苇茎汤合麻杏石甘汤加减联合半量激素治疗儿童毒热闭肺证难治性肺炎支原体肺炎

目的:观察苇茎汤合麻杏石甘汤加减联合半量激素治疗儿童毒热闭肺型难治性肺炎支原体肺炎的临床疗效。方法:120例患儿随机分为对照组和观察组,各60例。在基础治疗基础上,对照组给予连花清瘟颗粒+甲强尼龙(每次10 mg·kg-1,2次/日),观察组给予苇茎汤合麻杏石甘汤加减+甲强尼龙(每次10 mg·kg-1,1次/日),疗程均为14 d。观察两组治疗前后肺功能指标最大通气量(MVV),呼气达峰时间(TPTEF),第1秒用力呼气容积(FEV1),呼气达峰容积(VPTEF)],血浆心肌酶谱肌酸激酶(CK),肌酸激酶同工酶(CKMB),乳酸脱氢酶(LDH),胫丁酸脱氢酶(HBDH)],免疫功能免疫球蛋白G(IgG),免疫球蛋白M(IgM),红细胞免疫复合物(RBC-ICR),红细胞C3b受体(RBC-C3bR)],炎性因子肿瘤坏死因子-α(TNF-α),γ-干扰素(IFN-γ),白细胞介素-13(IL-13),白细胞介素-17A(IL-17A)],临床疗效和不良反应。结果:研究期间脱落4例。观察组总有效率96.6%(57/59),高于对照组的84.2%(48/57)(P<0.05)。与对照组治疗后比较,观察组MVV,TPTEF,FEV1,VPTEF,RBC-C3bR,IL-13升高(P<0.05);CK,CKMB,LDH,HBDH,IgG,IgM,RBC-ICR,TNF-α,IFN-γ和IL-17A降低(P<0.05)。观察组不良反应发生率低于对照组(P<0.05)。结论:苇茎汤合麻杏石甘汤加减联合半量激素可明显改善毒热闭肺型难治性肺炎支原体肺炎患儿的肺功能,心肌酶谱,免疫功能和炎性因子水平,不良反应发生率低。

Clinical Efficacy of Modified Weijingtang and Maxing Shigan Tang Combined with Half-dose Hormones on Refractory Mycoplcasma Pneumoniae Pneumonia in Children Caused by Toxic Heat Closing Lung

Objective:To observe the clinical efficacy of modified Weijingtang and Maxing Shigan Tang combined with half-dose hormones in the treatment of mycoplcasma pneumoniae pneumonia in children caused by toxic heat closing lung.Method:Totally 120 cases were randomly divided into control group and observation group,with 60 cases in each group.In addition to the basic therapy,control group was given Lianhua Qingwen granules+methanilone(10 mg·kg-1,2 times/day),while observation group was given modified Weijingtang and Maxing Shigan Tang+methanilone(10 mg·kg-1,1 time/day)for 14 days.Lung function indicatorsmaximal voluntary ventilation(MVV),time of peak tidal expiratory flow(TPTEF),forced expiratory volume in one second(FEV1),volume peak time expiratory flow(VPTEF)],plasma myocardial enzyme profilecreatine kinase(CK),creatine kinase isoenzyme(CKMB),lactate dehydrogenase(LDH),hydroxybutyric acid dehydrogenase(HBDH)],immune functionimmunoglobulin G(IgG),immunoglobulin M(IgM),erythrocyte immune complex(RBCICR),erythrocyte C3 b receptor(RBC-C3bR)],inflammatory factorstumor necrosis factor-alpha(TNF-α),gamma-interferon(IFN-γ),interleukin-13(IL-13),interleukin-17 A(IL-17 A)],clinical efficacy and adverse reactions were observed before and after treatment.Result:Four cases fell off during the study period.The total effective rate in observation group was 96.6%(57/59),which was higher than that in control group 84.2%(48/57,P<0.05).Compared with control group after treatment,lung function,RBC-C3bR and IL-13 were increased in observation group(P<0.05),while myocardial enzyme spectrum,IgG,IgM,RBC-ICR,TNF-α,IFN-γand IL-17A were decreased in observation group(P<0.05).The incidence of adverse reactions in observation group was,lower than that in control group(P<0.05).Conclusion:Modified Weijingtang and Maxing Shigan Tang combined with half-dose hormones can improve lung function,myocardial enzyme profile,immune function and inflammatory factor levels of refractory mycoplasma pneumoniae in children caused by toxic heat closing lung,with a incidence of adverse reactions.