中医辨证施治对儿童腺样体肥大的单组前后对照研究

Single-Group Before-After Controlled Study on TCM Syndrome Differentiation and Treatment for Children with Adenoid Hypertrophy

摘要: 目的：探讨单纯中药辨证施治对儿童腺样体肥大的临床疗效。方法：本研究采用自身前后对照设计，纳入2021年1月至2025年6月在三峡大学第一临床医学院中医科就诊、符合腺样体肥大诊断标准且接受单纯中药治疗的患儿。根据中医辨证分型，给予个体化中药治疗方案，疗程4~12周。通过中医证候积分、主要症状评分、AH分度积分及腺样体分度积分对治疗前后进行比较，并依据《中药新药临床研究指导原则》评定疗效。采用SPSS 21.0统计软件进行数据分析。结果：共纳入患儿142例，单纯中药辨证治疗后总有效率达97.18%。治疗后患儿的总证候积分由9.00 ± 1.41分下降至1.69 ± 1.43分，三项核心症状鼻塞、打鼾、张口呼吸积分均较治疗前有所下降(P < 0.05)。另外，在影像学方面，治疗后A/N值由0.80 ± 0.072下降至0.68 ± 0.10。此外，腺样体肥大分度改善，治疗前40例重度肥大患儿中，治疗后全部转为轻中度或恢复正常，差异具有统计学意义(P < 0.001)。结论：单纯中药辨证施治在治疗儿童腺样体肥大方面观察到具有改善作用，既可缓解临床症状，又能改善腺体结构，体现了中医整体观与辨证论治在儿童慢性呼吸道疾病治疗中的优势。该疗法可作为腺样体肥大的保守治疗手段，具有良好的临床应用前景。

Abstract: Objective: To explore the clinical efficacy of simple Traditional Chinese Medicine (TCM) syndrome differentiation and treatment in children with adenoid hypertrophy. Methods: This study adopted a self-before-and-after control design, enrolling children who visited the Department of Traditional Chinese Medicine of the First Clinical Medical College of China Three Gorges University from January 2021 to June 2025, met the diagnostic criteria for adenoid hypertrophy, and received simple TCM treatment. According to TCM syndrome differentiation, individualized TCM treatment plans were given, with a course of 4~12 weeks. Comparisons were made before and after treatment using TCM syndrome scores, main symptom scores, AH grading scores, and adenoid grading scores. The efficacy was evaluated in accordance with the Guiding Principles for Clinical Research of New Chinese Medicines. SPSS 21.0 statistical software was used for data analysis. Results: A total of 142 children were included. The total effective rate after simple TCM syndrome differentiation treatment reached 97.18%. The total syndrome score of the children decreased from 9.00 ± 1.41 points to 1.69 ± 1.43 points after treatment. The scores of the three core symptoms (nasal congestion, snoring, and mouth breathing) all decreased compared with those before treatment (P < 0.05). In addition, in terms of imaging, the A/N value decreased from 0.80 ± 0.072 to 0.68 ± 0.10 after treatment. Furthermore, the degree of adenoid hypertrophy improved. Among the 40 children with severe hypertrophy before treatment, all turned to mild to moderate or returned to normal after treatment, and the difference was statistically significant (P < 0.001). Conclusion: Simple TCM syndrome differentiation and treatment have been observed to have an improving effect in the treatment of children with adenoid hypertrophy. It can not only relieve clinical symptoms but also improve glandular structure, reflecting the advantages of TCM holistic view and syndrome differentiation in the treatment of children with chronic respiratory diseases. This therapy can be used as a conservative treatment for adenoid hypertrophy and has a good clinical application prospect.