特布他林联合匹多莫德对支原体肺炎患儿miR-223和miR-199a-3p表达的影响

Effects of terbutaline combined with pidotimod on the expression of miR-223 and miR-199a-3p in children with mycoplasma pneumonia

目的探究特布他林联合匹多莫德对支原体肺炎患儿miR-223和miR-199a-3p表达的影响。方法选取2018年6月—2020年6月湖州市第一人民医院收治的100例支原体肺炎患儿为研究对象,采用抽签法将其分为对照组和观察组,每组各50例患儿。两组患儿均采取常规治疗,对照组患儿在常规治疗基础上雾化吸入特布他林,观察组患儿在对照组基础上口服匹多莫德口服液。比较两组患儿肺功能指标、免疫功能指标、miR-223、miR-199a-3p表达量、可溶性B7-H3(sB7-H3)、血清嗜酸粒细胞阳离子蛋白(ECP)、趋化因子白细胞介素-8(CXCL8)水平、临床症状及疗效。结果治疗后,观察组患儿呼气峰值流速(PEF)、用力肺活量(FVC)、第1秒用力呼气容积(FEV1)及FEV1/FVC水平[(2.96±0.28)L/s、(1.42±0.11)L、(1.31±0.12)L及(74.75±2.85)%]均高于对照组患儿[(2.79±0.30)L/s、(1.30±0.14)L、(1.22±0.11)L及(69.34±2.46)%],差异均有统计学意义(t=2.929、4.766、3.909及10.160,均P<0.05)。观察组患儿CD3^(+)、CD4^(+)水平[(70.78±4.29)%、(41.45±8.72)%]高于对照组患儿[(65.14±4.75)%、(35.84±7.46)%],CD8+[(22.23±6.24)%]水平低于对照组患儿[(27.76±6.52)%],差异均有统计学意义(t=6.231、3.457及4.333,均P<0.05)。观察组患儿miR-223水平(6.69±1.37)低于对照组患儿(10.68±1.85),miR-199a-3p水平(15.50±3.80)高于对照组患儿(11.38±3.69),差异均具有统计学意义(t=12.261、5.500,均P<0.05)。观察组患儿sB7-H3、ECP及CXCL8水平[(3.62±1.23)ng/L、(21.52±7.76)μg/L及(160.26±29.81)ng/L]低于对照组患儿[(5.19±1.54)ng/L、(30.44±9.62)μg/L及(237.80±30.41)ng/L],G-CSF水平[(8.34±2.62)μg/L]高于对照组患儿[(5.49±2.43)μg/L],差异均具有统计学意义(t=5.633、5.103、12.884及5.641,均P<0.05)。观察组患儿咳嗽消失时间、喘息消失时间、发热消失时间及肺部啰音消失时间[(6.21±1.52)d、(6.57±1.12)d、(3.65±0.38)d及(6.41±1.53)d]均短于对照组患儿[(7.65±1.24)d、(8.21±1.42)d、(5.57±0.59)d及(8.72±1.46)d],差异均具有统计学意义(t=5.191、6.412、19.352及7.241,均P<0.05)。观察组患儿治疗总有效率(96.00%)明显高于对照组患儿(84.00%),差异具有统计学意义(χ^(2)=4.000,P<0.05)。结论特布他林联合匹多莫德治疗会让支原体肺炎患儿miR-223表达水平降低、miR-199a-3p表达水平升高,进而改善患儿机体炎症反应、提升机体免疫力。同时,联合治疗也会明显改善患儿的肺功能和临床症状,治疗有效率较高,值得临床推广。

Objective To explore the effect of terbutaline combined with pidotimod on the expression of miR-223 and miR-199a-3p in children with mycoplasma pneumonia.Methods A total of 100 patients with mycoplasma pneumonia admitted in Huzhou First People's Hospital from June 2018 to 2020 were selected for the study,and they were divided into control group and observation group by lottery,with 50 cases in each group.Children in the two groups were treated with conventional treatment.The children in the control group were inhaled terbutaline by nebulization on the basis of conventional treatment,and the children in the observation group were taken orally with pidotimod oral liquid on the basis of the control group.To compare and analyze the two groups of lung function indexes,immune function indexes,expression of miR-223,miR-199a-3p,soluble B7-H3(sB7-H3),serum eosinophil cationic protein(ECP),chemokine white blood cells Interleukin-8(CXCL8)level,clinical symptoms and efficacy.Results After treatment,the observation group peak expiratory flow rate(PEF),forced vital capacity(FVC),forced expiratory volume in the first second(FEV1),FEV1/FVC level[(2.96±0.28)L/s,(1.42±0.11)L,(1.31±0.12)L,(74.75±2.85)%]were all higher than the control group[(2.79±0.30)L/s,(1.30±0.14)L,(1.22±0.11)L,(69.34±2.46)%],the differences were statistically significant(t=2.929,4.766,3.909 and 10.160,all P<0.05).The CD3^(+) and CD4^(+) levels in the observation group[(70.78±4.29)%,(41.45±8.72)%]were higher than those in the control group[(65.14±4.75)%,(35.84±7.46)%],the CD8+level[(22.23±6.24)%]was lower than the control group[(27.76±6.52)%],the difference were statistically significant(t=6.231,3.457 and 4.333,all P<0.05).The level of miR-223 in the observation group[(6.69±1.37)]was lower than that of the control group[(10.68±1.85)],and the level of miR-199a-3p[(15.50±3.80)]was higher than that of the control group[(11.38±3.69)],the differences were statistically significant(t=12.261,5.500,all P<0.05).The levels of sB7-H3,ECP and CXCL8 in the observation group[(3.62±1.23)ng/L,(21.52±7.76)μg/L,(160.26±29.81)ng/L]were lower than those in the control group[(5.19±1.54))ng/L,(30.44±9.62)μg/L,(237.80±30.41)ng/L],G-CSF level[(8.34±2.62)μg/L]was higher than the control group[(5.49±2.43)μg/L],the difference were statistically significant(t=5.633,5.103,12.884 and 5.641,all P<0.05).Observation group cough disappearance time,wheezing disappearance time,fever disappearance time,lung rales disappearance time[(6.21±1.52)d,(6.57±1.12)d,(3.65±0.38)d,(6.41±1.53)d]were shorter than the control group[(7.65±1.24)d,(8.21±1.42)d,(5.57±0.59)d,(5.57±0.59)d,(8.72±1.46)d],the difference were statistically significant(t=5.191,6.412,19.352 and 7.241,all P<0.05).The total effective rate of treatment in the observation group(96.00%)was significantly higher than that in the control group(84.00%),and the difference was statistically significant(χ^(2)=4.000,P<0.05).Conclusion The combined treatment of terbutaline and pidotimod can reduce the expression of miR-223 and increase the expression of miR-199a-3p in children with mycoplasma pneumonia,thereby improving the body's inflammatory response and enhancing the body's immunity.At the same time,combined treatment will also effectively improve the lung function and clinical symptoms of children,and the treatment efficiency is significant,which was worthy of clinical promotion.