阿奇霉素序贯联合痰热清治疗小儿肺炎支原体肺炎临床观察
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摘要
目的探讨阿奇霉素序贯联合痰热清治疗儿童肺炎支原体肺炎(MPP)的效果及对临床症状、相关炎性指标、免疫功能的影响。方法选择2015年4月—2017年4月收治的MPP患儿120例,按照治疗方法分为对照组和观察组,每组60例。对照组给予阿奇霉素序贯治疗,观察组在对照组基础上给予痰热清注射液治疗。2组均治疗15 d。比较2组近期疗效及临床体征消失时间,检测2组T淋巴细胞亚群、C反应蛋白(CRP)、白介素-2(IL-2)、人可溶性髓系细胞触发受体-1(s TREM-1)、热休克蛋白70(HSP70)、降钙素原(PCT)、内毒素(LPS)水平。结果观察组总有效率高于对照组(P <0. 05)。观察组咳嗽、发热、肺部阴影消失时间短于对照组(P <0. 05)。观察组治疗后CD4+、CD4+/CD8+比值高于对照组,CD8+、CRP、IL-2、s TREM-1、HSP70、PCT和LPS水平均低于对照组(P <0. 05)。2组不良反应发生率比较差异无统计学意义(P>0. 05)。结论阿奇霉素序贯联合痰热清注射液治疗MPP可缩短病程,改善机体免疫力,降低炎性程度及PCT、LPS水平。
Objective To investigate effectiveness of Azithromycin combined with Tanreqing sequential therapy in treatment of children with mycoplasma pneumoniae pneumonia( MPP) and its effects on clinical symptoms,related inflammatory markers and immune function. Methods A total of 120 patients with MPP admitted during April 2015 and April 2017 were divided into control group and observation group according to therapeutic methods( n = 60 for each group). Control group was treated with Azithromycin sequential therapy,while observation group was added with Tanreqing injection on the basis of treatment for control group. Both groups were treated for 15 d. In two groups,short-term efficacy and time for clinical signs disappearance were compared,and levels of T lymphocyte subsets,C-reactive protein( CRP),interleukin-2( IL-2),human soluble triggering receptor expresses on myeloid cells-1( s TREM-1),heat shock protein 70( HSP70),procalcitonin( PCT) and endotoxin( LPS) were detected. Results The total effective rate in observation group was significantly higher than that in control group( P < 0. 05). Times for cough,fever and lung shadow disappearance in observation group were shorter than those in control group( P < 0. 05). After treatment,values of CD4 + and CD4 +/CD8 + ratio in observation group were significantly higher than those in control group,while CD8 +,CRP,IL-2,s TREM-1,HSP70,PCT and LPS levels were significantly lower than those in control group( P < 0. 05).There was no significant difference in incidence rate of adverse reactions between two groups( P > 0. 05). Conclusion Azithromycin combined with Tanreqing sequential therapy in treatment of children with MPP may shorten course of disease,improve immunity,reduce inflammatory degree and PCT and LPS levels.
Objective To investigate effectiveness of Azithromycin combined with Tanreqing sequential therapy in treatment of children with mycoplasma pneumoniae pneumonia( MPP) and its effects on clinical symptoms,related inflammatory markers and immune function. Methods A total of 120 patients with MPP admitted during April 2015 and April 2017 were divided into control group and observation group according to therapeutic methods( n = 60 for each group). Control group was treated with Azithromycin sequential therapy,while observation group was added with Tanreqing injection on the basis of treatment for control group. Both groups were treated for 15 d. In two groups,short-term efficacy and time for clinical signs disappearance were compared,and levels of T lymphocyte subsets,C-reactive protein( CRP),interleukin-2( IL-2),human soluble triggering receptor expresses on myeloid cells-1( s TREM-1),heat shock protein 70( HSP70),procalcitonin( PCT) and endotoxin( LPS) were detected. Results The total effective rate in observation group was significantly higher than that in control group( P < 0. 05). Times for cough,fever and lung shadow disappearance in observation group were shorter than those in control group( P < 0. 05). After treatment,values of CD4 + and CD4 +/CD8 + ratio in observation group were significantly higher than those in control group,while CD8 +,CRP,IL-2,s TREM-1,HSP70,PCT and LPS levels were significantly lower than those in control group( P < 0. 05).There was no significant difference in incidence rate of adverse reactions between two groups( P > 0. 05). Conclusion Azithromycin combined with Tanreqing sequential therapy in treatment of children with MPP may shorten course of disease,improve immunity,reduce inflammatory degree and PCT and LPS levels.
引文
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[18]周成,王书举,翟玉峰,等.布地奈德雾化吸入对支原体肺炎患儿炎症因子与免疫功能的影响[J].中华医院感染学杂志,2016,26(9):2136-2138.
[19]王艳萍,王美芬,董伯素,等.严重腹腔感染患者血液滤过对血浆内毒素和细胞因子的影响[J].中华医院感染学杂志,2016,26(19):4407-4409.
