清热解毒方治疗儿童难治性肺炎支原体肺炎的临床疗效及其肺泡灌洗液细胞因子的变化

Clinical efficacy of Qingre Jiedu Formula in treating children with refractory mycoplasma pneumoniae pneumonia and the change of cytokines in BALF

目的:探讨清热解毒方治疗儿童难治性肺炎支原体肺炎(RMPP)的临床疗效及其肺泡灌洗液(BALF)中细胞因子的变化。方法:选取在河北省儿童医院呼吸科诊断为RMPP患儿60例,随机分入中药治疗组和非中药治疗组,各30例,入组患儿均给予阿奇霉素抗菌、糖皮质激素抗炎、支气管镜灌洗等治疗,中药治疗组加服清热解毒方中药5d,记录两组患儿5d退热例数、退热时间、咳嗽明显减轻时间,测定治疗前后BALF中的白细胞介素(IL)-4、IL-6、IL-10、γ干扰素(IFN-γ)水平,设置同期支气管镜取异物的20例患儿为对照组。结果:与非中药治疗组比较,中药治疗组5d退热例数更多(P<0.05),退热时间、咳嗽明显减轻时间均显著缩短(P<0.05)。治疗前与对照组比较,两组RMPP患儿BALF的IL-4、IL-6、IL-10、IFN-γ显著升高(P<0.05);治疗5d后中药治疗组较非中药治疗组IL-6水平显著降低(P<0.05)。结论:清热解毒方治疗RMPP疗效显著。调节因MP感染导致的高细胞因子可能是清热解毒方治疗RMPP的作用机制之一。

Objective: To investigate the clinical efficacy of Qingre Jiedu Formula in treating children with refractory mycoplasma pneumoniae pneumonia(RMPP) and the change of cytokines in BALF. Methods: Sixty children diagnosed RMPP in the Respiratory Department of Hebei Children’s Hospital randomly assigned into TCM treatment group and non-TCM treatment group, each group of 30 cases. All the children were given Azithromycin antibacterial, glucocorticoid anti-inflammatory,bronchoscopic irrigation and other therapy, TCM treatment group add Qingre Jiedu Formula for 5 days, fever and cough reduction time in both groups were recorded and IL-4, IL-6, IL-10, IFN-γ levels in BALF before and after treatment were detected. At the same time, children admitted for bronchoscopy due to bronchial foreign body were set as the control group(20 cases). Results:Compared with non-TCM treatment group, more antipyretic cases in the TCM treatment group after 5 days later(P<0.05), the antipyretic time and cough reduction time in TCM group were significantly shorter(P<0.05). Compared with control group, IL-4, IL-6, IL-10, IFN-γ in BALF in two groups of RMPP were increased(P<0.05). After five days, compared with non-TCM treatment group, IL-6 level decreased in TCM treatment group(P<0.05). Conclusion: Qingre Jiedu Formula in treating RMPP has obvious effect. Improving abnormal cytokines due to MP infection may be one of the mechanisms of Qingre Jiedu Formula in treating RMPP.