清肺通络方序贯治疗儿童肺炎支原体肺炎的临床研究

Clinical study of sequential therapy with Qingfei Tongluo Decoction on children with mycoplasma pneumoniae pneumonia

目的观察清肺通络方口服序贯治疗儿童肺炎支原体肺炎(MPP)的临床疗效。方法将120例MPP患儿随机分为中药组与对照组各60例,2组均先静滴阿奇霉素5 d,中药组第6天起给予清肺通络方口服15 d,对照组则停药3 d,第9天起给予阿奇霉素口服5 d,停药4 d后,再口服3 d,2组均至第20天治疗完毕后停药。统计2组治疗结束后总体疗效及治疗12周后血清肺炎支原体抗体-IgM(MP-IgM)转化情况,观察2组治疗前及治疗20 d后中医证候积分及血常规、C反应蛋白(CRP)、降钙素原(PCT)水平变化情况,记录2组不良反应发生情况。结果 2组总体疗效比较差异无统计学意义(P>0.05);治疗12周后,对照组MP-IgM转化率明显高于中药组(P<0.05);2组治疗后主要证候积分、次要证候积分及总分均明显降低(P均<0.05),且中药组痰壅症状积分及次要证候积分、总分均明显低于对照组(P均<0.05)。2组治疗后血白细胞计数、中性粒细胞百分比及CRP、PCT水平均明显降低(P均<0.05),淋巴细胞百分比均明显升高(P均<0.05),但2组治疗后各指标比较差异无统计学意义(P均>0.05)。2组均无药物过敏及严重胃肠道反应等不良反应发生。结论清肺通络方口服序贯治疗儿童MPP的总体疗效与阿奇霉素相当,能够促进MP-IgM转阴,抑制炎性反应,且化痰效果更好,安全性高,值得临床推广应用。

Objective It is to observe the clinical efficacy of sequential therapy with Qingfei Tongluo Decoction in the treatment of children with mycoplasma pneumoniae pneumonia (MPP). Methods 120 children with MPP were randomly divided into the Chinese medicine group and the control group, 60 cases in each group. The two groups were given azithromycin for 5 days. After that, the Chinese medicine group was treated with Qingfei Tongluo decoction by oral administration for 15 days, and the control group was treated with azithromycin for 5 days from the 9th day after 3 days of withdrawal, and then repeated for 3 days after 4 days of withdrawal, both groups were stopped after the treatment on the 20th day. The overall efficacy of the two groups after treatment and the transformation of serum mycoplasma pneumoniae antibody-IgM (MP-IgM) after 12 weeks of treatment were observed. The TCM syndrome scores and blood routine and the levels of C-reactive protein (CRP) and procalcitonin (PCT) were observed before and after treatment for 20 days, and the incidence of adverse reactions in the two groups was recorded. Results There was no significant difference in the overall efficacy between the two groups ( P >0.05). After 12 weeks of treatment, the conversion rate of MP-IgM in the control group was significantly higher than that in the Chinese medicine group ( P <0.05). The main and secondary syndrome scores and total scores were significantly decreased in the two groups( P <0.05), and the symptom scores of accumulation of phlegm and secondary syndrome scores and total scores of the Chinese medicine group were significantly lower than those of the control group ( P <0.05). After treatment, the white blood cell count, the percentage of neutrophils and the levels of CRP and PCT were significantly decreased ( P <0.05), and the percentage of lymphocytes were significantly increased ( P <0.05), but there was no significant difference in the indexes between the two groups ( P >0.05). No adverse reactions such as drug allergy and severe gastrointestinal reactions occurred in either group. Conclusion The overall efficacy of sequential therapy with Qingfei Tongluo Decoction which can promote the conversion of MP-IgM and inhibit the inflammatory reaction, with better expectoration effects and higher safety is similar to that of azithromycin in the treatment of children with MPP. It is worthy of clinical application.