【摘要】：目的： 研究加味五虎湯對(duì)痰熱閉肺型小兒支原體肺炎的臨床治療效果及對(duì)細(xì)胞免疫功能的影響；綜合評(píng)價(jià)加味五虎湯治療痰熱閉肺型小兒支原體肺炎的治療方案,并為加味五虎湯治療痰熱閉肺型小兒支原體肺炎的推廣應(yīng)用及進(jìn)一步的研究提供臨床依據(jù)及細(xì)胞免疫水平的相關(guān)參數(shù)。 方法： 本研究采用前瞻的隨機(jī)臨床對(duì)照研究,將60例符合痰熱閉肺型小兒支原體肺炎住院患兒隨機(jī)分為2組：試驗(yàn)A組、試驗(yàn)B組,每組30例。試驗(yàn)B組在基礎(chǔ)治療及硝黃散的基礎(chǔ)上加阿奇霉素(希舒美)進(jìn)行治療；試驗(yàn)A組在試驗(yàn)B組的基礎(chǔ)上予加味五虎湯治療。分別對(duì)治療前、后癥候積分(主要癥候、次要癥候)進(jìn)行計(jì)算,同時(shí)分別檢測(cè)治療前后T細(xì)胞亞群(CD3+、CD4+、CD8+、CD4+/CD8+)及外周血細(xì)胞因子IL-10、IL-17、TGF-β1水平。通過(guò)對(duì)治療前后T淋巴細(xì)胞亞群、細(xì)胞因子IL-17、IL-10、TGF-β1水平的觀察,并與同期30例年齡相當(dāng)健康兒童外周血T細(xì)胞亞群、細(xì)胞因子IL-10、IL-17、TGF-β1水平測(cè)定進(jìn)行對(duì)比分析。觀察加味五虎湯對(duì)小兒支原體肺炎T淋巴細(xì)胞亞群、細(xì)胞因子IL-17、IL-10、TGF-β1水平的調(diào)節(jié)作用。 結(jié)果： 1.共觀察痰熱閉肺型小兒支原體肺炎患兒60例,治療前,兩組患兒在性別、年齡分布、咳嗽時(shí)間、發(fā)熱時(shí)間等情況經(jīng)統(tǒng)計(jì)學(xué)處理無(wú)顯著性差異,具有可比性(P0.05)；兩組在主要癥候、次要癥候、總癥候積分,經(jīng)統(tǒng)計(jì)學(xué)處理均無(wú)顯著性差異,具有可比性(P0.05)。 2.治療前,試驗(yàn)A組與試驗(yàn)B組分別與30例健康組兒童T淋巴細(xì)胞亞群CD3、CD4+、CD8+、CD4+/CD8+比較,均無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)；與正常組進(jìn)行IL-10,IL-17, TGF-p1水平比較,兩組患兒IL-10, IL-17, TGF-β1水平均明顯增高,與健康組相比差異顯著(P0.01)。 3.治療前,兩組患兒治療前T淋巴細(xì)胞亞群CD3+、CD4+、CD8+、CD4+/CD8+水平比較,無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),兩組患兒IL-10、IL-17、TGF-β1水平比較,經(jīng)統(tǒng)計(jì)學(xué)處理均無(wú)顯著差異(P0.05)。 4.治療后,對(duì)A、B兩組臨控率、控顯率、總有效率進(jìn)行比較,經(jīng)統(tǒng)計(jì)學(xué)處理均無(wú)顯著性差異(P0.05)；但兩組的治療后積分、癥候積分減少、住院發(fā)熱時(shí)間、咳嗽時(shí)間、肺部噦音持續(xù)時(shí)間進(jìn)行比較,差異顯著(P0.01),試驗(yàn)A組臨床療效明顯優(yōu)于試驗(yàn)B組。 5.治療后,試驗(yàn)A組、試驗(yàn)B組與健康組進(jìn)行T淋巴細(xì)胞亞群CD3+、CD4+、CD8+、 CD4+/CD8+比較,兩組患兒與健康組比較均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。 6.兩組患兒治療后CD3、CD4+與治療前的差值經(jīng)統(tǒng)計(jì)學(xué)處理均無(wú)顯著性差異,(P0.05)；兩組患兒CD8+、CD4+/CD8+與治療前的差值相比差異顯著(P0.01),試驗(yàn)A組在調(diào)節(jié)淋巴細(xì)胞亞群方面可能優(yōu)于試驗(yàn)B組。 7.治療后,試驗(yàn)A組、試驗(yàn)B組分別與健康組進(jìn)行IL-10、IL-17、TGF-β1水平比較,差異均具有顯著性(P0.01)。 8.治療后,兩組患兒IL-10、IL-17、TGF-β1水平與治療前的差值分別為：IL-10(-35.17±29.67)pg/ml、(-13.73±29.87)pg/ml；TGF-β1(-473.05±6462.15) pg/ml、(2801.31±2806.61)pg/ml.