罐药综合治疗儿童MPP的临床疗效及对凝血功能的影响
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摘要
[目的]评价罐药综合治疗儿童肺炎支原体肺炎(MPP)的临床疗效及其对患儿凝血功能影响。[方法]选取2014年7月—2017年6月北京中医药大学东方医院儿科门诊及病房收治的140例MPP患儿,将其随机分为对照组(70例)与治疗组(70例)。前者采用单纯西医即阿奇霉素静脉滴注治疗,后者在前者基础上实施罐药综合治疗,对比两组在治疗前后临床症状(主要及次要症状积分)凝血功能指标(凝血酶原时间、凝血酶原活动度及D-二聚体)的变化。[结果]治疗组的总有效率高于对照组。治疗组、对照组总分治疗前后组内比较均有统计学差异(P<0.05)。观察终点时在主要症状(咳嗽、痰壅、气喘、发热、听诊)方面,治疗组愈显率更高,症状总分更低(P<0.05),提示治疗组的治疗优于对照组。两组治疗前后凝血酶原时间、凝血酶原活动度及D-二聚体均有不同程度改善,治疗组优于对照组(P<0.05)。[结论]小儿MPP早期应尽早介入中医药内、外治法,有助于改善MPP患儿的临床症状及凝血功能,从而达到更满意的临床效果,并为有效预防严重并发症及降低单用大环内酯类抗生素普遍耐药性提供了临床思路。
[Objective] To evaluate the advantages and effect on blood coagulation function using a comprehensive cupping treatment of mycoplasma pneumoniae pneumonia(MPP) in children. [Methods] The 140 cases of MPP from July 2014 to June 2017 in the inpatient and outpatient pediatrics department of Beijing University of Chinese Medicine's Affiliated Dongfang Hospital were selected and randomly divided into a control group(70 cases) and a treatment group(70 cases). The former group received only Azithromycin treatment,while the other group received additional comprehensive cupping therapy,and the treatment effects for both groups were compared. Each group received treatment for 1 week,and they were followed up for 2 weeks. Both groups were evaluated based on the changes in coagulation function indexes(including pro-thrombin time(PT),pro-thrombin activity(PTA) and D-dimer(DD)) before and after treatment.[Results] The total effective rate of the treatment group was higher than that of the control group. The total scores of the treatment group and the control group were significantly different before and after the treatment(P<0.05). At the end of the clinical course,there were no significant differences in the main symptoms(cough,sputum,asthma,fever,auscultation) between the two groups(P>0.05). In terms of treatment of the main symptoms(cough,phlegm,wheezing,fever,auscultation),the treatment group revealed a higher recovery rate and a lower total symptom score,which was a statistically significant difference(P<0.05). This might suggest that the comprehensive cupping therapy treatment group is superior to the control group. Both groups displayed different levels of improvement in terms of PT,PTA and DD. The treatment group was superior to the control group,with a statistically significant difference. [Conclusion] Early intervention in the treatment of pediatric MPP with Traditional Chinese Medicine can help to reduce the clinical course of this disease,as well as improve the child's coagulation function. This in turn would yield more satisfactory clinical results,effectively prevent any serious complications,and reduce universal resistance arising from the single use of macrolide antibiotics.
[Objective] To evaluate the advantages and effect on blood coagulation function using a comprehensive cupping treatment of mycoplasma pneumoniae pneumonia(MPP) in children. [Methods] The 140 cases of MPP from July 2014 to June 2017 in the inpatient and outpatient pediatrics department of Beijing University of Chinese Medicine's Affiliated Dongfang Hospital were selected and randomly divided into a control group(70 cases) and a treatment group(70 cases). The former group received only Azithromycin treatment,while the other group received additional comprehensive cupping therapy,and the treatment effects for both groups were compared. Each group received treatment for 1 week,and they were followed up for 2 weeks. Both groups were evaluated based on the changes in coagulation function indexes(including pro-thrombin time(PT),pro-thrombin activity(PTA) and D-dimer(DD)) before and after treatment.[Results] The total effective rate of the treatment group was higher than that of the control group. The total scores of the treatment group and the control group were significantly different before and after the treatment(P<0.05). At the end of the clinical course,there were no significant differences in the main symptoms(cough,sputum,asthma,fever,auscultation) between the two groups(P>0.05). In terms of treatment of the main symptoms(cough,phlegm,wheezing,fever,auscultation),the treatment group revealed a higher recovery rate and a lower total symptom score,which was a statistically significant difference(P<0.05). This might suggest that the comprehensive cupping therapy treatment group is superior to the control group. Both groups displayed different levels of improvement in terms of PT,PTA and DD. The treatment group was superior to the control group,with a statistically significant difference. [Conclusion] Early intervention in the treatment of pediatric MPP with Traditional Chinese Medicine can help to reduce the clinical course of this disease,as well as improve the child's coagulation function. This in turn would yield more satisfactory clinical results,effectively prevent any serious complications,and reduce universal resistance arising from the single use of macrolide antibiotics.
