世界中医药

目的：探讨刺络联合舒利迭吸入疗法治疗小儿哮喘的临床疗效，并观察其用药前后的代谢组学变化。方法：选取2013年10月至2015年9月上海市宝山区中西医结合医院收治的哮喘患儿50例作为研究对象，按照随机数字表法随机分为对照组和观察组，每组25例。对照组采用沙美特罗替卡松粉吸入剂治疗，观察组在对照组治疗的基础上针刺四缝和少商穴位以及耳尖放血，间隔1 d进行1次，周期90 d。采集患儿用药前0 d，用药30 d，用药60 d，用药90 d的尿液，采用气相色谱-质谱联用技术（GC-MS）检测尿液内源性代谢物，观察治疗前后2组患儿临床症状评分、免疫指标以及代谢谱的变化情况。结果：观察组总有效率高于对照组，2组比较差异有统计学意义(P<0.05)；与治疗前比较，2组患儿各项中医症候均明显减轻,观察组改善程度比对照组更为显著，差异有统计学意义，2组免疫学指标与治疗前比较均显著降低(P<0.05)，与对照组比较（90 d），观察组（90 d）各指标降低程度更为明显，差异均有统计学意义(P<0.05)。采用有监督的分析-OPLS分析了治疗前对照组和观察组（0 d），治疗后（90 d）对照组和观察组的尿液代谢谱，结果显示4组代谢谱分离良好，鉴定了21个相关代谢标志物。结论：刺络联合舒利迭吸入疗法治疗小儿哮喘的临床效果确切，可改善患儿症状，降低免疫指标，其作用机制可能与丙氨酸，天冬氨酸和谷氨酸代谢、乙醛酸和二羧酸代谢和组氨酸代谢等代谢异常有关。

English Summary:

To investigate the clinical efficacy of prevention and treatment of asthma in children with joint therapy of meridian-prick and seretide inhalation therapy,and to study the metabolomic changes before and after drug use. Methods:A total of 50 patients selected in Baoshan District Hospital of Integrated Traditional Chinese Medicine of Shanghai,who met the inclusion criteria were randomly divided into 2 groups according to random number table,with 25 in each group. The control group was inhaled with salmeteroploxapine powder inhaler and the observation group acupunctured four sutures and acupuncture points on Shao Shang and blood on the tip of the ears on the basis of the control group. The blood was bleeded once a day and the period was 90 d. Urine was collected from patients 0 d,30 d,60 d,90 d before medication,and for 90 days for medication. Gas chromatography-mass spectrometry (GC-MS) was used to detect endogenous metabolites in urine,and the clinical symptom scores,immune parameters and metabolic profiles were observed before and after treatment. Results:The total effective rate in the observation group was significantly higher than that in the control group. There was a statistically significant difference between the 2 groups (P<0.05). The TCM symptoms in the observation group and the control group were significantly reduced compared with those before the treatment (P<0.05). The degree of improvement was more significant than that in the control group (P<0.05). The difference was statistically significant. Both groups had significantly lower immunological parameters compared with those before treatment (P<0.05). Compared with the control group（90 d）. The decreased degree of the indexes in the observation group （90 d）was more obvious (P<0.05),and the difference was statistically significant(P<0.05). Additionally,the supervised analysis-OPLS was used to analyze the urine metabolic profiles of the pre-treatment control group and the observation group (0 d),and after the treatment (90 d) in the control group and the observation group. The results showed that the 4 groups were well separated and 21 related metabolic markers were identified. Conclusion:The clinical effects of pricking collateral combined with salizidine inhalation therapy for children with asthma is definite,which can improve the symptoms of children and reduce the immune index. Its mechanism of action may be related to metabolic abnormalities such as alanine,aspartate and glutamate metabolism,glyoxylate and dicarboxylate metabolism and histidine.

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