转移因子口服液联合阿奇霉素序贯疗法治疗肺炎支原体肺炎患儿及对肺泡灌洗液MPO、GM-CSF的影响

Effect of transfer factor oral solution combined with azithromycin sequential therapy on mycoplasma pneumoniae pneumonia in children and MPO and GM-CSF in alveolar lavage

目的研究转移因子口服液联合阿奇霉素序贯疗法治疗肺炎支原体肺炎(MPP)患儿及对肺泡灌洗液髓过氧化物酶(MPO)、粒细胞巨噬细胞集落刺激因子(GM-CSF)的影响。方法前瞻性纳入2015年1月至2019年12月长沙市第四医院收治的MPP患儿126例,依据随机数字表法分为试验组(n=63)与对照组(n=63)。对照组给予对症治疗+阿奇霉素序贯治疗,试验组在对照组基础上给予转移因子口服液治疗。观察2组患儿发热、咳嗽、肺部啰音及肺部炎症等临床症状消失时间;比较2组患儿治疗前、治疗30 d后的第1秒用力呼气容积(FEV1)、用力肺活量(FVC)及FEV1/FVC等肺功能指标,血清免疫球蛋白A(IgA)、免疫球蛋白G(IgG)、免疫球蛋白M(IgM)等免疫因子水平,血清白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)及C反应蛋白(CRP)等炎症因子水平,肺泡灌洗液MPO、GM-CSF水平;比较2组患儿的临床疗效及不良反应。结果试验组患儿发热消失时间、咳嗽消失时间、肺部炎症吸收时间及肺部啰音消失时间均小于对照组,差异均有统计学意义(P<0.05)。治疗前,2组患儿FEV1、FVC及FEV1/FVC、血清IgA、IgG、IgM水平,血清IL-6、TNF-α、CRP水平以及肺泡灌洗液MPO、GM-CSF水平比较,差异均无统计学意义(P>0.05)。治疗30 d后,试验组患儿FEV1、FVC及FEV1/FVC均高于对照组,血清IgA、IgG、IgM水平均高于对照组,血清IL-6、TNF-α、CRP水平均低于对照组,肺泡灌洗液MPO、GM-CSF水平均低于对照组,差异均有统计学意义(P<0.05)。试验组的总有效率92.06%高于对照组的77.78%,差异有统计学意义(P<0.05)。治疗期间,2组患儿均未见严重不良反应。结论转移因子口服液联合阿奇霉素序贯疗法治疗小儿MPP可增强患儿机体免疫功能,抑制炎症因子及MPO、GM-CSF生成,快速改善临床症状,增强肺功能,疗效显著,安全可靠。

Objective To study the effect of transfer factor oral solution combined with azithromycin sequential therapy on mycoplasma pneumoniae pneumonia(MPP)in children and myeloperoxidase(MPO)and granulocyte macrophage colony stimulating factor(GM-CSF)in alveolar lavage.Methods A total of 126 children with MPP admitted to the Fourth Hospital of Changsha from January 2015 to December 2019 were prospectively included,and were divided into Experimental group(n=63)and Control group(n=63)according to the random number table method.The control group was given symptomatic treatment+Azithromycin sequential therapy,and the experimental group was given transfer factor oral solution on the basis of the control group.The disappearance time of clinical symptoms such as fever,cough,pulmonary rales and pulmonary inflammation in the two groups of children was observed;the lung function indicators forced expiratory volume in 1 second(FEV1)and forced vital capacity(FVC)and FEV1/FVC,immune factors serum immunoglobulin A(IgA),immunoglobulin G(IgG),immunoglobulin M(IgM)levels,inflammatory factors serum interleukin-6(IL-6)),tumor necrosis factor-α(TNF-α)and C-reactive protein(CRP)levels,alveolar lavage fluid MPO,GM-CSF levels were compared before treatment and 30 days after treatment in the two groups;the clinical efficacy and adverse reactions of the two groups of children were compared.Results The disappearance time of fever,cough,lung inflammation absorption time,lung rales disappearance time and other clinical symptoms in the experimental group were all less than those in the control group,the differences were statistically significant(P<0.05).Before treatment,the two groups of children had no difference in FEV1,FVC and FEV1/FVC,serum IgA,IgG,IgM levels,serum IL-6,TNF-α,CRP levels,and alveolar lavage fluid MPO and GM-CSF levels statistically significant(P>0.05).After 30 days of treatment,the FEV1,FVC,and FEV1/FVC in the experimental group were higher than those in the control group,the levels of serum IgA,IgG,and IgM in the experimental group were higher than those in the control group,and the levels of serum IL-6,TNF-α,and CRP in the experimental group were lower than in the control group,the levels of the alveolar lavage fluid MPO and GM-CSF in the experimental group were lower than those in the control group,and the differences were statistically significant(P<0.05).The total effective rate of the test group was 92.06%higher than that of the control group 77.78%,the difference was statistically significant(P<0.05).During the treatment,no serious adverse reactions were found in the two groups.Conclusion The transfer factor oral solution combined with azithromycin sequential therapy can enhance the immune function of children with MPP,inhibit the generation of inflammatory factors and MPO and GM-CSF,rapidly improve the clinical symptoms,enhance the lung function,and have a significant,safe and reliable effect.