儿童重症支原体肺炎毒热闭肺证微观辨证特点研究

Study on Microscopic Syndrome Differentiation Characteristics of Toxin-heat Obstructing Lung Syndrome in Children with Severe Mycoplasma Pneumonia Based on Collateral Disease Theory

目的借助纤维支气管镜技术,基于络病理论将儿童重症支原体肺炎(SMPP)毒热闭肺证镜下表现分为肺络痰结证和肺络痰瘀证,并结合现代实验室检测技术和手段,比较两组临床差异。方法收集北京儿童医院中医科住院部行纤维支气管镜检查SMPP患儿206例,根据中西医诊断标准,结合络病理论及纤维支气管镜镜下分为肺络痰结证和肺络痰瘀证。分别记录患儿一般资料、实验室指标,并分别比较两组差异,从中、西医角度探讨两组辨证分型的意义。结果肺络痰瘀证患儿C反应蛋白(CRP)、铁蛋白(SF)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、D-二聚体(D-D)、纤维蛋白原(FIB)较肺络痰结证患儿升高(P<0.05),血小板(PLT)、白蛋白(ALB)较肺络痰结证患儿降低(P<0.05),余差异均无统计学意义(P>0.05)。结论在SMPP毒热闭肺证微观辨证分型中,肺络痰瘀证毒热更甚,伤津耗气,瘀血阻络更为明显,更易传变。在治疗过程中,毒热闭肺证要在常规辨证治疗的基础上,结合支气管镜结果,加强化瘀通络、疏肝泄热、益气扶正等治疗,以期促进临床康复。

Objective:To classify the microscopic manifestations of severe mycoplasma pneumoniae pneumonia(SMPP)with toxic-heat obstructing lung syndrome in children into"lung collateral phlegm obstruction syndrome"and"lung collateral phlegm stasis syndrome"using fiberoptic bronchoscopy technology and based on the theory of collaterals.Combined with modern laboratory detection technology and methods,the clinical differences between the two groups are compared to enrich the basis for SMPP diagnosis and improving clinical efficacy.Methods:A total of 206 children with SMPP who underwent fiberoptic bronchoscopy in the Department of Traditional Chinese Medicine at Beijing Children's Hospital were collected.Based on the diagnostic criteria of Chinese and western medicine,combined with the theory of collaterals and the microscopic manifestations under fiberoptic bronchosco⁃py,children with SMPP with toxic-heat obstructing lung syndrome were divided into"lung collateral phlegm ob⁃struction syndrome"and"lung collateral phlegm stasis syndrome".The general information and laboratory indica⁃tors of the children were recorded and the differences between the two groups were compared,and the significance of the two groups of diagnostic typing was discussed from the perspectives of Chinese and western medicine.Results:In the lung collateral phlegm stasis syndrome,CRP,SF,ALT,AST,D-D,and FIB were higher than in the lung collateral phlegm obstruction syndrome(P<0.05),and PLT,ALB were lower than in the lung collateral phlegm obstruction syndrome(P<0.05);the rest of the differences were not statistically significant(P>0.05).Con⁃clusion:In the microscopic diagnostic typing of SMPP with toxic heat and lung closure,the toxic-heat in the lung collateral phlegm stasis syndrome is more severe,the damage to the body fluid and the consumption of Qi are more obvious,and the obstruction of blood stasis is more obvious,which is more likely to lead to changes.There⁃fore,in future treatment,toxic-heat obstructing lung syndrome may need to be treated on the basis of routine diag⁃nostic treatment,combined with bronchoscopy results,strengthening the treatment of removing blood stasis,dredg⁃ing the liver and discharging heat,benefiting Qi and supporting the body′s resistance,in order to promote clinical recovery.