盐酸氨溴索联合盐酸丙卡特罗治疗小儿支原体肺炎的疗效及对CRP、T淋巴细胞亚群、免疫球蛋白水平的影响

Effect of ambroxol hydrochloride combined with procaterol hydrochloride in the treatment of mycoplasma pneumonia in children and its influence on C-reactive protein,T lymphocyte subsets,and immunoglobulin.

目的研究盐酸氨溴索联合盐酸丙卡特罗治疗小儿支原体肺炎的疗效及对患儿C反应蛋白(CRP)、T淋巴细胞亚群免疫球蛋白水平的影响。方法选取深圳市宝安区石岩人民医院儿科2020年7月至2021年12月期间接诊的60例小儿支原体肺炎患儿作为研究对象。按随机数表法分为观察组和对照组各30例。在常规治疗基础上对照组采用盐酸氨溴索治疗,观察组在对照组治疗的基础上再联合盐酸丙卡特罗治疗,两组患儿均治疗7 d。比较两组患儿的治疗效果、退热时间、止咳时间、啰音消失时间、住院时间和肺功能指标[第1秒用力呼气容积(FEV1)、用力肺活量(FVC)、最大呼气中期流速(MMEF)]水平以及治疗前后的CRP水平、T淋巴细胞亚群[诱导性T细胞(CD4^(+))、抑制性T细胞(CD8^(+))、CD4^(+)/CD8^(+)]水平、免疫球蛋白[免疫球蛋白A(IgA)、免疫球蛋白G(IgG)、免疫球蛋白M(IgM)]水平。结果观察组患儿的治疗总有效率为96.67%,明显高于对照组的73.33%,差异有统计学意义(P<0.05);观察组患儿的退热时间、止咳时间、啰音消失时间、住院时间分别为(2.68±0.56)d、(2.54±0.62)d、(3.87±1.06)d、(8.02±2.34)d,明显快(短)于对照组的(3.86±1.03)d、(4.16±1.23)d、(6.52±1.25)d、(10.56±3.18)d,差异均有统计学意义(P<0.05);治疗后,观察组患儿的FEV1、FVC、MMEF分别为(62.13±7.03)%、(60.54±6.32)%、(68.12±6.98)%,明显高于对照组的(50.64±6.23)%、(52.13±7.03)%、(54.36±7.02)%,差异均有统计学意义(P<0.05);治疗后,观察组患儿的CRP、T淋巴细胞群指标CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)分别为(10.56±3.02)mg/L、(50.12±4.97)%、(27.98±3.12)%、1.95±0.48,对照组患儿则分别为(16.58±4.98)mg/L、(44.34±5.23)%、(30.23±2.98)%、1.52±0.43,两组患儿的CRP、T淋巴细胞群指标CD4^(+)、CD8^(+)均明显降低,且观察组明显低于对照组,而CD4^(+)/CD8^(+)明显升高,且观察组明显高于对照组,差异均有统计学意义(P<0.05);治疗后,两组患儿的免疫球蛋白指标IgA、IgG、IgM均明显升高,且观察组患儿IgA、IgG、IgM分别为(3.02±0.12)g/L、(13.65±2.64)g/L、(1.72±0.42)g/L,明显高于对照组患儿的(2.56±0.36)g/L、(12.03±2.18)g/L、(1.42±0.38)g/L,差异均有统计学意义(P<0.05)。结论盐酸氨溴索联合盐酸丙卡特罗治疗小儿支原体肺炎能改善患儿CRP、T淋巴细胞亚群细胞因子水平,提高免疫球蛋白水平,治疗效果显著,具有临床应用价值。

Objective To study the efficacy of ambroxol hydrochloride combined with procaterol hydrochloride in the treatment of mycoplasma pneumonia in children and its effect on the levels of C-reactive protein(CRP),T lymphocyte subsets,and immunoglobulin in children.Methods Sixty children with mycoplasma pneumonia were selected as the research objects from Department of Pediatrics,Shiyan People's Hospital of Bao'an District of Shenzhen from July 2020 to December 2021.They were randomly divided into a study group and a control group,with 30 cases in each group.On the basis of routine treatment,the control group was treated with ambroxol hydrochloride,and the study group was treated with procaterol hydrochloride on the basis of the control group.The two groups of children were treated for 7 days.The treatment effect,antipyretic time,cough relief time,rale disappearance time,length of hospital stay,lung function index level[forced expiatory volume in the first second(FEV1),forced vital capacity(FVC),maximum mid-expiatory flow(MMEF)],CRP level before and after treatment,T lymphocyte subsets level[induced T cells(CD4^(+)),inhibitory T cells(CD8^(+)),CD4^(+)/CD8^(+)],immunoglobulin[immunoglobulin A(IgA),immunoglobulin G(IgG),immunoglobulin M(IgM)]levels were compared between the two groups.Results The total effective rate of the study group was 96.67%,which was significantly higher than 73.33%of the control group(P<0.05).The antipyretic time,cough relief time,rale disappearance time,and length of hospital stay of children in the study group were(2.68±0.56)d,(2.54±0.62)d,(3.87±1.06)d,and(8.02±2.34)d,which were significantly faster(shorter)than(3.86±1.03)d,(4.16±1.23)d,(6.52±1.25)d,and(10.56±3.18)d in the control group(P<0.05).After treatment,FEV1,FVC,and MMEF in the study group were(62.13±7.03)%,(60.54±6.32)%,(68.12±6.98)%,which were significantly higher than(50.64±6.23)%,(52.13±7.03)%,(54.36±7.02)%in the control group(P<0.05).After treatment,the levels of CRP,and T lymphocyte group CD4^(+),CD8^(+),and CD4^(+)/CD8^(+)in the study group were(10.56±3.02)mg/L,(50.12±4.97)%,(27.98±3.12)%,1.95±0.48,while those in the control group were(16.58±4.98)mg/L,(44.34±5.23)%,(30.23±2.98)%,1.52±0.43;the levels of CRP and T lymphocyte group CD4^(+),CD8^(+)in the two groups were significantly lower than those before treatment,and the levels in the study group after treatment were significantly lower than those in the control group;CD4^(+)/CD8^(+)in the two groups increased significantly compared with those before treatment,and the level in the study group after treatment was significantly higher than that in the control group;the differences were statistically significant(P<0.05).After treat-ment,the immunoglobulin indexes IgA,IgG,and IgM in the two groups were significantly increased,and the IgA,IgG,and IgM in the study group were(3.02±0.12)g/L,(13.65±2.64)g/L,and(1.72±0.42)g/L,which were significantly high-er than(2.56±0.36)g/L,(12.03±2.18)g/L,and(1.42±0.38)g/L in the control group(P<0.05).Conclusion Ambroxol hydrochloride combined with procaterol hydrochloride in the treatment of mycoplasma pneumonia in children can im-prove the levels of CRP,T lymphocyte subsets,and immunoglobulin,which has significant treatment effect and is of great clinical application value.