| Objective:A real-world study was conducted to investigate the clinical efficacy and safety of cupping intervention in children with pneumonia and cough(wind-heat closed lung syndrome)using a retrospective cohort-matched study.Methods:A retrospective cohort study was conducted in which the exposure factor was cupping therapy,and the groups were divided into non-exposed and exposed groups according to the exposure factor,and matched by 1:1 propensity score according to the stratification by antibiotic type factor,with conventional treatment(herbal soup combined with antibiotics)in the non-exposed group and cupping therapy combined with conventional treatment in the exposed group.The main symptoms and signs scores,lung radiographs,and laboratory tests were collected before and after treatment in the two groups of children with pneumonia and wheezing to explore the differences in cure rate,hospitalization days,time to onset of effect,time to disappearance of main symptoms(fever,cough,sputum congestion)and signs(pulmonary rales),and the disappearance rate of each symptom after 3 and 5 days of treatment,respectively,between the overall children and children stratified by antibiotic type factor.There was no difference in the effectiveness rate after 3 and 5 days of treatment.Results:1.A total of 1209 children with pneumonia and wheezing(wind-heat closed lung evidence)hospitalized in the pediatric ward of the First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine from October 2019 to December 2021 were collected.They were divided into non-exposed group(706 cases)and exposed group(503 cases)according to exposure factors.After 1:1 propensity score matching according to the stratification by antibiotic type factor,there were 423 cases in each of the two groups.There were 163 cases of children with herbal soup combined with azithromycin,102 cases of children with herbal soup combined with cephalosporin,and 158 cases of children with herbal soup combined with azithromycin+cephalosporin in the exposed group;163 cases of children with herbal soup combined with azithromycin,102 cases of children with herbal soup combined with cephalosporin,and 158 cases of children with herbal soup combined with azithromycin+cephalosporin in the non-exposed group.2.The collected 1209 cases of children with pneumonia and wheezing were explored in terms of gender,age,disease duration,main symptoms and signs score,lung X-ray,laboratory tests,and severity.Among 1209 children with pneumonia and wheezing,627 were males and 582 were females,with a male-to-female ratio of 1.08:1.0,with more males than females.There were 1076 cases(89.00%)in preschool age(3-7 years),127 cases(10.50%)in school age(after 7 years-13 years),and 6 cases(0.50%)in adolescence(after 13 years-18 years),which showed that the age of onset was predominantly in preschool-age children.Exploration of the course of the disease revealed that the children generally had a febrile course of 3-4 days before admission and a cough course of about 5 days.The pre-treatment main symptom scores were 4-5 for fever and cough,3-4 for sputum,and 2-3 for asthma.The pre-treatment auscultation score was mostly 3-4.Chest radiograph scores were mostly 4-5.Pre-treatment laboratory tests:The proportion of abnormal WBC counts was higher than the normal proportion in both groups,with an overall abnormal WBC count rate of 66.50%.The percentage of normal NE%was higher than the percentage of abnormal in the non-exposed group in both groups,while the percentage of abnormal NE%was higher than the percentage of normal in the exposed group,and the overall abnormal NE%rate was 47.39%.The normal proportion of PCT and CRP was higher than the abnormal proportion in both groups,and the overall abnormal rate of PCT was 29.69%and the overall abnormal rate of CRP was 32.01%.Severity of pneumonia:observation of the severity of pneumonia in children in the two groups before treatment revealed that the proportion of severe disease in children with wind-heat closed lung evidence CAP was lower,and the overall proportion of severe disease was 1.08%.3.Exploration results of children in the exposed and non-exposed groups after matching(1)The baseline comparison between the two groups was conducted for 846 children with pneumonia and wheezing after matching,and it was found that there were no significant differences in gender,age,disease duration,main symptoms and sign scores,lung X-ray,laboratory tests and severity between the two groups,and the differences were all>0.05,which were not statistically significant and comparable.(2)Comparison of efficacy between the two groups of 846 matched children with pneumonia and wheezing(1)Comparing the hospitalization time of children in the two groups,we found that P<0.05,indicating that cupping interventions for children with pneumonia and wheezing can significantly shorten the hospitalization time and shorten the duration of the disease in children.(2)Comparing the time of fever reduction,cough disappearance,sputum disappearance,rales disappearance,onset of action and cure rate of the two groups,we found that P<0.05,indicating that cupping intervention for children with pneumonia and wheezing was effective in reducing fever,cough,sputum,eliminating rales,shortening onset of action and increasing cure rate.(3)Comparison of the disappearance rate and effective rate of symptoms after 3 and 5 days of treatment between the two groups of childrenThe cough disappearance rate and sputum congestion disappearance rate of children in both groups after 3 and 5 days of treatment were found by chi-square test,and P<0.05,indicating that the cough disappearance rate and sputum congestion disappearance rate of the exposed group were significantly higher than those of the non-exposed group after 3 and 5 days of treatment.The rate of disappearance of asthma in both groups after 3 and 5 days of treatment was found by chi-square test to be>0.05,indicating that the rate of disappearance of asthma in the exposed and non-exposed groups was comparable after 3 and 5 days of treatment.In terms of efficiency and fever disappearance rate,the efficiency and fever disappearance rate of children in both groups were found to be lower than 0.05 by chi-square test after 3 days of treatment,indicating that the efficiency and fever disappearance rate of the exposed group were significantly higher than those of the non-exposed group after 3 days of treatment.After 5 days of treatment,the efficiency and fever disappearance rate of children in both groups were found by chi-square test,P>0.05,indicating that the efficiency and fever disappearance rate of the exposed group were comparable to those of the non-exposed group after 5 days of treatment.4.Results of exploring children stratified by antibiotic type factor after matching(1)The baseline comparison between the two groups of children stratified by antibiotic type after matching revealed no significant differences in gender,age,duration of illness,main symptoms and signs,laboratory tests,and severity between the two groups of children with different antibiotic types,and the differences were not statistically significant and comparable.