Discussion On Clinical Efficacy Of Traditional Chinese Medicine Treatment By Stages In Children With Cough Variant Asthma Based On Th1/Th2 Imbalance Mechanism

Objective:To observe the clinical efficacy of Traditional Chinese Medicine(TCM)treatment by stages in children with cough variant asthma(CVA)and changes in serum levels of TSLP,IL-4,IL-5,EL-13,IL-33 and IgE before and after treatment,in order to explore the association between the onset of CVA and Thl/Th2 immune imbalance,clarify the mechanism of TCM treatment of CVA in stages and provide new ideas for the clinical treatment of CVA in children..Methods:1.Literature review of domestic and overseas published randomized control trials(RCTs)of Chinese medicine for treating children with CVA.Document screening,scoring and effective data extraction,systematic evaluation methods were used to meta analyse clinical efficacy,incidence of adverse reactions,recurrence rate and serum IgE levels.2.Sixty cases of children with CVA participated from outpatient clinics of Fujian University of Traditional Chinese Medicine Affiliated People' s Hospital and Perth Chinese Medical College Australia from 1st March 2016 to 30th February 2018.The patient cohort were randomly divided into TCM treatment group(Group A)and TCM-Western Medicine treatment group(Group B)in equal numbers.Additionally 30 healthy children were selected from the Physical Examination Centre of Fujian University of Traditional Chinese Medicine Affiliated People's Hospital as control group for comparison(Group C).The groups were treated by TCM in stages with comparison of the group being treated with salididine powder.After eight weeks of treatment,changes of serum TSLP,IL-4,IL-5,IL-13,IL-33 and IgE levels in group A and B were observed and also differences in cough scores,visual analogue scores and syndrome scores to assess the total clinical effectiveness.Results:1.31 RCTs were included in this systematic review with a total of 2191 patients.The results of the methodological quality evaluation show that all literature in the RCT were of medium and high quality.However,most of the studies did not explicitly described their process of patient blind and random allocation.The results of the meta-analysis show that TCM treatment of children with CVA was superior to Western Medicine alone/TCM and Western Medicine in overall clinical efficacy,relapse rate,incidence of adverse reactions and reduction in serum IgE levels(P<0.05).However,there was significant statistical heterogeneity in the comparison of clinical total efficacy,incidence of adverse reactions and serum IgE levels between the study groups.There is publication bias in the comparison of total clinical efficiency.The results of the sensitivity analysis show that the overall stability of the results of this system evaluation is good.2.Before treatment,serum levels of TSLP,IL-4,IL-5,IL-13,IL-33 and IgE in group A and group B were significantly higher than those in group C(P<0.05).There is not much difference in the related serum levels between group A and group B.There was no significant difference in visual analog scores,cough scores,and scores of syndromes of TCM between group A and group B(all P>0.05).After treatment,the concentrations of serum TSLP,IL-4,IL-5?IL-13,IL-33 and IgE were significantly lower than that of serum before treatment in group A and group B.No significant difference exists when comparing group A and group B.(P>0.05);Visual analog scale scores,cough scores,and main syndrome scores of TCM in group A and group B were significantly lower than those before treatment(P<0.05).There was no significant difference between group A and B(P>0.05).The results of efficacy evaluation showed that in group A,7 cases were clinically controlled,15 cases were markedly effective,5 cases were effective,3 cases were ineffective,and the total effective rate was 90.0.%;In group B,8 cases were clinically controlled,17 cases were markedly effective,3 cases were effective and 2 cases were ineffective.The total effective rate was 93.33%.There was no significant difference between the two groups in total effective rate(P>0.05).Conclusions:1.Comparing TCM treatment of children with CVA and Western Medicine or combined TCM and Western Medicine treatment,TCM have obvious advantages in clinical efficacy and safety.However,due to the limitations of the sample size and methodological quality of the studies included,this conclusion still requires more rigorous design and reliable methods for prospective,multicenter,large sample randomized double-blind controlled trials to verify.2.After 8 weeks of TCM treatment of children with CVA,Chinese Medicine can significantly improve the symptoms of cough with significant clinical effects.TCM treatment by stages embodies the key of TCM syndrome differentiation and treatment,and provides new ideas for the clinical treatment of CVA in children.3.TSLP,IL-4,IL-5,IL-13,IL-33 and IgE are associated with the onset of CVA.After eight weeks of TCM treatment,children have significantly lower serum TSLP,IL-4,IL-5,IL-13,IL-33 and IgE concentrations.It is suggested that TCM staging treatment may reduce the airway inflammatory response,relieve cough symptoms and improve the clinical efficacy of CVA by correcting the Thl/Th2 immune imbalance.4.The levels of serum TSLP,IL-4,IL-5,IL-13 and IL-33 changed significantly in the early stage of the onset of CVA and after the treatment of CVA.Therefore,it can be used as a follow-up target for CVA treatment,and it can also provide a good evaluation basis for the prognosis of CVA.