匹多莫德颗粒,且药物安全性良好,具有临床推广价值。
Objective
2
To evaluate the clinical efficacy and safety of Longmu Zhuanggu granule for the treatment of children recurrent respiratory infection due to lung-spleen Qi deficiency.
Method
2
This multicenter stratified, block-randomized, double-blind, double-dummy, positive drug (pidotimod granule) parallel controlled, and non-inferiority trail intended to included 240 children patients and divided them into the experimental group (
n
=120) and the control group (
n
=120) at the ratio of 1∶1. Patients in both groups were treated for eight successive weeks and followed up for 12 months. The cure rates, numbers of respiratory infections, average courses of disease, curative effects of traditional Chinese medicine (TCM) syndrome, curative effects of individual symptoms, curative effects of immune indexes, and safety indexes between the two groups were observed and compared.
Result
2
A total of 237 subjects were collected from 10 research centers, including 119 cases in the control group and 118 in the experimental group. There were 236 cases enrolled into the full analysis set (FAS), 210 into the per-protocol set (PPS), and 236 into the safety set (SS). The baseline data of the two groups were not significantly different from each other, indicating that they were comparable. The cure rates of the experimental group and control group were 75.21% (88/117) and 73.95%(88/119), respectively, with the 95% confidence interval (CI) of difference between the two groups being 1.26% (-9.85%,12.37%) for FAS and 3.81% (-6.28%,13.90%) for PPS. The 95% CI fell within the 10% non-inferiority margin, implying that non-infertility test of the cure rate in the treatment of endpoint disease was valid, and the conclusions of FAS and PPS analysis were consistent. There was no significant difference in the number or course of upper respiratory infection, bronchitis, and pneumonia. The difference in curative effects of TCM syndrome between the two groups after four weeks of treatment was not remarkable. After eight weeks of treatment, the total effective rate of the experimental group was 84.62%(99/117), statistically higher than 78.15%(93/119) of the control group(
χ
2
=-3.26,
P
<
0.05). There were no significant differences in the disappearance rates of individual symptoms between the two groups after four weeks of treatment. After eight weeks of treatment, the experimental group and control group exhibited the disappearance rates of 67.50%(54/80) and 47.37%(36/76) for shortness of breath and laziness to speak, 75.00%(54/72) and 53.33%(40/75) for poor appetite, 54.55%(60/110) and 37.84%(42/111) for hyperhidrosis, respectively, with obviously better outcomes observed in the experimental group (
P
<
0.05,
P
<
0.01). The inter-group comparison revealed significant differences in immune indexes after eight weeks of treatment. As demonstrated by comparison with the situations before treatment, IgA, IgG, IgM, and CD4 did not change significantly after treatment. Except for CD8 in the experimental group (
P
<
0.05)
there was no significant difference in other immune indexes before and after treatment There was no significant difference in the incidence of adverse reactions.
Conclusion
2
Longmu Zhuanggu granule is not inferior to pidomod granule in the treatment of children recurrent respiratory infection due to lung-spleen Qi deficiency, and it exhibits good safety, implying its promising clinical application value.
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