迁延性细菌性支气管炎T细胞水平动态变化的临床研究

目的　探讨迁延性细菌性支气管炎（protracted bacterial bronchitis，PBB）发病机制与T细胞亚群失调的关系，评价免疫调节治疗对PBB的预后和预防反复发作的临床意义。方法　选取2015年5月至2018年5月包头市第四医院收治的127例PBB患儿，采用流式细胞术检测外周血T细胞亚群CD4、 CD8及CD4/CD8细胞水平。所有PBB患儿（PBB组）均给予口服阿莫西林克拉维酸钾治疗2～4周， 联合槐杞黄治疗的66例PBB患儿为槐杞黄组，未联合槐杞黄治疗的61例PBB患儿为非槐杞黄组，选取39例体检健康儿童为对照组。治疗3个月后复查T细胞亚群水平。分析PBB患儿治疗后2周、4周、12周咳嗽症状积分，评价治愈、好转情况及1年后复发率。采用SPSS16.0软件进行数据处理， P＜0.05为差异有统计学意义。结果　治疗前PBB组CD4/CD8异常48例（37.80%），对照组CD4/CD8异常4例（10.26%），两组间差异有统计学意义（P＜0.01）。治疗后PBB组CD4/CD8异常例数降至18例（14.17%），与治疗前相比，差异有统计学意义（P＜0.01）。槐杞黄组治疗前CD4/CD8异常33例（50.00%），治疗后12周CD4/CD8异常降为8例（12.12%），治疗前后差异有统计学意义（P＜0.01）。而非槐杞黄组治疗前CD4/CD8异常15例（24.59%），治疗12周后CD4/CD8异常10例（16.39%），治疗前后差异无统计学意义（P＞0.05）。治疗2周后PBB组的咳嗽积分开始减少，其中非槐杞黄组减少明显，差异有统计学意义（P＜0.05）。继续治疗4周、12周后PBB组的咳嗽积分虽继续减少，但两组间差异无统计学意义（P＞0.05）。PBB组患儿治疗结束后1年，槐杞黄组的复发率低于非槐杞黄组，两组比较差异有统计学意义（P＜0.01）。结论　PBB患儿存在T细胞亚群失调，抗感染治疗联合槐杞黄治疗至少4周对PBB预后及预防反复发作有积极作用。

Clinical study of dynamic changes of T lymphocyte level in children with protracted bacterial bronchitis

Objective　To investigate the relationship between pathogenesis of PBB and the T cell subsets disorders and to evaluate the clinical significance of immunomodulatory therapy to the prognosis of PBB and the prevention of recurrent PBB. Methods　A total of 127 cases of PBB children treated in the Fourth Hospital of Baotou City from May 2015 to May 2018 were selected. Blood samples were collected before treatment，and the levels of CD4，CD8 cells and CD4/CD8 in peripheral blood T cell subsets were detected by flow cytometry. All children with PBB（PBB group） were given oral amoxicillin and clavulanate potassium for 2 to 4 weeks. The subjects were divided into Huaiqihuang group（n＝66） and non-Huaiqihuang group（n＝66）. The Huaiqihuang group was given Huaiqihuang granules based on the anti-infective treatment. In addition，healthy children were enrolled as control group（n＝39）. T cell subsets of the two groups were reexamined 3 months after treatment. By analyzing the cough symptom scores of all children after 2 weeks， 4 weeks and 12 weeks of treatment，the rate of cure and improvement and the recurrence rate after 1 year were evaluated. SPSS16.0 software was used for data processing， and the difference was significant if P＜0.05. Results　Before treatment，there were 48 cases（37.80%） of CD4/CD8 abnormalities in the PBB group and 4 cases（10.26%） in the control group. The difference between the two groups was statistically significant（P＜0.01）. After treatment， the number of abnormal CD4/CD8 cases in the PBB group was reduced to 18 cases（14.17%）， and the difference was statistically significant compared with that before treatment（P＜0.01）. Prior to treatment， there were 33 cases（50.00%） of abnormal CD4/CD8 in Huaiqihuang group， and the number decreased to 8 cases（12.12%） after 12 weeks of treatment， showing statistically significant differences（P＜0.01）. However， in the non-Huaiqihuang group， there were 15 cases（24.59%） of CD4/CD8 abnormality before treatment， and 10 cases（16.39%） of CD4/CD8 abnormality after treatment， showing no statistically significant difference（P＞0.05）. In 2 weeks after treatment， the cough symptom scores of the PBB group began to decrease， and the non-Huaiqihuang group decreased more significantly， with statistically significant difference（P＜0.05）. After 4 weeks and 12 weeks of continuous treatment， although the cough symptom scores of the PBB group continued to decrease， the difference between the two groups was not statistically significant（P＞0.05）. Follow-up showed that the recurrence rate of Huaiqihuang group was lower than that of non-Huaiqihuang group in 1 year after the end of treatment， and the difference between the two groups was statistically significant（P＜0.01）. Conclusion　Children with PBB have T cell subsets disorder， and the treatment of anti-infection combined with Huaiqihuang granules for at least 4 weeks has a positive effect on PBB prognosis and recurrence prevention.