标准桃金娘油肠溶胶囊联合匹多莫德治疗小儿肺炎支原体肺炎的疗效及对肺功能和免疫炎性反应的影响
|
摘要
目的探讨标准桃金娘油肠溶胶囊联合匹多莫德治疗小儿肺炎支原体肺炎的疗效及对患儿肺功能和免疫炎性反应的影响。方法 2016年3月至2017年1月住院治疗的肺炎支原体肺炎患儿90例,随机分为匹多莫德组和联合治疗组,每组45例。2组均静脉滴注阿奇霉素,连用3 d。匹多莫德组口服匹多莫德分散片,400 mg/次,2次/d,连用14 d后调整为1次/d。联合治疗组在匹多莫德组治疗基础上,加用标准桃金娘油肠溶胶囊,1粒/次,2次/d,连用2周。观察2组临床疗效及治疗前后症状体征改善情况、肺功能[肺活量(FVC)、最大呼气第1秒容积(FEV1)、峰值呼气流速(PEF)、每分钟最大通气量(MVV)]、血常规(白细胞计数、中性粒细胞比例、淋巴细胞比例)、T淋巴细胞亚群(CD+3、CD_4~+、CD_8~+、CD_4~+/CD_8~+)、免疫球蛋白(IgM、IgA、IgG)、血清炎性因子[白介素-6(IL-6)、白介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)、C-反应蛋白(CRP)]变化。结果联合治疗组总有效率高于匹多莫德组,症状体征恢复时间短于匹多莫德组,差异有统计学意义(P <0. 05)。2组治疗前FVC、FEV1、PEF、MVV、白细胞计数、中性粒细胞比例、淋巴细胞比例、CD+3、CD_4~+、CD_8~+、CD_4~+/CD_8~+、IgM、IgA、IgG、血清IL-6、IL-8、TNF-α、CRP比较,差异无统计学意义(P> 0. 05)。2组治疗后FVC、FEV1、PEF、MVV、淋巴细胞比例、CD+3、CD_4~+、CD_4~+/CD_8~+、IgM、IgA、IgG明显高于治疗前,白细胞计数、中性粒细胞比例、CD_8~+、血清IL-6、IL-8、TNF-α、CRP明显低于治疗前(P <0. 05),且联合治疗组FVC、FEV1、PEF、MVV、淋巴细胞比例、CD+3、CD_4~+、CD_4~+/CD_8~+、IgM、IgA、IgG高于匹多莫德组,白细胞计数、中性粒细胞比例、CD_8~+、血清IL-6、IL-8、TNF-α、CRP低于匹多莫德组,差异均有统计学意义(P <0. 05)。结论标准桃金娘油肠溶胶囊联合匹多莫德治疗小儿肺炎支原体肺炎,可以改善患儿症状体征,增强患儿肺功能和免疫功能,抑制患儿血清炎性因子水平,临床效果显著。
Objective To investigate the curative effects of Myrtol standardized enteric coated soft capsules combined with pidotimod in the treatment of mycoplasma pneumoniae pneumonia( MPP) in children and their effects on lung function and immune inflammatory response of patients. Methods Ninety children with MPP who were hospitalized and treated in our hospital from March 2016 to January 2017 were randomly divided into the pidotimod group and the combination treatment group,with 45 cases in each group. Azithromycin was intravenously administered in both groups for 3 d. The Pidotimod group was given oral Pidotimod dispersible tablets,400 mg twice daily,which was adjusted to 400 mg once daily after 14 d. The combination treatment group was supplemented with Myrtol Standardized Enteric Coated Soft Capsules,1 capsule twice daily for 2 weeks. The clinical efficacy,improvement of symptoms and signs before and after treatment,and changes in lung function indexes [lung capacity( FVC),maximum forced expiratory volume in 1 second( FEV1),peak expiratory flow rate( PEF),maximum voluntary ventilation( MVV) per minute],blood routine indexes [white blood cell( WBC) count,neutrophil ratio,and lymphocyte ratio],T lymphocyte subsets( CD+3,CD_4~+,CD_8~+,CD_4~+/CD_8~+),immunoglobulin( IgM,IgA,and IgG),serum inflammatory factors [interleukin-6( IL-6),interleukin-8( IL-8),tumor necrosis factor-α( TNF-α),and C Reactive protein( CRP) ] were observed and compared between the two groups. Results The total effective rate in combination treatment group was significantly higher than that in pidotimod group,and the recovery time of symptoms and signs was significantly shorter than that in pidotimod group( P < 0. 05). Before treatment there were no significant differences in FVC,FEV1,PEF,MVV,WBC count,neutrophil ratio,lymphocyte ratio,CD+3,CD_4~+,CD_8~+,CD_4~+/CD_8~+,IgM,IgA,IgG,serum IL-6,IL-8,TNF-α,and CRP between two groups( P > 0. 05). After treatment,the levels of FVC,FEV1,PEF,MVV,lymphocyte ratio,CD+3,CD_4~+,CD_4~+/CD_8~+,IgM,IgA,and IgG were significantly increased in both groups,as compared with those before treatment,while WBC count,neutrophil ratio,CD_8~+,serum IL-6,IL-8,TNF-α,and CRP were significantly decreased( P < 0. 