CAJ | 학술논문

目的：探讨小儿推拿疗法在小儿支气管哮喘（哮喘）慢性持续期的相应作用机制和临床治疗效果。方法选取2010年1月—2012年12月到河北联合大学附属医院、广州医科大学附属第五医院、江苏省无锡市第三人民医院及黑龙江中医药大学附属医院就诊且符合本研究纳入及排除标准的慢性持续期哮喘患儿160例，以入选病例随机分组方法将其分为治疗组和对照组各80例。对照组采用常规雾化治疗方法，治疗组在常规雾化治疗方法的基础上应用小儿推拿疗法，各治疗3个月。分别记录两组患儿治疗前后的哮喘发作次数、呼吸道感染次数、儿童哮喘控制测试（C _ ACT）评分及最大呼气流量（PEF）；取两组患儿治疗前后的外周静脉血，记录巨噬细胞 Toll 样受体（Toll _ like receptors，TLR）中 TLR1、TLR2和 TLR4的表达强度。结果治疗后，治疗组患儿的哮喘发作次数和呼吸道感染次数低于对照组患儿，C _ ACT 评分和 PEF%（PEF%= PEF 实测值/ PEF 预计值×100%）高于对照组患儿，差异有统计学意义（p <0.05）；治疗后，两组患儿的临床疗效比较，差异有统计学意义（p <0.05）；治疗后，治疗组患儿外周静脉血巨噬细胞 TLR1、TLR2和 TLR4的表达荧光强度高于对照组，差异有统计学意义（p <0.05）。结论小儿推拿疗法在小儿哮喘慢性持续期有一定的临床治疗效果，其可能是通过上调巨噬细胞 TLR1、TLR2和 TLR4的表达水平来改善小儿哮喘的临床症状。
목적：탐토소인추나요법재소인지기관효천（효천）만성지속기적상응작용궤제화림상치료효과。방법선취2010년1월—2012년12월도하북연합대학부속의원、엄주의과대학부속제오의원、강소성무석시제삼인민의원급흑룡강중의약대학부속의원취진차부합본연구납입급배제표준적만성지속기효천환인160례，이입선병례수궤분조방법장기분위치료조화대조조각80례。대조조채용상규무화치료방법，치료조재상규무화치료방법적기출상응용소인추나요법，각치료3개월。분별기록량조환인치료전후적효천발작차수、호흡도감염차수、인동효천공제측시（C _ ACT）평분급최대호기류량（PEF）；취량조환인치료전후적외주정맥혈，기록거서세포 Toll 양수체（Toll _ like receptors，TLR）중 TLR1、TLR2화 TLR4적표체강도。결과치료후，치료조환인적효천발작차수화호흡도감염차수저우대조조환인，C _ ACT 평분화 PEF%（PEF%= PEF 실측치/ PEF 예계치×100%）고우대조조환인，차이유통계학의의（p <0.05）；치료후，량조환인적림상료효비교，차이유통계학의의（p <0.05）；치료후，치료조환인외주정맥혈거서세포 TLR1、TLR2화 TLR4적표체형광강도고우대조조，차이유통계학의의（p <0.05）。결론소인추나요법재소인효천만성지속기유일정적림상치료효과，기가능시통과상조거서세포 TLR1、TLR2화 TLR4적표체수평래개선소인효천적림상증상。
[AbstraCt] ObjeCtive To investigate the therapeutic effect and mechanism of massage on Pediatric asthma during chronic duration. Methods From January,2010 to December,2012,160 asthmatic children according to the diagnostic criteria were recruited from the Affiliated Hospital,Hebei Associated University and the First Affiliated Hospital,Guangzhou Medical University and the Third Peopleˊs Hospital,Wuxi,Jiangsu province and the Affiliated Hospital,Chinese Medicine University of Heilongjiang and were randomly divided into the control group who were treated by conventional atomization and the treatment group who were treated by traditional techniques of pediatric massage and conventional atomization,both for 3 months. Time of attack of asthma,the incidence of respiratory infection,C _ ACT score and maximal expiratory flow(PEF)were recorded both before and after treatment;peripheral venous blood samples were collected to detect the expression intensity of TLR1,TLR2 and TLR4 in Toll _ like receptors,TLR. Results After treatment,compared with those in control group,time of attack of asthma and the incidence of respiratory infection in trial group were lower while C _ ACT score and PEF% were higher,with significant differences(p < 0. 05);the therapeutic efficacy between the two groups was statistically significant( p < 0. 05);the ANG expression levels(ANG fluorescence intensity)of TLR1,TLR2 and TLR4 in macrophagocyte were stronger in trial group than those in control group,with significance( p < 0. 05). ConClusion Massage has a certain clinical effectiveness on pediatric asthma during chronic duration. It may improve the clinical symptoms by up _ regulating the expression level of TLR1,TLR2 and TLR4 in macrophagocyte.