【摘要】：目的:探討兒童MPP中T細(xì)胞亞群、HMGB1的表達(dá);探討復(fù)方甘草酸苷對(duì)T細(xì)胞亞群、HMGB1的調(diào)控作用;觀察復(fù)方甘草酸苷對(duì)MPP的療效及副作用。方法:本研究選取2015年1月至2016年12月在吉林大學(xué)第一醫(yī)院小兒呼吸二科住院就診的60例符合MPP診斷的患者,按其治療藥物分為對(duì)照組、復(fù)方甘草酸苷組、激素組3個(gè)組,按照入院順序隨機(jī)分配進(jìn)入3個(gè)組,每組為20人,所有患者均給予退熱、止咳化痰及霧化對(duì)癥治療,對(duì)照組加用阿奇霉素;復(fù)方甘草酸苷組在對(duì)照組基礎(chǔ)上加用復(fù)方甘草酸苷;激素組在對(duì)照組基礎(chǔ)上加用甲潑尼龍琥珀酸鈉,總療程均為10天。同時(shí)選取我院56例健康兒童作為空白組。流式細(xì)胞儀檢測(cè)T細(xì)胞亞群,ELISA法檢測(cè)HMGB1含量,觀察患兒5天內(nèi)發(fā)熱、呼吸急促、鼻翼煽動(dòng)、口周發(fā)紺等癥狀及肺部Up音情況,比較治療后的臨床有效率及副作用。運(yùn)用SPSS Statistics21.0統(tǒng)計(jì)軟件行統(tǒng)計(jì)學(xué)分析。結(jié)果:1.MPP組與空白組相比,MPP組急性期CD4+降低,CD8+升高,CD4+/CD8+降低,P0.05,兩組差異明顯。2.復(fù)方甘草酸苷組和激素組治療后,CD4+升高,CD8+降低,CD4+/CD8+升高,P0.05,差異顯著,但復(fù)方甘草酸苷組治療后CD4+/CD8+接近正常兒童水平。3.MPP組與空白組相比,MPP急性期HMGB1升高,P0.05,兩組比較有差異;治療后,HMGB1降低,P0.05,差異明顯,但仍高于空白組。4.復(fù)方甘草酸苷組和激素組治療后HMGB1水平與對(duì)照組相比明顯降低,P0.05,差異明顯;但復(fù)方甘草酸苷組與激素組比較,P0.05,差異不顯著。5.臨床療效比較:兩治療組有效率明顯高于對(duì)照組,P0.05,差異顯著;但復(fù)方甘草酸苷組與激素組比較,P0.05,差異不明顯。復(fù)方甘草酸苷組(0)副作用明顯低于激素組(20%),P0.05,兩組差異明顯。結(jié)論:1.兒童MPP急性期CD4+降低,CD8+升高,CD4+/CD8+降低,提示T細(xì)胞亞群紊亂參與了MPP的發(fā)病。2.復(fù)方甘草酸苷治療后CD4+、CD4+/CD8+細(xì)胞水平升高,CD8+細(xì)胞水平降低,且CD4+/CD8+細(xì)胞水平接近正常兒童,說(shuō)明復(fù)方甘草酸苷對(duì)T細(xì)亞群的紊亂有糾正作用。3.MPP急性期HMGB1升高,治療后降低,但仍高于正常兒童,說(shuō)明HMGB1可以作為反應(yīng)疾病急性期的炎癥因子,且持續(xù)存在時(shí)間長(zhǎng),可以作為晚期炎癥因子預(yù)測(cè)病情變化。4.復(fù)方甘草酸苷治療后HMGB1下降程度與激素組相當(dāng),明顯高于對(duì)照組,說(shuō)明甘草酸苷可以作為HMGB1抑制劑在兒童MPP中應(yīng)用。5.在兒童MPP中,復(fù)方甘草酸苷的臨床有效率與激素相近,但無(wú)食欲增強(qiáng)、體重增長(zhǎng)等副作用。
[Abstract]:Aim: to investigate the expression of T cell subsets and HMGB1 in children with MPP, to investigate the regulatory effects of compound glycyrrhizin on T cell subsets and HMGB1, and to observe the efficacy and side effects of compound glycyrrhizin on MPP. Methods: from January 2015 to December 2016, 60 patients who were hospitalized in Department of Pediatric Respiratory, first Hospital of Jilin University were selected and divided into control group, compound glycyrrhizin group and hormone group. According to the order of admission, the patients were randomly assigned into three groups, 20 persons in each group. All the patients were given antipyretic, cough, phlegm and atomization treatment, while the control group was treated with azithromycin. Compound glycyrrhizin was added to the control group and methylprednisolone sodium succinate was added to the control group for 10 days. At the same time, 56 healthy children in our hospital were selected as blank group. T-cell subsets were detected by flow cytometry, HMGB1 content was detected by ELISA method, and symptoms such as fever, shortness of breath, nasal wing incitement, perioral cyanosis and pulmonary Up sound were observed within 5 days after treatment. The clinical efficacy and side effects were compared. SPSS Statistics21.0 statistical software was used for statistical analysis. Results: compared with the control group, the CD4, CD8 and CD4 / CD8 in 1.MPP group were decreased, and the ratio of CD4 / CD8 was decreased in MPP group in acute phase (P 0.05), the difference between the two groups was significant (2. 2). After treatment with compound glycyrrhizin group and hormone group, CD4 increased, CD8 decreased, CD4 / CD8 increased and P0.05, but CD4 / CD8 in compound glycyrrhizin group was close to normal children after treatment. Compared with control group, CD4 / CD8 in 3.MPP group was higher than that in blank group. The level of HMGB1 in the acute phase of MPP was higher than that in the control group (P0.05), and there was a difference between the two groups. After treatment, HMGB1 decreased, P 0.05, the difference was significant, but still higher than the blank group. 4. 4. The level of HMGB1 in compound glycyrrhizin group and hormone group was significantly lower than that in control group (P 0.05), but the difference was not significant between compound glycyrrhizin group and hormone group (P 0.05). Comparison of clinical efficacy: the effective rate of the two treatment groups was significantly higher than that of the control group (P0.05), but the difference between the compound glycyrrhizin group and the hormone group was not significant (P0.05). The side effect of compound glycyrrhizin group (0) was significantly lower than that of hormone group (20%), and the difference between the two groups was significant (P 0.05). Conclusion: 1. In children with acute MPP, CD4 decreased, CD8 increased, and CD4 / CD8 decreased, suggesting that T cell subsets disorder was involved in MPP. 2. 2. After treatment with compound glycyrrhizin, CD4 / CD8 cell level increased, CD8 cell level decreased, and CD4 / CD8 cell level was close to that of normal children, which indicated that compound glycyrrhizin could correct the disorder of T subgroup. HMGB1 increased in acute 3.MPP stage. The results showed that HMGB1 could be used as inflammatory factor in acute stage of reaction disease, and it lasted for a long time, and it could be used as a late inflammatory factor to predict the change of disease. 4. The decrease of HMGB1 in the compound glycyrrhizin group was similar to that in the hormone group, which was significantly higher than that in the control group, indicating that glycyrrhizin could be used as a HMGB1 inhibitor in children with MPP. In children with MPP, the clinical effective rate of compound glycyrrhizin was similar to that of hormone, but had no side effects such as increased appetite and weight gain.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R725.6

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