(2)Comparison of efficacy between the two groups of children stratified by antibiotic type factor after matching(1)Comparing the length of hospitalization between the two groups of children stratified by antibiotic type after matching,we found that P<0.05,indicating that the cupping intervention could significantly shorten the length of hospitalization for the children stratified by antibiotic type,and play a positive role in the early recovery of the children.(2)Comparing the cough elimination time,sputum congestion disappearance time,rales disappearance time and onset time between the two groups of children stratified by antibiotic type factor after matching,we found that all P<0.05,indicating that the difference between cupping intervention on children stratified by antibiotic type factor with CAP was statistically significant,and the effect was significant in stopping cough,resolving sputum,eliminating rales and shortening onset time.In terms of time to fever remission,P<0.05 between the two groups of children with Chinese herbal soup combined with azithromycin and Chinese herbal soup combined with azithromycin+cephalosporin,indicating that the fever remission effect was better in the exposed group than in the non-exposed group.In contrast,P>0.05 for the comparison between the two groups of children with herbal tonics combined with cephalosporins,indicating that the antipyretic effect was comparable between the exposed and non-exposed groups.In terms of cure rate,the difference between the two groups of children with Chinese herbal tonics combined with azithromycin was statistically significant at P<0.05,indicating that children in the exposed group had a higher cure rate than those in the non-exposed group.As for the comparison between the two groups of children with Chinese herbal soup combined with cephalosporin and Chinese herbal soup combined with azithromycin+cephalosporin,both P>0.05,indicating that the efficacy of children in the exposed group and the non-exposed group was comparable in terms of cure rate.(3)Comparison of the disappearance rate of symptoms and efficiency rate of children stratified by antibiotic type factor after 3 and 5 days of treatment after matchingIn terms of the fever disappearance rate,after 3 days of treatment,the fever disappearance rate between the two groups was found to be statistically significant with P<0.05 by chi-square test,indicating that the fever disappearance rate in the exposed group was significantly higher than that in the non-exposed group after 3 days of treatment.After 5 days of treatment,the fever disappearance rate between the two groups was found by chi-square test to be P>0.05,and the difference was not statistically significant,indicating that the fever disappearance rates in the exposed and non-exposed groups were comparable after 5 days of treatment.In terms of cough disappearance rate,after 3 and 5 days of treatment,the cardinality test found that P<0.05 between the two groups stratified by the type of antibiotic,indicating that the cough disappearance rate was significantly higher in the exposed group than in the non-exposed group.Regarding the disappearance rate of sputum congestion,after 3 days of treatment,a chi-square test between the two groups stratified by antibiotic type revealed that P<0.05,indicating that the disappearance rate of sputum congestion was significantly higher in the exposed group than in the non-exposed group after 3 days of treatment.After 5 days of treatment,the disappearance rate of sputum congestion in both groups was found to be>0.05 by chi-square test,indicating that the disappearance rate of sputum congestion in the exposed and non-exposed groups was comparable after 5 days of treatment.In terms of asthma disappearance rate,after 3 days of treatment,the cardinality test between the two groups stratified by the type of antibiotic was found to be P<0.05,indicating that the asthma disappearance rate in the exposed group was significantly better than that in the non-exposed group when compared between the two groups.After 5 days of treatment,a chi-square test between the two groups of children stratified by antibiotic type revealed that P>0.05,indicating that the rate of asthma disappearance was comparable between the exposed and non-exposed groups.In terms of effective rate,only children with Chinese herbal soup combined with cephalosporin and children with Chinese herbal soup combined with azithromycin+cephalosporin were found to have an effective rate between the two groups after 3 days of treatment by chi-square test,P<0.05,indicating that the effective rate of the exposed group was significantly better than that of the non-exposed group after 3 days of treatment.After 5 days of treatment,children stratified by antibiotic type factor between the two groups were found to have P>0.05 by chi-square test,indicating that the efficiency of the exposed group was comparable to that of the non-exposed group when compared between the two groups.Conclusion:1.Cupping intervention in children with pneumonia and wheezing(wind-heat closed lung evidence)can shorten the hospitalization time of children with pneumonia and wheezing,shorten the course of pneumonia,and play a positive role in the early recovery of the children.It is also effective in reducing fever,relieving cough,resolving sputum,eliminating rales,and improving the onset of action and cure rate.2.It was also found that cupping intervention for children stratified by antibiotic type:cupping intervention for children with herbal soup combined with azithromycin,herbal soup combined with cephalosporin,and herbal soup combined with azithromycin+cephalosporin could significantly shorten the hospitalization time and make children with pneumonia and wheezing return to a healthy state earlier,and the efficacy of cupping intervention was also significant in relieving cough,resolving sputum,eliminating rales and improving the onset of effect.The combination of cupping intervention with azithromycin also shortened the fever remission time and improved the cure rate.The efficacy of cupping intervention in children with azithromycin+cephalosporin was also significant in shortening the time to fever remission.3.Cupping intervention for children with pneumonia and asthma(wind-heat closed lung syndrome)has a high safety profile. |
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