痰热清注射液联合阿奇霉素、阿昔洛韦治疗MPP合并EBV感染患儿的效果

Effects of Tanreqing Injection Combined with Azithromycin and Acyclovir in the Treatment of Children with Mycoplasma pneumoniae Pneumonia Complicated with EB Virus Infection

目的:探讨痰热清注射液联合大环内酯类抗菌药物(阿奇霉素)、抗病毒药(阿昔洛韦)治疗肺炎支原体肺炎(MPP)合并EB病毒(EBV)感染患儿的效果,以及对血清白细胞介素(IL)2、IL-12表达的影响。方法:选取2022—2023年佳木斯市妇幼保健院收治的MPP合并EBV患儿92例,随机数字列表法分为A组(n=46)与B组(n=46)。A组患儿采用阿奇霉素、阿昔洛韦常规治疗,B组患儿在A组的基础上加用痰热清注射液。疗程结束后,比较两组患儿的疗效、不良反应总发生率、症状改善时间和EBV转阴情况,血清IL-2、IL-12水平,CD4+、CD8+和CD4+/CD8+水平,绘制ROC曲线分析血清IL-2、IL-12水平预测儿童MPP合并EBV感染治疗效果的效能。结果:B组患儿的总有效率为95.65%(44/46),显著高于A组的76.09%(35/46),差异有统计学意义(P<0.05)。B组患儿退热时间、咳嗽消失时间、肺部啰音消失时间及住院时间相较于A组显著缩短,B组抗EBV衣壳抗原IgM(EBV-CA-IgM)阴性患儿所占比例和EBV-DNA阴性患儿所占比例相较于A组明显升高,差异均有统计学意义(P<0.05)。治疗后,两组患儿血清IL-2、CD8+水平明显低于治疗前,血清IL-12、CD4+和CD4+/CD8+水平明显高于治疗前;且B组患儿血清IL-2、CD8+水平明显低于A组,血清IL-12、CD4+和CD4+/CD8+水平明显高于A组,上述差异均有统计学意义(P<0.05)。B组患儿的不良反应总发生率为15.22%(7/46),略高于A组的6.52%(3/46),但差异无统计学意义(P>0.05)。92例MPP合并EBV感染患儿中,治疗有效79例,治疗无效13例;相较于治疗有效组,治疗无效组患儿血清IL-2水平显著升高,血清IL-12水平显著降低,差异均有统计学意义(P<0.05)。绘制ROC曲线发现,血清IL-2联合IL-12水平预测儿童MPP合并EBV感染治疗效果的曲线下面积(95%CI)为0.848(0.770~0.927),灵敏度为60.33,特异度为95.73。结论:痰热清注射液联合阿奇霉素、阿昔洛韦治疗MPP合并EBV感染患儿获得了较好疗效,有助于促进EBV清除和症状改善,能调节外周血IL-2、IL-12及T淋巴细胞亚群水平,且血清IL-2联合IL-12水平检测对于MPP合并EBV感染患儿治疗效果有较高的评估价值。

OBJECTIVE:To probe into the effects of Tanreqing injection combined with macrolide antibiotics(azithromycin)and antiviral drugs(acyclovir)in the treatment of children with Mycoplasma pneumoniae pneumonia(MPP)complicated with EB virus(EBV)infection,and its effects on the expression of serum interleukin(IL)-2 and IL-12.METHODS:A total of 92 children with MPP complicated with EBV admitted into Jiamusi Maternal and Child Health Hospital from 2022 to 2023 were divided into group A(n=46)and group B(n=46)by random number list method.Group A was given azithromycin and acyclovir for conventional treatment,while group B was given Tanreqing injection based on the group A.After the treatment,the efficacy,total incidence of adverse drug reactions,time for symptom improvement and negative conversion of EB virus,the serum IL-2 and IL-12 levels,the CD4+,CD8+and CD4+/CD8+levels were compared between two groups,and the ROC curve was plotted to analyze efficiency of serum IL-2 and IL-12 in predicting the therapeutic effects of MPP complicated with EBV.RESULTS:The total effective rate of group B was 95.65%(44/46),significantly higher than 76.09%(35/46)of group A,with statistically significant difference(P<0.05).The remission time of fever,disappearance time of cough,disappearance time of lung rales and length of stay of group B were significantly shorter than those of group A;the proportion of anti-EBV-CA-IgM-negative patients and the proportion of EBV-DNA-negative patients in group B were significantly higher those in group A,with statistically significant difference(P<0.05).After treatment,the serum IL-2 and CD8+levels were significantly lower,the serum IL-12,CD4+and CD4+/CD8+levels were significantly higher in both groups than those before treatment;the serum IL-2 and CD8+levels were significantly lower,the serum IL-12,CD4+and CD4+/CD8+levels were significantly higher in group B than those in group A,with statistically significant differences(P<0.05).The total incidence of adverse drug reactions of group B was 15.22%(7/46),slightly higher than 6.52%(3/46)of group A,while the difference was not statistically significant(P>0.05).Among the 92 children with MPP complicated with EBV,the treatment was effective in 79 cases and ineffective in 13 cases;compared with the effective treatment group,patients in the ineffective treatment group had significantly higher serum IL-2 level and lower serum IL-12 level,with statistically significant differences(P<0.05).Plotting the ROC curve revealed that the AUC(95%CI)was 0.848(0.770-0.927),the sensitivity was 60.33 and the specificity was 95.73 in serum IL-2 combined with IL-12 for predicting the therapeutic effects of MPP combined with EBV in children.CONCLUSIONS:Tanreqing injection combined with azithromycin and acyclovir in the treatment of children with MPP complicated with EBV infection has significant efficacy,which can help to promote EBV clearance and symptom improvement,regulate the levels of peripheral blood IL-2,IL-12 and T-lymphocyte subpopulations,the serum IL-2 combined with IL-12 test has high value for the assessment of the therapeutic effects of MPP complicated with EBV infection in children.