差值相比差異顯著(P0.0l、P0.01)IL-17(-10.88±9.24)pg/ml、(-7.15±8.71)pg、ml；差值相比無(wú)顯著意義(P0.05)。 結(jié)論： 1.支原體肺炎患兒細(xì)胞因子IL-10、IL-17、TGF-β1水平升高,提示抗炎性細(xì)胞因子和促炎性細(xì)胞因子平衡失調(diào),可能導(dǎo)致Treg/Th17平衡失調(diào),機(jī)體發(fā)生細(xì)胞免疫紊亂,引起患兒肺部出現(xiàn)免疫炎癥反應(yīng)、免疫損傷及纖維化,而出現(xiàn)一系列臨床表現(xiàn)。 2.恢復(fù)期,試驗(yàn)A組、試驗(yàn)B組患兒T淋巴細(xì)胞亞群水平都接近正常兒童水平；IL-10、IL-17水平較治療前下降,但與正常兒童相比,差異顯著,且TGFβ1水平仍保持高水平,提示支原體患兒恢復(fù)期肺部可能還存在慢性炎癥反應(yīng),肺纖維化,體內(nèi)Treg/Th17的免疫平衡仍未完全恢復(fù),患兒仍存在氣道高反應(yīng)性,可能是導(dǎo)致MP感染患兒易反復(fù)發(fā)作甚至發(fā)展為哮喘的機(jī)制。 3.試驗(yàn)A組的臨床療效明顯優(yōu)于試驗(yàn)B組；在T淋巴細(xì)胞亞群水平的調(diào)節(jié)方面可能優(yōu)于試驗(yàn)B組；在調(diào)節(jié)細(xì)胞因子IL-10、TGF-β1水平方面明顯優(yōu)于試驗(yàn)B組。在調(diào)節(jié)細(xì)胞因子IL-17水平方面與試驗(yàn)B組相比無(wú)顯著差異。試驗(yàn)A組可能是通過(guò)加味五虎湯對(duì)痰熱閉肺型MPP的開(kāi)肺平喘、清熱化痰,化瘀通絡(luò)作用,減輕了肺部免疫炎癥反應(yīng)及肺部纖維化,調(diào)節(jié)細(xì)胞因子IL-10、IL-17、TGF-β1水平及Treg/Th17平衡,而提高臨床療效。
[Abstract]:Objective:
To study the clinical effect of Jiawei Wuhu Decoction on mycoplasma pneumonia in children with phlegm-heat occlusion and its effect on cellular immune function; to evaluate comprehensively the treatment scheme of Jiawei Wuhu Decoction on mycoplasma pneumonia in children with phlegm-heat occlusion, and to promote the application of Jiawei Wuhu Decoction in treating mycoplasma pneumonia in children with phlegm-heat occlusion and To provide clinical evidence and parameters related to cellular immunity.
Method:
In this study, 60 hospitalized children with mycoplasma pneumonia were randomly divided into two groups: experimental group A and experimental group B, with 30 cases in each group. Five tigers Decoction treatment. Before and after treatment, the symptom scores (main symptoms, secondary symptoms) were calculated, and T cell subsets (CD3 +, CD4 +, CD8 +, CD4 + / CD8 +) and peripheral blood cytokines IL-10, IL-17, TGF-beta 1 levels were detected before and after treatment. The levels of T lymphocyte subsets, cytokines IL-10, IL-17 and TGF-beta 1 in peripheral blood of 30 healthy children were measured and compared.
