【摘要】：目的： 泄瀉是小兒常見病,其中脾虛瀉多病程較長(zhǎng),癥狀遷延反復(fù),伴有腹脹、納差、神疲倦怠、形體消瘦等證候,對(duì)小兒生長(zhǎng)發(fā)育影響較大,給患兒及家長(zhǎng)帶來(lái)生理、心理及經(jīng)濟(jì)上多重負(fù)擔(dān)。導(dǎo)師所在課題組總結(jié)多年臨床經(jīng)驗(yàn),認(rèn)為“脾虛濕勝”是小兒泄瀉主要病機(jī),以“運(yùn)脾化濕”為治法治療小兒泄瀉均取得良好效果。本課題以運(yùn)脾化濕方加味治療小兒脾虛瀉,通過(guò)觀察臨床療效及治療前、后患兒血清IgA、IgG、IgM、糞便SIgA含量的變化,從體液免疫學(xué)角度探討運(yùn)脾化濕方加味治療小兒脾虛瀉的作用機(jī)制。 方法： 1.收集20例健康嬰幼兒進(jìn)行血清IgA、IgG、IgM及糞便SIgA含量檢測(cè) 2.采用簡(jiǎn)單隨機(jī)對(duì)照試驗(yàn)法,將符合診斷標(biāo)準(zhǔn)的60例患兒分為觀察組及對(duì)照組。觀察組給予運(yùn)脾化濕方加味；對(duì)照組予思密達(dá),兩組均根據(jù)病情給予必要的對(duì)癥處理和液體療法,療程5天。 3.對(duì)60例患兒進(jìn)行臨床療效觀察,并觀察治療前、后血清IgA、IgG、IgM及糞便SIgA含量的變化。 結(jié)果： 1.脾虛瀉患兒較健康對(duì)照組的血清IgM、IgA及糞便SIgA降低(P0.05),而血清IgG無(wú)變化(P0.05)。 2.觀察組治療后血清IgM、IgA及糞便SIgA增加(P0.05),血清IgG無(wú)變化(P0.05)。其中SIgA恢復(fù)至健康對(duì)照組水平,IgM, IgA則仍低于健康對(duì)照組(P0.05) 3.對(duì)照組治療后糞便SIgA下降(P0.05)；血清IgG、IgA、IgM無(wú)變化(P0.05) 4.觀察組總有效率為83.33%,優(yōu)于對(duì)照組的56.67%(P0.05)；治療后證候總積分低于對(duì)照組(P0.05),尤其在改善大便次數(shù)、腹脹、食欲下降的3個(gè)證候上優(yōu)于對(duì)照組,且無(wú)不良反應(yīng)。 結(jié)論： 運(yùn)脾化濕方加味對(duì)小兒脾虛瀉有良好療效,能明顯改善癥狀,如大便次數(shù)、腹脹、食欲下降,且作用安全。脾虛瀉患兒體液免疫功能降低,表現(xiàn)在血清IgA、IgM及糞便SIgA含量的下降。運(yùn)脾化濕方加味治療本病可能是通過(guò)提高患兒體液免疫功能而發(fā)揮療效。
[Abstract]:Objective: diarrhea is a common disease in children, in which spleen deficiency and diarrhea have a long course of disease, symptoms have been delayed and repeated, accompanied by abdominal distension, anorexia, fatigue, body wasting and other syndromes, which have great influence on the growth and development of children, and bring physiology to the children and their parents. Psychological and economic burdens. The teacher's group summarized the clinical experience for many years and concluded that "spleen deficiency and dampness victory" was the main pathogenesis of infantile diarrhea and the treatment of infantile diarrhea by "transferring spleen and removing dampness" had achieved good results. In this study, we treated children with spleen asthenia and diarrhea with modified decoction to transfer spleen and remove dampness. The changes of serum IgA,IgG,IgM, fecal SIgA content before and after treatment were observed. From the aspect of humoral immunology, the mechanism of treating diarrhea due to spleen deficiency in children was discussed. Methods: 1. The contents of serum IgA,IgG,IgM and fecal SIgA were detected in 20 healthy infants. 60 children who met the diagnostic criteria were divided into observation group and control group by a simple randomized controlled trial. The observation group was treated with modified decoction for removing spleen and dampness, the control group was treated with smecta, the two groups were given necessary symptomatic treatment and liquid therapy according to the condition of the disease, the course of treatment was 5 days. 3. The changes of serum IgA,IgG,IgM and fecal SIgA levels before and after treatment were observed in 60 children. Results: 1. Compared with the healthy control group, the serum IgM,IgA and fecal SIgA decreased in the children with spleen deficiency diarrhea (P0.05), but the serum IgG did not change (P0.05). 2. Serum IgM,IgA and stool SIgA increased after treatment in the observation group (P0.05), while serum IgG did not change (P0.05). SIgA returned to the level of healthy control group, IgM, IgA is still lower than the healthy control group (P0.05) 3. In the control group, the fecal SIgA decreased (P0.05), while the serum IgG,IgA,IgM did not change (P0.05). The total effective rate of the observation group was 83.33%, which was better than that of the control group (56.67%) (P0.05). After treatment the total score of syndromes was lower than that of control group (P0.05) especially in improving the number of stool abdominal distension appetite loss than the control group on the three syndromes and no adverse reactions. Conclusion: the modified decoction can improve the symptoms such as defecation times, abdominal distension, appetite decline, and the effect is safe. The decrease of humoral immune function in children with spleen deficiency and diarrhea was manifested by the decrease of serum IgA,IgM and fecal SIgA content. The treatment of this disease may be by improving the humoral immune function of the children.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R272

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