葶黄润肺饮与穴位贴敷联合阿奇霉素治疗小儿支原体肺炎临床研究

Clinical study on the effect of oral and acupoint application of traditional chinese medicine combined with azithromycin for the children with mycoplasma pneumonia

目的评价葶黄润肺饮与穴位贴敷联合阿奇霉素治疗小儿支原体肺炎（mycoplasma pneumonia，MP）的疗效。方法将符合入选标准的160例支原体肺炎患儿按随机数字表法分为2组，每组80例。对照组在止咳、化痰等常规治疗基础上联合阿奇霉素治疗，治疗组在对照组基础上口服葶黄润肺饮与穴位贴敷治疗。2组均治疗3周。采用酶联免疫法检测血清IL-8、TNF-α、凝血酶调节蛋白（thrombomodulin，TM），采用乳胶增强免疫比浊法检测血清D．二聚体（D．dimer），比较2组患儿退热时间、咳嗽消失时间、肺部哕音消失时间，评价临床疗效。结果治疗组总有效率为97．5％（78／80）、对照组为88．8％（71／80），2组比较差异有统计学意义（Х^2=4．783，P=0．029）。治疗后，治疗组血清IL-8[（9．98±4．26）ng／L比（14．18±4．82）ng／L，f=5．8403、TNF-α[（20．78±5．93）ng／L比（26．07±6．42）ng／L，f=5．414]、TM[（9．63±2．88）μg／L比（13．08±3．37）μg／L，f=6．961]、D—dimer[（0．09±0．04）ng／L比（0．15±0．06）ng／L，t=7．442]水平低于对照组（P〈0．01）。治疗组退热时间[（3．8±1．7）d比（4．9±1．6）d，t=3．846]、咳嗽消失时间[（8．2±2．4）d比（10．4±2．6）d，f=5．389]及肺部哕音消失时间[（6．2±1．9）d比（7．8±2．1）d，t=4．997]低于对照组（P〈0．01）。结论葶黄润肺饮与穴位贴敷联合阿奇霉素可有效缓解MP患儿症状，降低血清IL-8、TNF-α、TM、D-dimer水平，提高临床疗效。

Objective To investigate the clinical curative effect of oral and acupoint application of traditional chinese medicine combined with Azithromycin for the children with Mycoplasma Pneumonia. Methods A total of 160 children with mycoplasma pneumonia were divided into two groups according to digital random table method, with 80 cases in each group. The patients of the two groups were given conventional treatment to relieve cough and reduce phlegm; On the basic treatment of conventional treatment, the control group were treated with azithromycin, wile the treatment group were treated with oral traditional chinese medicine Tinghuang runfei decotion and acupointion application of Tinglizi, Baijiezi, Shengnanxing, Dahuang, and Bingpian. The treatment of both groups last 3 weeks. The time of defervescence, the disappearance time of cough and pulmonaryrales of the two groups were compared, and the serum levels of inter leukin 8 （IL-8）, tumor necrosis factor-α （TNF-α）, thrombin regulatory proteins （TM）, D-dimer were compared before and after treatment. The total effect rate and the incidence of adverse events were compared. Results The defervesce time （3.79 ±1.68 d vs. 4.88 ± 1.61 d, t=-3.846）, disappearance time of cough （8.21 ± 2.42 d vs. 10.35 ± 2.60 d, t=5.389） and disappearance time of pulmonary tales （6.21 ±1.89 d vs. 7.78 ±2.08 d, t=4.997） in the treatment group were significantly less than those in the control group （P〈0.01）. The levels of IL-8 （9.98± 4.26 ng/L vs. 14.18 ±4.82 ng/L, t=-5.840）, TNF-α （20.78 ±5.93ng/L vs. 26.07 ±6.42 ng/L, t=5.414）, TM （9.63 ±2.88 gg/L vs. 13.08 4- 3.37 gg/L, t=6.961）, D-dimer levels （0.09 4- 0.04 ng/L vs. 0.15 ± 0.06 ng/L, t=-7.442） the treatment group were significantly better than those in the control group （P〈0.01）. The total effect rate in the treatment gruop was significantly higher than that of the control group （97.5% vs. 88.8%; 2,2=4.783, P=-0.029）, but there was no significant difference in the incidence of adverse events between the two groups （16.3% vs. 10.0%; Х^2=1.370, P=-0.272）. Conclusions Oral and acupointion of traditional chinese medicine Tinghuang runfei decotion combined with azithromycin could relieve the symptoms, improve the clincal effect and show its safety for the children with mycoplasma pneumonia.