| Objective:1.to observe the clinical effect of xuanfeiqingluo decoction on children with spasmodic cough of MPP syndrome of phlegm-heat blocking lung2.To explore the therapeutic mechanism of xuanfeiqingluo decoction in treating spasmodic cough of MPP syndrome of phlegm-heat and lung-blocking.Content:Part I: meta analysis of the treatment of children MPP syndrome of phlegm-heat blocking lung with traditional Chinese medicine auxiliary Azithromycin : This study searched the literature databases of cnki and Pub Med from the date of establishment to October 2020.The study subjects were children with MPP syndrome of phlegm-heat blocking the lung.The intervention measures in the test group were Chinese medicine(Chinese medicine extract,Chinese patent medicine,compound)+ Azithromycin + basic treatment,and in the control group were Azithromycin + basic treatment.The outcome measures were effective rate,fever symptom score,cough symptom score,antitussive time,antipyretic time,incidence of adverse reactions and the levels of CRP,ESR,D-dimer,ifn-γ,tnf-α.To be included in the Randomized controlled trial.According to the retrieval strategy,two independent researchers screened the literature.Note Express was used to extract the titles and to screen out the duplicate literature.According to the title,abstract,screening research types,objects,intervention methods and other non-relevant literature.Read the full article to further filter out.The methodological quality of the included studies was evaluated according to the Cochrane Collaboration.Methods of intervention,outcome measures and other relevant data were extracted and incorporated into the study.The data were analyzed with the software revman 5.3.Q statistics and I2 statistics are used in the statistical test of heterogeneity.Part II: the clinical effect and mechanism of xuanfeiqingluo decoction in treating spasmodic cough of children with MPP syndrome of phlegm-heat blocking lung:A total of 34 cases of children with spasmodic cough in the outpatient and emergency department of the Second Affiliated Hospital of the Tianjin University of Traditional Chinese Medicine were collected.The children were randomly divided into two groups: Chinese Medicine Group and Western medicine group,on the basis of Azithromycin treatment,the traditional Chinese medicine group was given Xuanfeiqingluo granule,and the Western medicine group was given Ambroxol oral liquid for 1 week.To observe the curative effect and TCM syndrome score of the two groups,and to explore the possible mechanism through the changes of serum ifn-γ,IL-4,Il-10 and urine LTE4.SPSS25.0 was used for statistical analysis.Results:1.The first part of the Meta analysis results: a total of 23 articles were included in the Meta analysis,published in Chinese between 2009 and 2020.A total of 1,649 children were enrolled in the study,825 children in the trial group and 824 children in the control group.The results of the Meta analysis were as follows: 1.The Meta analysis showed that the combined treatment of TCM was superior to single Azithromycin treatment [ p < 0.00001,OR = 4.56,95% CL(3.05,6.83)],combined Results: the test group was better able to shorten the time of fever [ MD =-0.99,95% CL(-1.07,-0.90),(p < 0.00001)],[ SMD =-1.09,95% CL(-1.23,-0.94),(p < 0.00001)];the integral changes of fever syndrome were reported in 8studies,the results showed that the fever score in the test group was significantly lower than that in the control group [ SMD =-2.09,95% CL(-3.12,-1.06),(p < 0.0001)],compared with the control group,the test group could effectively reduce the cough score [ MD =-0.90,95%CL(-1.03,-0.77),(p < 0.00001)],the results showed that MD =-5.18,95% CL(-7.83,-2.53),(p = 0.0001),and MD =-5.18,95% CL(-7.83,-2.53),ESR was analyzed in three studies.The results showed that ESR levels in the test group were significantly lower than those in the control group [ MD =-6.66,95% CL(-11.83,-1.50),(p = 0.01)].Two studies described IFN-γ levels in 180 patients.The results showed that there was no significant difference between the two groups,[ MD = 11.32,95% CL(-15.38,38.01),(p = 0.28)].Two studies described the level of tnf-α in 212 patients.The results showed that there was no significant difference between the two groups [ MD =-7.77,95% CL(-18.80,3.27),(p = 0.17)].A total of eight studies reported clinical adverse events with mild heterogeneity(i2 = 44%),indicating that compared with Azithromycin,the adverse reaction rate of MPP in children with phlegm-heat syndrome can be effectively reduced by the combined treatment of TCM[ RD =-0.08,95% CL(-0.14,-0.03),(p < 0.001)].2.The second part of the clinical research results: 1 after treatment,compared with before treatment,the TCM syndrome scores of cough(total cough score(p < 0.001),daytime cough score(p < 0.01),nocturnal cough score(p < 0.01),expectoration(p < 0.01),spirit(p< 0.05),sleep(p < 0.01),diet(p < 0.05),defecation(p < 0.05)and tongue coating(p < 0.01)were significantly decreased,the differences were statistically significant.2 after treatment,compared with before treatment,in the Western medicine group,the symptom scores of cough(total cough score p < 0.001,daytime cough score p < 0.01,nocturnal cough score p <0.001),expectoration(p < 0.001),spirit(p < 0.05),sleep(p < 0.01)and diet(p < 0.05)were significantly decreased,the differences were statistically significant.There was no significant difference in the integral scores of TCM syndromes between er-defecation and tongue coating(p > 0.05).3 after treatment,there was no significant difference in the TCM syndrome scores of cough,expectoration,spirit,sleep,diet,defecation and tongue coating between the two groups(P > 0.05).4 the expression levels of IL-4,IL-10,IFN-γ and LET-4 were compared between the two groups after treatment and before treatment,the difference was statistically significant(p < 0.05),there was no significant difference between the two groups(P > 0.05)Conclusion:1.Meta analysis showed that the treatment of children MPP with phlegm-heat syndrome assisted by Azithromycin can improve clinical efficiency,shorten the time of fever and cough,and reduce the incidence of adverse reactions.2.Xuanfei qingluo decoction can improve the score of TCM syndrome of children with spasmodic cough of MPP syndrome of phlegm-heat blocking lung.3.The curative effect of Xuanfei Qingluo decoction is similar to that of Western medicine ambroxol in treating spasticity and cough of children with MPP syndrome of phlegm-heat blocking lung.The possible mechanism is to adjust the balance between Th1 and Th2 by decreasing the level of serum inflammatory factors and proinflammatory mediators. |
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