麻杏石甘汤加味佐治小儿支原体肺炎的疗效及对叉头样转录因子3、调节性T细胞表达的影响

Efficacy of Modified Maxing Shigan Decoction in the Adjuvant Treatment of Mycoplasma Pneumonia in Children and its Effect on the Expression of Forkhead-Like Transcription Factors 3 and T Regulatory Cell

目的:探讨麻杏石甘汤加味佐治小儿支原体肺炎的临床疗效,分析其治疗机制。方法:选择2018年6月至2020年6月秦皇岛市中医医院收治的支原体肺炎患儿110例,按照随机数字表法分为两组,每组55例。对照组患儿予以阿奇霉素治疗,研究组患儿在对照组治疗基础上应用中药麻杏石甘汤加味。比较两组患儿治疗前后的中医证候评分,潮气呼吸肺功能指标[最大呼气流量(MEF)、达峰容积(VPEF)、潮气量(VT)和达峰容积比(VPEF/VE)]、呼出气一氧化氮(FeNO)、血清白三烯B4(LTB4)和嗜酸性粒细胞阳离子蛋白(ECP)水平,比较两组患儿外周血叉头样转录因子3(Foxp3)蛋白、Foxp3 mRNA表达及CD4^(+)CD25^(+)调节性T细胞(Treg)、CD4^(+)Foxp3^(+)Treg含量,并比较两组患儿的治疗总有效率。结果:治疗后,研究组患儿高热、咳嗽、胸痛和喘息等中医证候评分明显低于对照组,MEF、VPEF、VT和VPEF/VE水平明显高于对照组,FeNO、血清LTB4和血清ECP水平明显低于对照组,外周血Foxp3蛋白、Foxp3 mRNA表达及CD4^(+)CD25^(+)Treg、CD4^(+)Foxp3^(+)Treg含量明显高于对照组,上述差异均有统计学意义(P<0.01);研究组患儿的治疗总有效率为96.36%(53/55),明显高于对照组的83.64%(46/55),差异有统计学意义(P<0.05)。结论:麻杏石甘汤加味辅助治疗小儿支原体肺炎,可有效改善患儿的中医证候评分和肺功能,抑制气道炎症,效果显著;其机制可能与上调Foxp3基因表达,促进Treg的合成和分泌,增强机体免疫功能有关。

OBJECTIVE:To probe into the clinical efficacy of Maxing Shigan decoction in the adjuvant treatment of mycoplasma pneumonia in children,and to analyze its therapeutic mechanism.METHODS:Totally 110 children with mycoplasma pneumonia admitted into Qinhuangdao Hospital of Traditional Chinese Medicine from Jun.2018 to Jun.2020 were selected and randomly divided into two groups via the random number table,with 55 cases in each group.The control group was treated with azithromycin,while the research group was treated with modified Maxing Shigan decoction on the basis of the control group.The traditional Chinese medicine(TCM)syndrome integral,pulmonary function indicators of tidal breathing[maximal expiratory flow(MEF),volume at peak tidal expiratory flow(VPEF),tidal volume(VT),ratio of volume at peak tidal expiratory flow to expiratory tidal volume(VPEF/VE)],exhaled nitric oxide(FeNO),serum leukotriene B4(LTB4)and eosinophil cationic protein(ECP)levels before and after treatment were compared between two groups;the expression of forkhead transcription factors 3(Foxp3)protein and Foxp3 mRNA,the contents of CD4^(+)CD25^(+)regulatory T cell(Treg)and CD4^(+)Foxp3^(+)Treg in peripheral blood were compared between two groups,and the total effective rate was compared between two groups.RESULTS:After treatment,the TCM syndrome integral of fever,cough,chest pain and wheezing of the research group were significantly lower than those of the control group,the MEF,VPEF,VT and VPEF/VE levels of the research group were significantly higher than those of the control group,the FeNO,serum LTB4 and ECP levels of the research group were significantly lower than those of the control group,the expression of Foxp3 protein and Foxp3 mRNA,the contents of CD4^(+)CD25^(+)and CD4^(+)Foxp3^(+)Treg of the research group were significantly higher than those of the control group,with statistically significant differences(P<0.01);the total effective rate of research group was 96.36%(53/55),which was significantly higher than that of the control group(83.64%,46/55),with statistically significant difference(P<0.05).CONCLUSIONS:The modified Maxing Shigan decoction in the adjuvant treatment of mycoplasma pneumonia in children can effectively improve the TCM syndrome integral and pulmonary function of children,inhibit airway inflammation,with remarkable efficacy;the mechanism may be related to the up-regulation of Foxp3 gene expression,promotion of synthesis and secretion of Treg,and enhancement of immune function.