痰热浓煎剂联合阿奇霉素治疗小儿肺炎支原体肺炎的疗效及对患儿气道炎症的影响

Clinical Efficacy of Phlegm-heat Concentrated Decoction Combined with Azithromycin in the Treatment of Mycoplasma Pneumoniae Pneumonia and its Effect on Airway Inflammation in Children

目的:探讨痰热浓煎剂联合阿奇霉素治疗小儿肺炎支原体肺炎(mycoplasmal pneumoniae pneumonia,MPP)的疗效及对患儿气道炎症的影响。方法:选取2018年4月至2019年3月南京市中西医结合医院收治的小儿MPP患者86例,采用简单随机数字表法将其分成观察组和对照组,每组43例。对照组患儿给予阿奇霉素治疗,观察组患儿在对照组的基础上联合痰热浓煎剂治疗,两组患儿均治疗14 d。观察两组患儿的临床疗效、主要临床表现的缓解时间和不良反应发生情况,治疗前后潮气呼吸肺功能指标[呼吸频率(RR)、潮气量(VT/kg)、达峰容积比(VPEF/VE)及吸/呼比(Ti/Te)变化]水平、血常规指标[外周血嗜酸性粒细胞(EOS)绝对值]水平、呼出气一氧化氮(FeNO)浓度及血清嗜酸粒细胞阳离子蛋白(ECP)、白三烯B4(LTB4)水平。结果:观察组患儿的总有效率为95.3%(41/43),明显高于对照组的81.4%(35/43),差异有统计学意义(P<0.05)。观察组患儿发热、咳嗽、肺部啰音及X线阴影的改善时间较对照组明显缩短,差异均有统计学意义(P<0.05)。治疗后,两组患儿的RR明显低于治疗前,VT/kg、VPEF/VE及Ti/Te值明显高于治疗前,差异均有统计学意义(P<0.05);且治疗后,观察组患儿RR、VT/kg、VPEF/VE及Ti/Te的改善效果明显优于对照组同期,差异均有统计学意义(P<0.05)。与治疗前比较,两组患儿治疗后外周血EOS绝对值、FeNO浓度及血清ECP、LTB4含量均明显降低;且治疗后,观察组患儿外周血EOS绝对值、FeNO浓度及血清ECP、LTB4水平均明显低于对照组同期,差异均有统计学意义(P<0.05)。两组患儿均无严重不良反应发生。结论:痰热浓煎剂联合阿奇霉素治疗小儿MPP的整体疗效良好,可迅速促进患儿主要临床表现的缓解,改善肺功能,可能与患儿气道炎症反应的显著减轻有关。

OBJECTIVE:To probe into the efficacy of phlegm-heat concentrated decoction combined with azithromycin in the treatment of mycoplasma pneumoniae pneumonia(MMP)and its effect on airway inflammation in children.METHODS:Totally 86 children with MPP admitted into Nanjing Integrated Traditional Chinese and Western Medicine Hospital from Apr.2018 to Mar.2019 were selected and divided into observation group and control group via random number table,with 43 cases in each group.The control group was treated with azithromycin,while the observation group was given phlegm-heat concentrated decoction based on the control group,both groups were treated for 14 days.The clinical efficacy,remission times of main clinical manifestation,incidences of adverse drug reactions,tidal breathing pulmonary function[respiratory rate(RR),tidal volume(VT/kg),peak-to-volume ratio(VPEF/VE)and inhalation/expiration ratio(Ti/Te)],blood routine index[changes of absolute value of eosinophils(EOS)in peripheral blood],concentration of exhaled nitric oxide(FeNO),serum eosinophils cationic protein(ECP)and leukotrienes B4(LTB4)levels of before and after treatment were observed.RESULTS:The total effective rate of observation group was 95.3%(41/43),which was significantly higher than that of the control group(81.4%,35/43),with statistically significant difference(P<0.05).The remission times of fever,cough,lung rales and X-ray of observation group were significantly shorter than those of the control group,with statistically significant differences(P<0.05).After treatment,the RR values of both group were significantly lower than those of before treatment,while the VT/kg,VPEF/VE and Ti/Te were significantly higher,with statistically significant differences(P<0.05);after treatment,the improvements of RR,VT/kg,VPEF/VE and Ti/Te of observation group were significantly better than those of the control group,with statistically significant differences(P<0.05).Compared with before treatment,the EOS absolute value in peripheral blood,concentration of FeNO,serum ECP and LTB4 levels of both groups had been significantly decreased;after treatment,the EOS absolute value in peripheral blood,concentration of FeNO,serum ECP and LTB4 levels of observation group were significantly lower than those of the control group,with statistically significant differences(P<0.05).No severe adverse drug reactions occurred in both groups.CONCLUSIONS:The general efficacy of phlegm-heat concentrated decoction combined with azithromycin in the treatment of MPP in children is significant,which can rapidly promote the remission of main clinical manifestation and improve pulmonary function,and may be related to the significant relief of the airway inflammation.