[20]韩阳.肺炎支原体肺炎患者血WBC计数、C反应蛋白及内毒素水平的分析[J].国际检验医学杂志,2013,34(21):2924-2925.
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[24]张秀军,王建华,尉理梁.川芎嗪注射液联合阿奇霉素序贯治疗大叶性肺炎及迁延性肺炎的临床研究[J].中国临床药理学杂志,2017,33(8):675-677,680.
[25]韩燕鸿,张荷.痰热清注射液治疗小儿上呼吸道感染的系统评价[J].中国实验方剂学杂志,2016,22(12):215-219.
[26]唐启令,孙永旭,康爱绒,等.基于真实世界研究的痰热清注射液儿童临床应用安全性分析[J].中国医院药学杂志,2015,35(16):1488-1490.
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[28]王绚,张永,许静,等.痰热清注射液治疗小儿支气管肺炎疗效和安全性的系统评价[J].中国医院药学杂志,2017,37(3):264-269,282.
[29]刘沛,马乐,王琼,等.三黄颗粒中黄芩素代替黄芩苷素的药理比较[J].中成药,2015,37(2):265-268.
[30]陈会丛,杨海润,钟雨秋,等.山羊角替代羚羊角后同仁牛黄清心丸的毒理学研究[J].中华中医药杂志,2016,31(2):668-673.
[31]王佳婧,郑勇凤,秦晶,等.熊胆粉的药理作用与新剂型研究进展[J].中国医院药学杂志,2016,36(7):598-602.
[32]赵媛媛,杨倩茹,郝江波,等.金银花与忍冬藤及叶药理作用差异的研究进展[J].中国中药杂志,2016,41(13):2422-2427.
[33]全云云,袁岸,龚小红,等.连翘抗炎药效物质基础筛选研究[J].天然产物研究与开发,2017,29(3):435-438,471.
[34]刘秋霞,杨莹,杨淑晴,等.开胸术后肺部感染患者应用痰热清注射液对炎性因子代谢的影响研究[J].中华医院感染学杂志,2016,26(14):3249-3251.
[35]宋媛媛,周越.痰热清注射液治疗老年急性支气管炎的临床疗效及对气道炎症和呼吸功能的影响[J].中药材,2017,40(1):220-222.
[36]李潇潇,卓琳,杨毅恒,等.痰热清注射液儿童应用安全性再评价的真实世界研究[J].中华流行病学杂志,2017,38(2):248-252.
[37]石绍顺,张会宗,于雪峰,等. 466例痰热清注射液安全性医院集中监测研究[J].时珍国医国药,2016,27(10):2438-2440.
[2] Rios A M,Fonseca-Aten M,Mejias A,et al. Microbiologic and immunologic evaluation of a single high dose of azithromycin for treatment of experimental mycoplasma pneumoniae pneumonia[J]. Antimicrob Agents Chemother,2005,49(9):3970-3973.
[3]胡利军,李胖.痰热清联合阿奇霉素序贯疗法治疗小儿肺炎支原体肺炎的效果分析[J].辽宁中医杂志,2017,42(7):1442-1444.
[4]胡亚美,江载芳.诸福棠实用儿科学[M]. 7版.北京:人民卫生出版社,2012:1204-1205.
[5]中华医学会儿科学分会呼吸学组.儿童肺炎支原体肺炎诊治专家共识(2015年版)[J].中华实用儿科临床杂志,2015,30(17):1304-1308.
[6] Chaudhry R,Ghosh A,Chandolia A. Pathogenesis of Mycoplasma pneumoniae:An update[J]. Indian J Med Microbiol,2016,34(1):7-16.
[7]孙红,孙红妹.肺炎支原体直接损伤及其免疫学致病机制研究进展[J].中华微生物学和免疫学杂志,2015,35(1):65-68.
[8]王菲,尚云晓.肺炎支原体肺炎发病机制及相关临床问题[J].中国实用儿科杂志,2015,30(3):184-189.
[9]雷辉,邵荣昌.肺炎支原体肺炎患儿外周血和肺泡灌洗液中T细胞及细胞因子变化研究[J].国际检验医学杂志,2017,38(10):1407-1410.
[10]梁粤.肺炎支原体肺炎患儿外周血IL-10/IL-17表达与肺功能变化的相关性研究[J].临床儿科杂志,2015,33(8):686-689.
[11]郭飞波,韩利蓉,余卉,等.血清补体、免疫球蛋白及炎性细胞因子动态检测在儿童肺炎支原体感染中的应用价值[J].中国免疫学杂志,2017,33(6):910-913.
[12]甄波,胡国斌,曾艳.难治性肺炎支原体肺炎患儿血清炎性细胞因子水平变化及意义[J].山东医药,2015,55(44):73-75.
