沙参麦冬汤加减辅助治疗小儿支原体肺炎阴虚肺热证45例临床观察

Clinical observation on 45 cases of mycoplasmal pneumoniae pneumonia in children with yin-deficiency resulting in lung-heat syndrome adjuvantly treated by modified Shashen Maidong Tang(沙参麦冬汤)

目的 观察沙参麦冬汤加减辅助治疗小儿支原体肺炎(MPP)阴虚肺热证的临床疗效。方法 选取温州医科大学附属第二医院江南分院(苍南县第三人民医院)儿科2019年1月至2020年12月收治的MPP阴虚肺热证患儿87例,按照随机数字表法分为对照组42例和治疗组45例。对照组在常规对症治疗的基础上予阿奇霉素分散片口服,持续用药5 d并停服2 d后进行下一个疗程;治疗组在对照组治疗方法的基础上联合沙参麦冬汤加减。2组均7 d为1个疗程,治疗2个疗程后比较2组的临床疗效,治疗前后中医证候积分、免疫指标和炎症因子的变化情况。结果 对照组总有效率为83.33%(35/42),治疗组为97.78%(44/45),2组比较,差异有统计学意义(P<0.05)。治疗前2组中医证候积分比较,差异无统计学意义(P>0.05),具有可比性;治疗后2组中医证候积分均明显下降,与同组治疗前比较,差异有统计学意义(P<0.05),且治疗组下降更显著(P<0.05)。治疗前2组CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)水平比较,差异无统计学意义(P>0.05),具有可比性;治疗后2组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平明显升高,CD8^(+)水平明显下降,与同组治疗前比较,差异有统计学意义(P<0.05),且治疗组升高或下降更显著(P<0.05)。治疗前2组血清白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平比较,差异无统计学意义(P>0.05),具有可比性;治疗后2组血清IL-6、TNF-α水平均明显下降,与同组治疗前比较,差异有统计学意义(P<0.05),且治疗组下降更显著(P<0.05)。结论 沙参麦冬汤加减辅助治疗小儿MPP阴虚肺热证,能有效缓解患儿临床症状,提高机体免疫力,减轻炎症反应,疗效显著,值得临床推广应用。

Objective To observe the clinical efficacy of modified Shashen Maidong Tang(沙参麦冬汤)in adjuvant treatment of mycoplasmal pneumoniae pneumonia(MPP)in children with yin-deficiency resulting in lung-heat syndrome.Methods From January 2019 to December 2020,87 cases of MPP in children with yin-deficiency resulting in lung-heat syndrome admitted into pediatrics department of the Second Hospital Jiangnan Branch Affiliated to Wenzhou Medical University(the Third People’s Hospital in Cangnan County)were chosen and divided into control group with 42 cases and treatment group with 45 cases according to random number table method.The control group was given azithromycin dispersible tablets orally on the basis of routine symptomatic treatment,continuous medication for 5 days and stopped for 2 days before the next course of treatment.On the basis of the therapeutic method of the control group,the treatment group was combined with modified Shashen Maidong Tang,7 days constituted 1 course of treatment for both groups,totally 2 courses of treatment.After the course of treatment,the clinical efficacy,the changes of TCM syndrome score,immune indexes and inflammatory factors between the 2 groups before and after treatment were compared.Results The total effective rate of the control group was 83.33%(35/42),that of the treatment group was 97.78%(44/45),and the difference was statistically significant between the 2 groups(P<0.05).Before treatment,the difference was not statistically significant in TCM syndrome score between the 2 groups(P>0.05),indicating comparability.After treatment,TCM syndrome score in the 2 groups significantly decreased,and the difference was statistically significant than that in the same group before treatment(P<0.05),moreover,the decrease in treatment group was more significant(P<0.05).Before treatment,the difference was not statistically significant in the levels of CD3^(+),CD4^(+),CD8^(+)and CD4^(+)/CD8^(+)between the 2 groups(P>0.05),indicating comparability.After treatment,the levels of CD3^(+),CD4^(+)and CD4^(+)/CD8^(+)significantly increased,whereas CD8^(+)significantly decreased in the 2 groups,and the difference was statistically significant than those in the same group before treatment(P<0.05),moreover,the increase or decrease in the treatment group was more significant(P<0.05).Before treatment,there was no statistically significant differences in serum levels of interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)between the 2 groups(P>0.05),indicating comparability.After treatment,serum levels of IL-6 and TNF-αin the 2 groups significantly decreased,and the differences were statistically significant than those in the same group before treatment(P<0.05),moreover,the decrease in treatment group was more significant(P<0.05).Conclusion It can effectively alleviate the clinical symptoms,improve the body immunity,reduce inflammatory reactions with marked efficacy to use modified Shashen Maidong Tang in adjuvant treatment of MPP in children with yin-deficiency resulting in lung-heat syndrome with marked efficacy,which is worthy of clinical promotion and application.