Result:
1. A total of 60 children with mycoplasma pneumonia of phlegm-heat type were observed. Before treatment, there was no significant difference in sex, age distribution, cough time and fever time between the two groups (P 0.05); there was no significant difference in the main symptoms, secondary symptoms and total symptoms scores between the two groups. Comparability (P0.05).
2. Before treatment, the levels of CD3, CD4 +, CD8 +, CD4 + / CD8 + in T lymphocyte subsets of group A and group B were not significantly different from those of 30 healthy children (P 0.05), but the levels of IL-10, IL-17 and TGF-p1 were significantly higher than those of normal children (P 0.01).
3. Before treatment, the levels of T lymphocyte subsets CD3 +, CD4 +, CD8 +, CD4 + / CD8 + were not significantly different between the two groups (P 0.05). The levels of IL-10, IL-17 and TGF-beta 1 were not significantly different between the two groups (P 0.05).
4. After treatment, there was no significant difference in the clinical control rate, control rate and total effective rate between the two groups (P 0.05), but there were significant differences in the scores, symptoms, fever time, cough time and duration of lung sounds between the two groups (P 0.01).
5. After treatment, the T lymphocyte subsets CD3 +, CD4 +, CD8 +, CD4 + / CD8 + in group A, group B and healthy group were compared. There was no significant difference between the two groups (P 0.05).
6. The difference of CD3 and CD4+ between the two groups after treatment was not statistically significant (P 0.05); the difference of CD8+ and CD4 +/CD8+ between the two groups was significant (P 0.01). The regulation of lymphocyte subsets in group A may be better than that in group B.
7. After treatment, the levels of IL-10, IL-17 and TGF-beta 1 in group A and group B were significantly different from those in healthy group (P 0.01).
8.After treatment, the levels of IL-10, IL-17, TGF-bet1 in the two groups were significantly higher than those before treatment (P 0.0l, P 0.01) IL-17 (-10.88 (-10.88 (-10.88 (-10.88 (-9.24) pg / ml, (-13.73 (-13.73 (-29.87) pg / ml, (-13.73 (-13.73 (-13.73 (-13.73 (-13.73 (-17.73 (-29.87) 87) pg / ml, (-47.73.05 (-473.05 (-473.05 (-646462.05 6562.15) 62.15) pg / ml, (There was no significant difference (P 0.05).
Conclusion:
1. The elevated levels of cytokines IL-10, IL-17 and TGF-beta 1 in children with mycoplasma pneumonia suggest that the imbalance between anti-inflammatory cytokines and pro-inflammatory cytokines may lead to Treg/Th17 imbalance, cellular immune disorders, and immune inflammation, immune injury and fibrosis in the lungs of children with Mycoplasma pneumonia.
2. In convalescence, the levels of T lymphocyte subsets in group A and group B were close to those of normal children; the levels of IL-10 and IL-17 were lower than those before treatment, but the differences were significant compared with normal children, and the levels of TGF-beta 1 remained high, suggesting that there might be chronic inflammation, pulmonary fibrosis and Treg/Th1 in children with Mycoplasma in convalescence. The immune balance of MP-7 has not been completely restored, and airway hyperresponsiveness still exists in children, which may be the mechanism of recurrent attacks and even asthma in MP-infected children.
3. The clinical curative effect of group A is better than that of group B. The regulation of T lymphocyte subsets may be better than that of group B. The regulation of cytokine IL-10 and TGF-beta 1 is better than that of group B. There is no significant difference between group A and group B in the regulation of cytokine IL-17. Decoction can relieve pulmonary immune inflammation and pulmonary fibrosis, regulate the levels of cytokines IL-10, IL-17, TGF-beta 1 and Treg/Th17 balance, and improve the clinical efficacy.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R272

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