05).Moreover the levels of FVC,FEV1,PEF,MVV,lymphocyte ratio,CD+3,CD_4~+,CD_4~+/CD_8~+,IgM,IgA,ad IgG in combination treatment group were significantly higher than those in pidotimod group,whereas WBC count,neutrophil ratio,CD_8~+,serum IL-6,IL-8,TNF-α and CRP in combination treatment were significantly lower than those in pidotimod group( P < 0. 05). Conclusion Myrtol standardized enteric coated soft capsules combined with pidotimod in treatment of MPP in children can improve the symptoms and signs of patients,enhance lung function and immune function,and inhibit serum inflammatory cytokines of patients,with significant clinical curative effects.
Objective To investigate the curative effects of Myrtol standardized enteric coated soft capsules combined with pidotimod in the treatment of mycoplasma pneumoniae pneumonia( MPP) in children and their effects on lung function and immune inflammatory response of patients. Methods Ninety children with MPP who were hospitalized and treated in our hospital from March 2016 to January 2017 were randomly divided into the pidotimod group and the combination treatment group,with 45 cases in each group. Azithromycin was intravenously administered in both groups for 3 d. The Pidotimod group was given oral Pidotimod dispersible tablets,400 mg twice daily,which was adjusted to 400 mg once daily after 14 d. The combination treatment group was supplemented with Myrtol Standardized Enteric Coated Soft Capsules,1 capsule twice daily for 2 weeks. The clinical efficacy,improvement of symptoms and signs before and after treatment,and changes in lung function indexes [lung capacity( FVC),maximum forced expiratory volume in 1 second( FEV1),peak expiratory flow rate( PEF),maximum voluntary ventilation( MVV) per minute],blood routine indexes [white blood cell( WBC) count,neutrophil ratio,and lymphocyte ratio],T lymphocyte subsets( CD+3,CD_4~+,CD_8~+,CD_4~+/CD_8~+),immunoglobulin( IgM,IgA,and IgG),serum inflammatory factors [interleukin-6( IL-6),interleukin-8( IL-8),tumor necrosis factor-α( TNF-α),and C Reactive protein( CRP) ] were observed and compared between the two groups. Results The total effective rate in combination treatment group was significantly higher than that in pidotimod group,and the recovery time of symptoms and signs was significantly shorter than that in pidotimod group( P < 0. 05). Before treatment there were no significant differences in FVC,FEV1,PEF,MVV,WBC count,neutrophil ratio,lymphocyte ratio,CD+3,CD_4~+,CD_8~+,CD_4~+/CD_8~+,IgM,IgA,IgG,serum IL-6,IL-8,TNF-α,and CRP between two groups( P > 0. 05). After treatment,the levels of FVC,FEV1,PEF,MVV,lymphocyte ratio,CD+3,CD_4~+,CD_4~+/CD_8~+,IgM,IgA,and IgG were significantly increased in both groups,as compared with those before treatment,while WBC count,neutrophil ratio,CD_8~+,serum IL-6,IL-8,TNF-α,and CRP were significantly decreased( P < 0. 05).Moreover the levels of FVC,FEV1,PEF,MVV,lymphocyte ratio,CD+3,CD_4~+,CD_4~+/CD_8~+,IgM,IgA,ad IgG in combination treatment group were significantly higher than those in pidotimod group,whereas WBC count,neutrophil ratio,CD_8~+,serum IL-6,IL-8,TNF-α and CRP in combination treatment were significantly lower than those in pidotimod group( P < 0. 05). Conclusion Myrtol standardized enteric coated soft capsules combined with pidotimod in treatment of MPP in children can improve the symptoms and signs of patients,enhance lung function and immune function,and inhibit serum inflammatory cytokines of patients,with significant clinical curative effects.
