麻杏石甘汤合清金化痰汤加减辅助西医治疗难治性肺炎支原体肺炎痰热闭肺证的临床效果观察

Observation on clinical effect of Maxingshigan Decoction combined with Qingjin Huatan Decoction supplemented with Western medicine in treating refractory mycoplasma pneumoniae pneumonia syndrome of phlegm-heat blocking lung

目的 观察麻杏石甘汤合清金化痰汤加减辅助西医治疗难治性肺炎支原体肺炎痰热闭肺证的临床效果。方法 前瞻性选取2020年3月至2023年3月东莞市中医院收治的150例痰热闭肺证难治性肺炎支原体肺炎患儿为对象,按照简单随机法将其分为两组,每组各75例。西医组给予西医治疗,汤剂组给予麻杏石甘汤合清金化痰汤加减辅助西医治疗。比较两组症状和体征消失时间,评估两组中医症状评分的差异,检测两组肺泡灌洗液(BALF)中MP-RNA病菌量及血清CXC趋化因子配体(CXCL)8、CXCL9、白细胞计数(WBC)、红细胞沉降率(ESR)、C反应蛋白(CRP)、白细胞介素(IL)-23的水平。结果 汤剂组的退热、止咳及水泡音消失时间、肺部影像学吸收时间分别为(2.05±0.68)、(6.69±1.21)、(10.12±1.89)、(15.24±2.61) d,均短于西医组[(3.89±1.54)、(8.14±1.45)、(13.64±2.13)、(18.52±3.49) d],差异均有统计学意义(P<0.05)。治疗10 d后,两组发热、咳嗽、气喘、咳黄黏痰等主要症状评分和面赤口渴、口唇发绀、烦躁不宁、咽喉肿痛等次要症状评分均较治疗前下降,且汤剂组治疗10 d后中医症状评分均低于西医组,差异均有统计学意义(P<0.05)。治疗10 d后,两组BALF中MP-RNA病菌量均较治疗前改善,汤剂组治疗10 d后BALF中MP-RNA病菌量优于西医组,差异均有统计学意义(P<0.05)。治疗10 d后,两组CXCL8、CXCL9、WBC、ESR、CRP、IL-23水平均较治疗前下降,且汤剂组治疗10 d后上述指标均低于西医组,差异均有统计学意义(P<0.05)。结论 麻杏石甘汤合清金化痰汤加减辅助西医治疗难治性肺炎支原体肺炎痰热闭肺证可促进症状和体征的消退,减少BALF中MP-RNA病菌量,可能与降低CXC趋化因子配体、WBC等指标的表达有关。

Objective To observe the clinical effect of Maxingshigan Decoction combined with Qingjin Huatan Decoction in the treatment of refractory mycoplasma pneumoniae pneumonia with phlegm-heat blocking lung syndrome.Methods A total of 150 children with refractory mycoplasma pneumoniae pneumonia of phlegm-heat blocking lung syndrome treated at Dongguan Hospital of Traditional Chinese Medicine from March 2020 to March 2023 were selected and divided into two groups by the simple random method,with 75 cases in each group.The Western medicine group was given Western medicine treatment,and the decoction group was given Majingshigan Decoction and Qingjin Huatan Decoction plus or minus Western medicine treatment.The disappearance time of symptoms and signs between the two groups were compared,the difference of TCM symptom score between the two groups was assessed,and the amount of MP-RNA bacteria in alveolar lavage fluid(BALF) and the levels of serum CXC chemokine ligand(CXCL)8,CXCL9,white blood cell count(WBC),erythrocyte sedimentation rate(ESR),C-reactive protein(CRP) and interleukin(IL)-23 were detected between the two groups.Results The disappearance time of fever,cough and blisters in decoction group and lung imaging absorption time were(2.05±0.68),(6.69±1.21),(10.12±1.89),and(15.24±2.61) days,respectively,which were shorter than those of the Western medicine group [(3.89±1.54),(8.14±1.45),(13.64±2.13),and(18.52±3.49) days],and the differences were statistically significant(P<0.05).Ten days after treatment,the scores of main symptoms such as fever,cough,asthma,yellow phlegm and minor symptoms such as blushing and thirst,cyanosis,irritability and sore throat were all decreased in two groups,the scores of TCM symptoms in the decoction group after treatment were lower than those in the Western medicine group,and the differences were statistically significant(P<0.05).Ten days after treatment,the amount of MP-RNA bacteria in BALF of both groups was improved,and the amount of MP-RNA bacteria in BALF of decoction group after treatment was better than that of Western medicine group,and the differences were statistically significant(P<0.05).Ten days after treatment,CXCL8,CXCL9,WBC,ESR,CRP and IL-23 in two groups were decreased compared with before,and the above factors in decoction group were lower than those in Western medicine group after treatment,and the differences were statistically significant(P<0.05).Conclusion Maxingshigan Decoction combined with Qingjinhuatan Decoction in the treatment of refractory mycoplasma pneumoniae pneumonia with phlegm-heat blocking lung syndrome can promote the regression of symptoms and signs and reduce the amount of MP-RNA bacteria in BALF,which may be related to the decrease of CXC chemokine ligand,WBC and other indicators.