儿童重症支原体肺炎中医证型与D-二聚体及免疫指标的关系

Relationship between TCM Syndrome Types and D-dimer and Immune Indexes in Children with Severe Mycoplasma Pneumoniae Pneumonia

目的探讨儿童重症支原体肺炎(SMPP)中医证型的特点以及与D-二聚体及免疫指标的关系。方法选择2019年9月至2020年2月在首都医科大学附属北京儿童医院中医科收治SMPP住院患儿73例,入院后进行中医辨证分型,观察各证型D-二聚体及免疫指标的表现特点。结果1)SMPP病程按风热闭肺证、痰热闭肺证、毒热闭肺证、阴虚肺热和肺脾气虚证逐渐延长(P<0.05)。2)痰热闭肺组、毒热闭肺组及肺脾气虚组D-二聚体均升高,毒热闭肺组升高最明显,各组比较差异有统计学意义(P<0.01)。3)肺脾气虚组与痰热闭肺组、毒热闭肺组比较,IgG、IgM差异具有统计学意义(P<0.01)。结论SMPP患儿在证型分布上以毒热闭肺正多见,中医证型与病程存在一定的相关性,毒热闭肺证血液高凝状态最明显,肺脾气虚证免疫功能紊乱最严重。

Objective:To explore the characteristics of traditional Chinese medicine(TCM)syndrome types of children with severe Mycoplasma pneumoniae pneumonia(SMPP)and the correlation with D-dimer and immune indexes.Methods:A total of 73 hospitalized children with SMPP from September 2019 to February 2020 were enrolled in the department of traditional Chinese medicine of Beijing Children’s Hospital,Capital Medical University.After admission,the syndrome differentiation and classification of traditional Chinese medicine was improved,the characteristics of each syndrome type were observed,and the correlation with D-dimer and immune index was discussed.Results:1)The course of SMPP was gradually prolonged according to wind-heat attacking lung syndrome,phlegm-heat obstructing lung syndrome,toxic-heat obstructing lung syndrome,yin deficiency and lung heat syndrome and lung spleen Qi deficiency syndrome(P<0.05).2)The level of D-dimer in the three groups increased significantly(P<0.01).3)There were significant differences in IgG and IgM between the lung spleen Qi deficiency group and phlegm-heat obstructing lung group、toxic-heat obstructing lung group(P<0.01).Conclusion:In the distribution of syndrome types of SMPP,toxic-heat obstructing lung syndrome is more common.There is a certain correlation between TCM syndrome type and course of disease.The most obvious hypercoagulable state of blood is in the syndrome of toxin heat closing lung,and the most serious immune dysfunction is in the syndrome of deficiency of lung qi and spleen.