引文
1 Amer HS,El-Anwar MW,Raafat A,et al. Laryngo-tracheo-bronchial foreign bodies in children:clinical presentations and complications. Iran J Otorhinolaryngol,2017,29:155-159.
2 Kollef MH,Chastre J,Fagon JY,et al. Global prospective epidemiologic and surveillance study of ventilator-associated pneumonia due to Pseudomonas aeruginosa. Critical Care Medicine,2014,42:2178-2187.
3 Johkoh T,Sumikawa H,Fukuoka J,et al. Do your really know precise radiologic-pathologic correlation of usual interstitial pneumonia? Eur J Radiol,2014,83:20-26.
4 Sharma S,Chhibber S,Mohan H,et al. Dietary supplementation with omega-3 polyunsaturated fatty acids ameliorates acute pneumonia induced by Klebsiella pneumonia in BALB/c mice. Can J Micro boil,2013,59:503-510.
5 Fraser BC,Anderson DE,White BJ,et al. Associations of various physical andblood analysis variables with experimentally induced Mycoplasma bovis pneumonia in calves. American Journal of Veterinary Research,2014,75:200-207.
6 Izumikawa K,Izumikawa K,Takazono T,et al. Clinical features,risk factors and treatment of fulminant Mycoplasma pneumoniae pneumonia:a review of the Japanese literature. J Inf Chemother,2014,20:181-185.
7 Chaudhry R,Ghosh A,Chandolia A. Pathogenesis of mycoplasma pneumoniae:an update. Ind J Med Microbiol,2015,34:7-16.
8 Goto Y,Nishimura R,Nohara A,et al. Minimal contribution of severe hypertriglyceridemia in L-asparaginase-associated pancreatitisdeveloped in a child with acute lymphocytic leukemia. Rinsho Ketsueki,2016,57:994-998.
9 Youn YS,Lee SC,Rhim JW,et al. Early Additional Immune-Modulators for Mycoplasma pneumonia Pneumonia in Children:An observation study. Inf Chemother,2014,46:239-247.
10 Fan Q,Gu T,Li P,et al. Roles of T-cell immunoglobulin and mucin domain genes and toll-like receptors in wheezy children with mycoplasma pneumoniae pneumonia. Heart Lung Circ,2016,25:1226-1231.
11 Ikeda S,Sekine A,Baba T,et al. Abundant immunoglobulin(Ig)G4-positive plasma cells in interstitial pneumonia without extrathorathoracic lesions of Ig G4-related disease:is this finding specific to Ig G4-related lung disease? Histopathology,2017,70:242-252.
12 Shimizu M,Katoh H,Hamaoka S,et al. Protective effects of intravenous immunoglobulin and antimicrobial agents on acute pneumonia in leukopenic mice. J Infect Chemother,2016,22:240-247.
13 Zhao J,Zhang W,Shen L,et al. Association of the ACE,GSTM1,IL-6,NOS3,and CYP1A1 polymorphisms with susceptibility of mycoplasma pneuponiae pneumnia in Chinease children. Medicine(Baltimore),2017,96:e6642.
14 Anderson SB,Baunbk Egelund G,Jensen AV,et al. Failure of CRP decline within three days of hospotalization is associated with poor prognosis of community-acquired pneumonia. Infect Dis(Lond),2017,49:251-260.
15 Leyenaar JK,Shieh MS,Lagu T,et al. Comparative effectiveness of ceftriaxone in combination with a macrolide compared with ceftriaxone alone for pediatric patients hospitalized with community-acquired pneumonia. Ped Inf Dis J,2014,33:387-392.
16 Anwar S,Crouch RA,Awadh Ali NA,et al. Hierarchical cluster analysis and chemical characterisation of Myrtuscommunis L. essential oil from Yemen region and its antimicrobial,antioxidant and anti-colorectal adenocarcinoma properties. Nat Prod Res,2017,9:1-6.