引文
[1]杨香红,李艳莉,罗春玉.肺炎支原体肺炎患儿免疫功能的变化及其与病情程度和疾病分期的关系[J].实用临床医药杂志,2016,20(7):113-116.
[2]柯莉芹,王凤美,李银洁,等.儿童肺炎支原体肺炎流行病学特征[J].中国当代儿科杂志,2013,15(1):33-36.
[3]Parrott GL,Kinjo T,Fujita J.A Compendium for Mycoplasma pneumoniae[J].Front Microbiol,2016,7:513.
[4]Shimizu T,Kimura Y,Kida Y,et al.Cytadherence of Mycoplasma pneumoniae induces inflammatory responses through autophagy and toll-like receptor 4[J].Infect Immun,2014,82(7):3076-3086.
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[6]郭山春,徐传伟,刘玉芹,等.不同类型肺炎支原体肺炎儿童血浆凝血酶调节蛋白和D-二聚体的变化[J].中国当代儿科杂志,2013,15(8):619-622.
[7]黄彩芝,莫丽亚,邓永超,等.重症肺炎患儿血小板参数与凝血指标的探讨[J].中国感染控制杂志,2015,14(2):98-100.
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[9]汪受传,赵霞,韩新民,等.小儿肺炎喘嗽中医诊疗指南[J].中医儿科杂志,2008,4(3):1-3.
[10]吴以岭.络病学[M].北京:中国中医药出版社,2006:56-60.
[11]王志华,孙健,刘艳,等.麻杏石甘汤对儿童肺炎支原体肺炎血清IL-17、TNF-α的影响[J].天津中医药,2018,35(6):419-421.
[12]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.
[13]Jacobs E.Mycoplasma pneumonia:now in the focus of clinicians and epidemiologists[J].Eur Surveill,2012,17(6):9-11.
[14]Bernard TJ,Goldenberg NA.Pediatric arterial ischemic stroke[J].Pediatr Clin North Am,2008,55(2):323-338.
[15]高冲,刘璐,胡爱菊,等.活血化瘀中药的药理作用研究进展[J].药物评价研究,2013,36(1):64-66.
[16]柯莉芹,王凤美,李银洁,等.儿童肺炎支原体肺炎流行病学特征[J].中国当代儿科杂志,2013,15(1):33-36.
[2]柯莉芹,王凤美,李银洁,等.儿童肺炎支原体肺炎流行病学特征[J].中国当代儿科杂志,2013,15(1):33-36.
[3]Parrott GL,Kinjo T,Fujita J.A Compendium for Mycoplasma pneumoniae[J].Front Microbiol,2016,7:513.
[4]Shimizu T,Kimura Y,Kida Y,et al.Cytadherence of Mycoplasma pneumoniae induces inflammatory responses through autophagy and toll-like receptor 4[J].Infect Immun,2014,82(7):3076-3086.
[5]田国治,王平.儿童支原体肺炎凝血状态及研究现状[J].世界最新医学信息文摘,2016,16(36):38-39.
[6]郭山春,徐传伟,刘玉芹,等.不同类型肺炎支原体肺炎儿童血浆凝血酶调节蛋白和D-二聚体的变化[J].中国当代儿科杂志,2013,15(8):619-622.
[7]黄彩芝,莫丽亚,邓永超,等.重症肺炎患儿血小板参数与凝血指标的探讨[J].中国感染控制杂志,2015,14(2):98-100.
[8]胡亚美,江载芳.诸福棠实用儿科学[M].第7版.北京:人民卫生出版社,2002:1175-1204.
[9]汪受传,赵霞,韩新民,等.小儿肺炎喘嗽中医诊疗指南[J].中医儿科杂志,2008,4(3):1-3.
[10]吴以岭.络病学[M].北京:中国中医药出版社,2006:56-60.
[11]王志华,孙健,刘艳,等.麻杏石甘汤对儿童肺炎支原体肺炎血清IL-17、TNF-α的影响[J].天津中医药,2018,35(6):419-421.
[12]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.
[13]Jacobs E.Mycoplasma pneumonia:now in the focus of clinicians and epidemiologists[J].Eur Surveill,2012,17(6):9-11.
[14]Bernard TJ,Goldenberg NA.Pediatric arterial ischemic stroke[J].Pediatr Clin North Am,2008,55(2):323-338.
[15]高冲,刘璐,胡爱菊,等.活血化瘀中药的药理作用研究进展[J].药物评价研究,2013,36(1):64-66.
[16]柯莉芹,王凤美,李银洁,等.儿童肺炎支原体肺炎流行病学特征[J].中国当代儿科杂志,2013,15(1):33-36.