百令胶囊联合阿奇霉素治疗小儿支原体肺炎疗效及对血清sPD-1、CYTL1水平的影响

Effect of Bailing capsule combined with azithromycin on mycoplasma pneumonia in children and the levels of serum sPD-1 and CYTL1

目的观察百令胶囊联合阿奇霉素治疗小儿支原体肺炎的疗效及对血清可溶性程序性死亡受体1(sPD-1)、细胞因子样蛋白1(CYTL1)水平的影响。方法选取2018年3月—2021年9月海南医学院第二附属医院儿科二区诊治支原体肺炎患儿140例,通过随机数字表法分为对照组和观察组,各70例。对照组给予阿奇霉素治疗,观察组在对照组基础上联合百令胶囊治疗。比较2组患儿的总有效率、症状改善时间,治疗前后肺功能指标[第一秒用力呼气容积(FEV_(1))、用力肺活量(FVC)、FEV_(1)/FVC)]、血气分析[动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))、pH、动脉血氧饱和度(SaO_(2))]、炎性因子[C反应蛋白(CRP)、白介素-6(IL-6)、IL-10、肿瘤坏死因子-α(TNF-α)]、免疫功能指标[CD4^(+)、CD4^(+)/CD8^(+)、CD3^(+)、免疫球蛋白G(IgG)]、血清sPD-1、CYTL1水平,以及不良反应发生情况。结果观察组总有效率高于对照组,差异有统计学意义(82.86%vs.67.14%,χ^(2)=4.809,P=0.028)。观察组咳嗽减轻时间、血象恢复时间、退热时间和啰音消失时间明显低于对照组(t=23.253、14.382、33.859、14.960,P均<0.001)。治疗2周后,观察组FEV_(1)、FEV_(1)/FVC水平明显高于对照组(t=17.305、8.743,P均<0.001);PaO_(2)、pH、SaO_(2)水平明显高于对照组,PaCO_(2)水平明显低于对照组(t=10.717、5.435、7.513、6.426,P均<0.001);血清CRP、IL-6、IL-10、TNF-α水平明显低于对照组(t=24.031、7.203、8.499、7.743,P均<0.001);CD4^(+)、CD4^(+)/CD8^(+)、CD3^(+)、IgG水平均高于对照组(t=7.130、4.830、7.298、5.698,P均<0.001);血清sPD-1水平明显低于对照组,CYTL1水平明显高于对照组(t=10.292、7.787,P均<0.001)。2组不良反应发生率比较差异无统计学意义(P>0.05)。结论百令胶囊联合阿奇霉素能明显提高支原体肺炎患儿的临床疗效,缩短症状改善时间,增强肺功能,改善血气分析指标,降低炎性因子水平,提高免疫功能,降低血清sPD-1水平,升高CYTL1水平,安全性良好。

Objective To observe the therapeutic effect of Bailing capsule combined with azithromycin on mycoplasma pneumonia in children and its influence on the levels of serum soluble programmed death receptor 1(sPD-1)and cytokine like protein 1(CYTL1).Methods From March 2018 to September 2021,140 children with mycoplasma pneumonia diagnosed and treated in Pediatric Division II of the Second Affiliated Hospital of Hainan Medical College were selected and divided into the control group and the observation group by random number table method,with 70 cases in each group.The control group was treated with azithromycin,and the observation group was treated with Bailing capsule on the basis of the control group.The total effective rate,symptom improvement time,pulmonary function indexes(FEV_(1),FVC,FEV_(1)/FVC),blood gas analysis(PaO_(2),PaCO_(2),pH,SaO_(2)),inflammatory factors(CRP,IL-6,IL-10,TNF-α)before and after treatment were compared between the two groups-α,immune function indicators[CD4^(+),CD4^(+)/CD8^(+),CD3^(+),immunoglobulin G(IgG)],serum sPD-1,CYTL1 levels,and adverse reactions.Results The total effective rate of the observation group was higher than that of the control group,the difference was statistically significant(82.86%vs.67.14%,χ^(2)=4.809,P=0.028).The cough relief time,blood picture recovery time,antipyretic time and rale disappearance time in the observation group were significantly lower than those in the control group(t=23.253,14.382,33.859,14.960,P<0.001).After 2 weeks of treatment,the levels of FEV_(1)and FEV_(1)/FVC in the observation group were significantly higher than those in the control group(t=17.305,8.743,P<0.001).PaO_(2),pH,SaO_(2)levels were significantly higher than those in the control group,and PaCO_(2)levels were significantly lower than those in the control group(t=10.717,5.435,7.513,6.426,all P<0.001).Serum CRP,IL-6,IL-10,TNF-αThe level was significantly lower than that of the control group(t=24.031,7.203,8.499,7.743,P<0.001).The levels of CD4^(+),CD4^(+)/CD8^(+),CD3^(+)and IgG in the control group were higher than those in the control group(t=7.130,4.830,7.298,5.698,P<0.001).The level of serum sPD-1 was significantly lower than that of the control group,and the level of CYTL1 was significantly higher than that of the control group(t=10.292,7.787,P<0.001).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Bailing capsule combined with azithromycin can significantly improve the clinical efficacy of children with mycoplasma pneumonia,shorten the time for symptom improvement,enhance lung function,improve blood gas analysis indicators,reduce the level of inflammatory factors,improve immune function,reduce the level of serum sPD-1,and increase the level of CYTL1,with good safety.