17 Li YY,Liu J,Li CW,et al. Myrtol standardized affects mucociliary clearance. Int Forum Allergy Rhinol,2017,7:304-311.
18 丁小军.五水头孢唑林钠加桃金娘油治疗儿童急性化脓性中耳炎.中国耳鼻咽喉头颈外科,2017,24:347-350.
2 Kollef MH,Chastre J,Fagon JY,et al. Global prospective epidemiologic and surveillance study of ventilator-associated pneumonia due to Pseudomonas aeruginosa. Critical Care Medicine,2014,42:2178-2187.
3 Johkoh T,Sumikawa H,Fukuoka J,et al. Do your really know precise radiologic-pathologic correlation of usual interstitial pneumonia? Eur J Radiol,2014,83:20-26.
4 Sharma S,Chhibber S,Mohan H,et al. Dietary supplementation with omega-3 polyunsaturated fatty acids ameliorates acute pneumonia induced by Klebsiella pneumonia in BALB/c mice. Can J Micro boil,2013,59:503-510.
5 Fraser BC,Anderson DE,White BJ,et al. Associations of various physical andblood analysis variables with experimentally induced Mycoplasma bovis pneumonia in calves. American Journal of Veterinary Research,2014,75:200-207.
6 Izumikawa K,Izumikawa K,Takazono T,et al. Clinical features,risk factors and treatment of fulminant Mycoplasma pneumoniae pneumonia:a review of the Japanese literature. J Inf Chemother,2014,20:181-185.
7 Chaudhry R,Ghosh A,Chandolia A. Pathogenesis of mycoplasma pneumoniae:an update. Ind J Med Microbiol,2015,34:7-16.
8 Goto Y,Nishimura R,Nohara A,et al. Minimal contribution of severe hypertriglyceridemia in L-asparaginase-associated pancreatitisdeveloped in a child with acute lymphocytic leukemia. Rinsho Ketsueki,2016,57:994-998.
9 Youn YS,Lee SC,Rhim JW,et al. Early Additional Immune-Modulators for Mycoplasma pneumonia Pneumonia in Children:An observation study. Inf Chemother,2014,46:239-247.
10 Fan Q,Gu T,Li P,et al. Roles of T-cell immunoglobulin and mucin domain genes and toll-like receptors in wheezy children with mycoplasma pneumoniae pneumonia. Heart Lung Circ,2016,25:1226-1231.
11 Ikeda S,Sekine A,Baba T,et al. Abundant immunoglobulin(Ig)G4-positive plasma cells in interstitial pneumonia without extrathorathoracic lesions of Ig G4-related disease:is this finding specific to Ig G4-related lung disease? Histopathology,2017,70:242-252.
12 Shimizu M,Katoh H,Hamaoka S,et al. Protective effects of intravenous immunoglobulin and antimicrobial agents on acute pneumonia in leukopenic mice. J Infect Chemother,2016,22:240-247.
13 Zhao J,Zhang W,Shen L,et al. Association of the ACE,GSTM1,IL-6,NOS3,and CYP1A1 polymorphisms with susceptibility of mycoplasma pneuponiae pneumnia in Chinease children. Medicine(Baltimore),2017,96:e6642.
14 Anderson SB,Baunbk Egelund G,Jensen AV,et al. Failure of CRP decline within three days of hospotalization is associated with poor prognosis of community-acquired pneumonia. Infect Dis(Lond),2017,49:251-260.
15 Leyenaar JK,Shieh MS,Lagu T,et al. Comparative effectiveness of ceftriaxone in combination with a macrolide compared with ceftriaxone alone for pediatric patients hospitalized with community-acquired pneumonia. Ped Inf Dis J,2014,33:387-392.
16 Anwar S,Crouch RA,Awadh Ali NA,et al. Hierarchical cluster analysis and chemical characterisation of Myrtuscommunis L. essential oil from Yemen region and its antimicrobial,antioxidant and anti-colorectal adenocarcinoma properties. Nat Prod Res,2017,9:1-6.
17 Li YY,Liu J,Li CW,et al. Myrtol standardized affects mucociliary clearance. Int Forum Allergy Rhinol,2017,7:304-311.
18 丁小军.五水头孢唑林钠加桃金娘油治疗儿童急性化脓性中耳炎.中国耳鼻咽喉头颈外科,2017,24:347-350.