【目的】 观察鼻渊通窍颗粒联合灸法治疗肺气虚寒型过敏性鼻炎（AR）的临床疗效，并探讨其作用机制。【方法】 选取 2020年11月到2022年11月临沂市人民医院耳鼻喉科门诊及病房收治的138例明确诊断为AR的患者为研究对象。按随机数 字表将患者随机分为观察组和对照组，每组各 69例。对照组给予糠酸莫米松鼻喷剂治疗，观察组在对照组治疗的基础上， 给予鼻渊通窍颗粒联合灸法治疗，2组均治疗4周。治疗结束后，评价2组临床疗效。观察2组患者治疗前后中医证候评分的 变化情况，以及血清白细胞介素（IL）-6、IL-8、C反应蛋白（CRP）水平的情况。比较2组患者治疗前后Treg细胞、Th17细胞 占比，计算 Treg/Th17 以及转化生长因子 β1（TGF-β1）和 IL-17 水平的变化情况。并评价 2 组的安全性及不良反应的发生情 况。治疗结束6个月后，随访患者的复发情况，并比较2组患者的复发率。【结果】（1）治疗后，2组患者的各项中医证候评分 均明显改善（P＜0.05），且观察组在改善各项中医证候评分方面明显优于对照组，差异有统计学意义（P＜0.05）。（2）治疗后， 2组患者的血清IL-6、CRP、IL-8水平均明显改善（P＜0.05），且观察组在改善血清IL-6、CRP、IL-8水平方面明显优于对照 组，差异有统计学意义（P＜0.05）。（3）治疗后，2 组患者的 Treg、Th17、Treg/Th17、TGF-β1、IL-17 水平均明显改善（P＜ 0.05），且观察组在改善 Treg、Th17、Treg/Th17、TGF-β1、IL-17水平方面明显优于对照组，差异有统计学意义（P＜0.05）。 （4）观察组总有效率为 97.10%（67/69），对照组为 76.81%（53/69）。观察组疗效优于对照组，差异有统计学意义（P＜0.05）。 （5）治疗6个月后随访，观察组复发率为5.80%（4/69），对照组为24.64%（17/69）。观察组复发率低于对照组，差异有统计学 意义（P＜0.05）。（6）2组患者不良反应发生率比较，差异无统计学意义（P＞0.05）。【结论】 鼻渊通窍颗粒联合灸法治疗肺气虚 寒型过敏性鼻炎，能明显改善患者的临床症状，有助于调节Treg/Th17细胞免疫失衡状态，改善炎症因子水平，且复发率低， 安全性较好，疗效显著。

Objective To observe the clinical efficacy of Biyuan Tongqiao Granules combined with moxibustion in the treatment of allergic rhinitis （AR） of lung qi deficiency and cold type，and to explore its possible mechanism of action. Methods A total of 138 patients diagnosed with AR in the otolaryngology outpatient and inpatient departments of Linyi People’s Hospital from November 2020 to November 2022 were selected as the study subjects. The patients were randomly divided into an observation group and a control group using a random number table， with 69 cases in each group. The control group was treated with Mometasone Furoate Nasal Spray， while the observation group received Biyuan Tongqiao Granules combined with moxibustion in addition to the control group’s treatment. Both groups were treated for 4 weeks. After the ending of treatment， the clinical efficacy of the two groups was evaluated. Changes in traditional Chinese medicine （TCM） syndrome scores， serum levels of interleukin-6（IL-6），interleukin-8（IL-8），and C-reactive protein （CRP） were observed. The proportions of Treg cells and Th17 cells were compared before and after treatment，and the Treg/Th17 ratio，as well as levels of transforming growth factor β1（TGF-β1） and interleukin-17（IL-17） were calculated. The safety and incidence of adverse reactions in the two groups were evaluated. Six months after the end of treatment，the recurrence rate of patients was followed up and compared between the two groups. Results （1） After treatment，the TCM syndrome scores of both groups were significantly improved （P＜0.05）， and the observation group showed significantly better improvement in TCM syndrome scores compared to the control group， with a statistically significant difference （P＜0.05）.（2） After treatment， the serum levels of IL-6， CRP， and IL-8 in both groups were significantly improved （P＜0.05），and the observation group showed significantly better improvement in serum IL-6，CRP，and IL-8 levels compared to the control group，with a statistically significant difference （P＜0.05）. （3） After treatment， the levels of Treg， Th17， Treg/Th17， TGF- β1， and IL-17 in both groups were significantly improved（P＜0.05）， and the observation group showed significantly better improvement in these levels compared to the control group，with a statistically significant difference（P＜0.05）.（4）The total effective rate in the observation group was 97.10%（67/69），while it was 76.81%（53/69） in the control group. The efficacy of the observation group was superior to that of the control group，with a statistically significant difference （P＜ 0.05）.（5） At the 6-month follow-up，the recurrence rate in the observation group was 5.80%（4/69），while it was 24.64%（17/69） in the control group. The recurrence rate in the observation group was lower than that in the control group， with a statistically significant difference （P＜0.05）.（6） There was no statistically significant difference in the incidence of adverse reactions between the two groups （P＞0.05）. Conclusion Biyuan Tongqiao Granules combined with moxibustion in the treatment of AR of lung qi deficiency and cold type can significantly improve patients’ clinical symptoms， help regulate the Treg/Th17 immune imbalance， improve inflammatory factor levels，and has a low recurrence rate，good safety，and significant efficacy.

R246.9

国家自然科学基金资助项目（编号：81978065）；山东省自然基金资助项目（编号：ZR2022LZY029）