[13]王爱,张海超,张亮,等.自发性高血压大鼠外周血CD4+/CD8+T淋巴细胞比率增加且连接子蛋白40(Cx40)和炎症因子水平升高[J].细胞与分子免疫学杂志,2016,32(2):145-148.
[14]段晨旺,周建宏,魏刚强.外周血可溶性髓系细胞触发受体-1与可溶性血红蛋白清道夫受体对烧伤患者脓毒症的诊断价值研究[J].中华医院感染学杂志,2018,28(5):730-733,756.
[15]邓鸿敖,张红艳,熊林朋,等.细胞外热休克蛋白70对严重烫伤大鼠肠道免疫功能的影响[J].中华烧伤杂志,2016,32(5):272-276.
[16]高颖,陈蕊,顾宁,等.藁本内酯对重组人热休克蛋白60诱导的THP-1源性巨噬细胞炎症反应的作用及机制[J].中华心血管病杂志,2016,44(9):793-798.
[17]王伟,王珂,秦殊. T细胞亚群及PCT监测在学龄前儿童支原体肺炎诊治中的价值[J].中国现代医学杂志,2017,27(14):83-86.
[18]周成,王书举,翟玉峰,等.布地奈德雾化吸入对支原体肺炎患儿炎症因子与免疫功能的影响[J].中华医院感染学杂志,2016,26(9):2136-2138.
[19]王艳萍,王美芬,董伯素,等.严重腹腔感染患者血液滤过对血浆内毒素和细胞因子的影响[J].中华医院感染学杂志,2016,26(19):4407-4409.
[20]韩阳.肺炎支原体肺炎患者血WBC计数、C反应蛋白及内毒素水平的分析[J].国际检验医学杂志,2013,34(21):2924-2925.
[21]郭敏,李奎臣,刘建云,等.肺炎支原体肺炎患儿不同疗程阿奇霉素的应用效果研究[J].中华医院感染学杂志,2016,26(8):1882-1883,1889.
[22]杜晓宁,梁丽霞,严慧芳,等.阿奇霉素序贯疗法联合特步他林治疗小儿支原体肺炎的临床观察[J].中国药房,2016,27(6):740-742.
[23]楚加元,许洲.阿奇霉素序贯疗法用于儿童支原体肺炎的临床观察[J].中国药房,2016,27(18):2521-2523.
[24]张秀军,王建华,尉理梁.川芎嗪注射液联合阿奇霉素序贯治疗大叶性肺炎及迁延性肺炎的临床研究[J].中国临床药理学杂志,2017,33(8):675-677,680.
[25]韩燕鸿,张荷.痰热清注射液治疗小儿上呼吸道感染的系统评价[J].中国实验方剂学杂志,2016,22(12):215-219.
[26]唐启令,孙永旭,康爱绒,等.基于真实世界研究的痰热清注射液儿童临床应用安全性分析[J].中国医院药学杂志,2015,35(16):1488-1490.
[27]郎明霞,雷兴丽.观察痰热清与阿奇霉素联合治疗支原体肺炎临床疗效[J].辽宁中医杂志,2015,42(6):1262-1263.
[28]王绚,张永,许静,等.痰热清注射液治疗小儿支气管肺炎疗效和安全性的系统评价[J].中国医院药学杂志,2017,37(3):264-269,282.
[29]刘沛,马乐,王琼,等.三黄颗粒中黄芩素代替黄芩苷素的药理比较[J].中成药,2015,37(2):265-268.
[30]陈会丛,杨海润,钟雨秋,等.山羊角替代羚羊角后同仁牛黄清心丸的毒理学研究[J].中华中医药杂志,2016,31(2):668-673.
[31]王佳婧,郑勇凤,秦晶,等.熊胆粉的药理作用与新剂型研究进展[J].中国医院药学杂志,2016,36(7):598-602.
[32]赵媛媛,杨倩茹,郝江波,等.金银花与忍冬藤及叶药理作用差异的研究进展[J].中国中药杂志,2016,41(13):2422-2427.
[33]全云云,袁岸,龚小红,等.连翘抗炎药效物质基础筛选研究[J].天然产物研究与开发,2017,29(3):435-438,471.
[34]刘秋霞,杨莹,杨淑晴,等.开胸术后肺部感染患者应用痰热清注射液对炎性因子代谢的影响研究[J].中华医院感染学杂志,2016,26(14):3249-3251.
[35]宋媛媛,周越.痰热清注射液治疗老年急性支气管炎的临床疗效及对气道炎症和呼吸功能的影响[J].中药材,2017,40(1):220-222.
[36]李潇潇,卓琳,杨毅恒,等.痰热清注射液儿童应用安全性再评价的真实世界研究[J].中华流行病学杂志,2017,38(2):248-252.
[37]石绍顺,张会宗,于雪峰,等. 466例痰热清注射液安全性医院集中监测研究[J].时珍国医国药,2016,27(10):2438-2440.