宣白承气汤加味调节儿童支原体肺炎免疫失衡随机对照研究

Effect of Modified Xuanbai Chengqi Decoction on Immune Imbalance in Children with Mycoplasma Pneumoniae Pneumonia:A Randomized Controlled Trial

目的观察宣白承气汤加味对肺炎支原体肺炎(MPP,肺热腑实证)患儿血清中可溶性B7同源体3(sB7-H3)及相关细胞因子表达水平的作用机制。方法88例MPP患儿按随机数字表法分为观察组(46例)和对照组(42例)。两组均给予阿奇霉素抗感染、止咳化痰等治疗,观察组在上述基础上予宣白承气汤加味,口服3天。观察两组临床疗效,检测血清中人sB7-H3及白细胞介素2、4、6、10、17(IL-2、4、6、10、17)、干扰素γ(IFN-γ)及C反应蛋白(CRP)、血沉(ESR)的表达水平。结果最终纳入分析86例,观察组45例,对照组41例。观察组总有效率95.6%(43/45)优于对照组的80.5%(33/41,χ^(2)=4.74,P=0.043)。与本组治疗前比较,治疗后两组患儿sB7-H3、CRP、ESR以及IL-4、6、10、17水平下降(P<0.05),IL-2和IFN-γ水平增高(P<0.05);与对照组比较,治疗后观察组IL-2和IFN-γ升高,sB7-H3、CRP、ESR以及IL-4、6、10、17降低(P<0.05)。结论宣白承气汤加味可通过影响sB7-H3和相关炎症因子的表达,对MPP机体免疫失衡起到一定的调节作用,改善急性期临床症状及体征。

Objective To observe the effects of modified Xuanbai Chengqi Decoction(XBCQD)on the expression levels of soluble B7 cognate body 3(sB7-H3)and associated cytokines in the serum of children suffering from mycoplasma pneumoniae pneumonia(MPP,Fei-heat and organ-sthenia syndrome),and to explore its underlying mechanisms.Methods Eighty-eight children with MPP were recruited and randomly assigned to the observation group(46 cases)and the control group(42 cases).Both groups received standard treatments including Azithromycin for anti-infection,and medications for cough relief and phlegm resolution.The observation group additionally received the modified XBCQD orally for three days.The clinical efficacy and serum levels of sB7-H3,C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),interleukin-2,4,6,10,17(IL-2,4,6,10,17),and interferon gamma(IFN-γ)were measured and compared before and after the treatment.Results Totally 86 patients were finally included in analysis,45 patients in the observation group and 43 patients in the control group.The total effectiveness rate in the observation group was 95.6%(42/45),which was significantly higher than the 80.5%(33/41)in the control group(χ^(2)=4.74,P=0.043).Compared with baseline,the sB7-H3,CRP,ESR,and IL-4,6,10,17 levels decreased(P<0.05),the IL-2 and IFN-γ levels increased in two groups after treatment(P<0.05).After treatment compared with the control group,the IL-2 and IFN-γ levels decreased,levels of sB7-H3,CRP,ESR,and IL-4,6,10,17 increased in the observation group(P<0.05).Conclusion1Modified XBCQD can modulate immune imbalance in children with MPP by affecting the expression of sB7-H3 and related inflammatory cytokines,thereby improving clinical symptoms and signs during the phase.