炎琥宁注射液辅助治疗难治性肺炎支原体肺炎患儿的临床疗效及其对免疫功能、细胞因子的影响研究

Clinical Effect of Andrographolide Injection in Treating Children with Refractory Mycoplasma Pneumoniae Pneumonia and the Impact on Immunologic Function and Cytokines

目的观察炎琥宁注射液辅助治疗难治性肺炎支原体肺炎(RMPP)患儿的临床疗效,并探讨其对免疫功能、细胞因子的影响。方法选取2013年1月—2016年6月广元市苍溪县人民医院收治的RMPP患儿80例,采用随机数字表法分为对照组和观察组,每组40例。对照组患儿在常规治疗基础上给予阿奇霉素及氢化可的松治疗,观察组患儿在对照组治疗基础上加用炎琥宁注射液治疗;两组患儿均连续治疗1周。比较两组患儿临床疗效,治疗前后T淋巴细胞亚群、血清免疫球蛋白及细胞因子水平;观察两组患儿治疗期间不良反应发生情况及随访3个月复发情况。结果观察组患儿临床疗效优于对照组(P<0.05)。治疗前两组患儿CD_3^+细胞分数、CD_4^+细胞分数、CD_8^+细胞分数及CD_4^+/CD_8^+细胞比值比较,差异无统计学意义(P>0.05);治疗后观察组患儿CD_4^+细胞分数和CD_4^+/CD_8^+细胞比值高于对照组(P<0.05),而两组患儿CD_3^+细胞分数和CD_8^+细胞分数比较,差异无统计学意义(P>0.05)。治疗前两组血清免疫球蛋白A(IgA)、免疫球蛋白G(IgG)、免疫球蛋白M(IgM)水平比较,差异无统计学意义(P>0.05);治疗后观察组患儿血清IgG、IgM水平低于对照组(P<0.05),而两组患儿血清IgA水平比较,差异无统计学意义(P>0.05)。治疗前两组患儿血清白介素2(IL-2)、白介素4(IL-4)、白介素10(IL-10)、干扰素γ(IFN-γ)水平比较,差异无统计学意义(P>0.05)。治疗后观察组患儿血清IL-2水平高于对照组,IL-4和IL-10水平低于对照组(P<0.05);而两组患儿血清IFN-γ水平比较,差异无统计学意义(P>0.05)。两组患儿治疗期间不良反应发生率比较,差异无统计学意义(P>0.05)。对显效及有效患儿随访3个月,两组患儿复发率比较,差异无统计学意义(P>0.05)。结论炎琥宁注射液辅助治疗RMPP患儿的临床疗效确切,能有效改善患儿免疫功能、降低血清细胞因子水平,且安全性较高。

Objective To observe the clinical effect of andrographolide injection in treating children with refractory mycoplasma pneumoniae pneumonia, to investigate the impact on immunologic function and cytokines. Methods From January 2013 to June 2016, a total of 80 children with refractory mycoplasma pneumoniae pneumonia were selected in the Peopled Hospital of Cangxi County, Guangyuan, and they were divided into control group and observation group according to random number table, each of 40 cases. Based on conventional treatment, children of control group received azithromycin and hydrocortisone, while children of observation group received extra andrographolide injection based on that of control group; both groups continuously treated for 1 week. Clinical effect, T - lymphocyte subsets, serum levels of immune globulin and cytokines before and after treatment were compared between the two groups, incidence of adverse reactions during the treatment and recurrence during the 3 - month follow - up were observed. Results Clinical effect of observation group was statistically significantly better than that of control group （ P〈0.05 ）. No statistically significant differences of CD3^＋ cell percentage, CD4^＋ cell percentage, CD8^＋ cell percentage or CD4^＋ /CD8^＋ cell ratio was found between the two groups before treatment （ P 〉 0. 05 ）; after treatment, CD4^＋ cell percentage and CD4^＋/CD8^＋ cell ratio of observation group were statistically significantly higher than those of control group （P 〈0. 05）,while no statistically significant differences of CD3^＋ cell percentage or CD8^＋ cell percentage was found between the two groups （P 〉 0. 05 ） . No statistically significant differences of serum level of IgA, IgG or IgM was found between the two groups before treatment （ P 〉 0. 05 ） ; after treatment, serum levels of IgG and IgM of observation group were statistically significantly lower than those of control group （P 〈0. 0 5 ） ,while no statistically significant differences of serum IgA level was found between the two groups （ P 〉 0. 05 ） . No statistically significant differences of serum level of IL-2, IL-4,IL- 10 or IFN-γ was found between the two groups before treatment （ P 〉 0. 05 ） ; after treatment, serum IL-2 level of observation group was statistically significantly higher than that of control group, serum levels of IL-4 and IL-10 of observation group were statistically significantly lower than those of control group （ P 〈 0. 05 ） , while no statistically significant differences of serum IFN-γ level was found between the two groups （ P 〉 0. 05 ）. No statistically significant differences of incidence of adverse reactions was found between the two groups during the treatment （ P 〉 0. 05 ）. During the 3 - month follow - up in children with excellent and effective effect, no statistically significant differences of recurrence rate was found between the two groups （P 〉 0. 05 ） . Conclusion Andrographolide injection has certain clinical effect in treating children with refractory mycoplasma pneumoniae pneumonia, can effectively improve the immunologic function and reduce the serum cytokines levels, and is relatively safe.