桑夏清肺汤分期免序贯治疗痰热壅肺型儿童支原体肺炎

Phlegm-Heat Obstructing in Lung of Mycoplasma Pneumonia in Children by Stage Non-Sequential Therapy with Sangxia Qingfei Decoction

目的:观察桑夏清肺汤分期免序贯治疗痰热壅肺型儿童支原体肺炎临床疗效、安全性及其对患者免疫功能、凝血状态的影响。方法:将120例支原体肺炎患儿随机分为对照组60例,观察组60例。对照组急性期以阿奇霉素静脉给药,恢复期以阿奇霉素干混剂口服序贯治疗。观察组急性期给以桑夏清肺汤联合阿奇霉素静脉给药,恢复期以桑夏清肺汤免阿奇霉素口服序贯治疗。比较两组患者证候积分、临床表现、临床疗效、安全性及免疫、凝血状态的变化。结果:(1)疗效指标:证候积分比较,观察组为(1.11±2.12)分,明显低于对照组的(2.43±2.92)分,差异有统计学意义(P<0.01);临床表现方面,两组患者体温、咳嗽、啰音消失时间及影像学恢复正常时间比较,观察组明显低于对照组,差异均有统计学意义(P值分别为0.021、0.04、0.02、0.01);临床疗效比较,观察组痊愈率为80%,明显优于对照组的61.7%,差异有统计学意义(P<0.05)。(2)免疫指标:治疗后两组患者CD_4^+、CD_4^+/CD_8^+、IgG明显升高,观察组患者CD_3^+、IgA明显升高,差异均有统计学意义(P<0.05)。与对照组比较,观察组CD_3^+、CD4^+、CD_4^+/CD_8^+、IgA、IgG明显较高,差异均有统计学意义(P<0.01)。(3)凝血指标:治疗后两组凝血酶原时间(prothrombin time,PT)显著升高,纤维蛋白原(fibrinogen,FIB)显著下降,观察组中血小板(platelets,PLT)、D二聚体(D-dimer,D-D)显著下降,凝血酶时间(thrombin time,TT)、部分凝血活酶时间(activated partial thromboplastin time,APTT)明显升高,差异均有统计学意义(P<0.05);与对照组比较,观察组PLT、FIB显著下降,PT、TT、APTT显著升高,差异均有统计学意义(P<0.05)。(4)安全性:观察组不良反应发生率为3.3%,显著低于对照组的18.3%(P<0.05)。结论:桑夏清肺汤分期免序贯治疗痰热壅肺型儿童支原体肺炎疗效显著,能明显改善症状、体征,促进免疫、凝血状态恢复平衡,且不良反应少。

Objective： To observe the effect,safety,immunity and the coagulation state on phlegm-heat obstructing in lung of mycoplasma pneumonia in children by stage non-sequential therapy with Sangxia Qingfei decoction. Methods： 120 cases of patients were randomly divided into the control group and the observation group,each of 60 cases. The azithromycin was given intravenous at the acute stage and orally in the sequential therapy at the recovery stage in the control group. The azithromycin was given intravenous combined with oral Sangxia Qingfei decoction at the acute stage and oral Sangxia Qingfei decoction only in the sequential therapy at the recovery stage in the treatment group. Compared the differences of syndrome scores,clinical manifestation,curative effect,safety,immunity and coagulation state between the two groups. Results：（1）The curative effect index： The score of syndrome in the observation group was（ 1. 11 ± 2. 12） points,which was significantly lower than that in the control group（ 2. 43 ± 2. 92） points. The difference was statistically significant（ P〈 0. 01）. The two groups were compared with the restoration time in clinical manifestations： high temperature,coughing,rales and imaging of pulmonary,P values were 0. 021,0. 04,0. 02 and 0. 01,the observation group was significantly better than the control group,the difference was statistically significant（ P〈 0. 05）. Compared with the control group,the cure rate of the observation group was 80%,which was significantly better than that of the control group 61. 7%,the difference was statistically significant（ P〈 0. 05）.（2）The immune index： CD4＋,CD4＋/CD8＋ and IgG were significantly increased in both two groups after treatment,CD3＋ and IgA in the observation group were significantly increased,the difference was statistically significant（ P〈 0. 05）,but there were no significant differences between the two groups with CD8＋ and IgM（ P〈 0. 05）.Compared with the control group,the CD3＋,CD4＋,CD4＋/CD8＋,IgA and IgG were significantly increased in the observation group,and the difference was statistically significant（ P〈 0. 01）,but there were no significant differences between the two groups with CD8＋and IgM（ P〈 0. 05）.（3） The coagulation index： Prothrombin time（ PT） was significantly increased while fibrinogen（ FIB） were significantly decreased in both two groups after treatment; platelets（ PLT） and D dimer（ D-D） decreased while thrombin time（ TT） and activated partial thromboplastin time（ APTT） increased in the observation group,the difference was statistically significant（ P〈 0. 05）. Compared with the control group,the PLT,FIB was decreased while PT,TT and APTT were significantly increased in the observation group. The difference was statistically significant（ P〈 0. 05）,but there were no significant differences between the two groups with D-D（ P〈 0. 05）.（4）The safety： the rate of side effects was 3. 3% in the treatment group and 18. 3%in the control group,the difference was statistical significance（ P〈 0. 05）. Conclusion： The effect of Sangxia Qingfei decoction in treating mycoplasma pneumonia in children with phlegm-heat obstructing in lung is remarkable. It could obviously improve symptoms and signs,promote immunity,restore balance of blood coagulation,and few adverse reactions.