【摘要】：目的：觀察支氣管肺炎患兒應用穿心蓮內(nèi)酯治療后體溫恢復正常的時間及相關(guān)細胞因子濃度的變化，探討穿心蓮內(nèi)酯平溫作用的可能機制，為穿心蓮內(nèi)酯在兒科的臨床應用提供一定的依據(jù)。 方法：采用前瞻性、隨機抽樣的方法，選擇符合納入標準的2011年10月 2012年3月在大連市兒童醫(yī)院呼吸科病房住院，年齡為2月 12歲，除外既往反復呼吸道感染史、先天性免疫功能低下、應用激素或免疫抑制劑、臨床診斷為支氣管肺炎的患兒，隨機分為觀察組和對照組。觀察組在常規(guī)治療的基礎(chǔ)上靜脈滴注穿心蓮內(nèi)酯注射液；對照組只給與常規(guī)治療，7-10天為1個療程。每組隨機抽取20例患兒于治療前和體溫平穩(wěn)24小時后的血清，采用ELISA法檢測血清前列腺素E2（PGE2）、白細胞介素-1β（IL-1β）、白細胞介素-6（IL-6）、干擾素-γ（IFN-γ）和腫瘤壞死因子-α（TNF-α）濃度。觀察兩組患兒平溫時間和咳嗽減輕的時間及治療前、后血清中PGE2、IL-1β、IL-6、IFN-γ和TNF-α濃度的變化。 結(jié)果： 1.一般情況：符合納入標準的患者共73例，男33例，女40例，平均年齡為3.22±0.199歲。其中觀察組41例，男19例，，女22例，平均年齡為3.43±0.30歲；對照組32例，男14例，女18例，平均年齡為2.95±0.24歲。經(jīng)方差齊性檢驗，兩組性別、年齡、病程比較P0.05，無顯著差異，具有可比性。 2.靜脈應用穿心蓮內(nèi)酯對臨床癥狀及轉(zhuǎn)歸的影響：應用穿心蓮內(nèi)酯治療的觀察組體溫平穩(wěn)的時間為3.10±0.25天，對照組為4.16±0.23天，觀察組體溫平穩(wěn)時間較對照組縮短，有統(tǒng)計學意義（P0.01）；觀察組咳嗽明顯減輕的時間為3.20±1.01天，對照組為5.22±1.13天，觀察組咳嗽明顯減輕的時間少于對照組，有統(tǒng)計學意義（P0.01）；兩組臨床總有效率為100%，觀察組41例，治愈36例，有效5例，治愈率為87.8%；對照組32例，治愈22例，有效10例，治愈率為68.8%，在所觀察7天內(nèi)，觀察組的治愈率高于對照組，觀察組的臨床轉(zhuǎn)歸程度優(yōu)于對照組，有統(tǒng)計學意義（χ~2=3.99，P0.05）。 3.細胞因子濃度的變化及比較：觀察組應用穿心蓮內(nèi)酯前、后血清中IL-6、IFN-γ的濃度差異顯著，有統(tǒng)計學意義（P0.05）；觀察組和對照組藥后血清中PGE2和IFN-γ濃度差異顯著，有統(tǒng)計學意義（P0.05）。 結(jié)論： 1.穿心蓮內(nèi)酯能縮短支氣管肺炎患兒的發(fā)熱和咳嗽時間，且臨床轉(zhuǎn)歸程度較好。 2.穿心蓮內(nèi)酯能夠直接作用于調(diào)節(jié)體溫中樞的重要介質(zhì)——PGE2，減少PGE2的釋放，調(diào)節(jié)體溫，使發(fā)熱患兒體溫降至正常，達到平溫效果。 3.穿心蓮內(nèi)酯可以通過抑制內(nèi)源性致熱源IFN-γ和IL-6，從而減少下丘腦釋放PGE2，達到調(diào)節(jié)體溫作用，使患兒體溫平穩(wěn)恢復正常。 4.穿心蓮內(nèi)酯對血清中的IL-1β和TNF-α的濃度在觀察例數(shù)內(nèi)影響不明顯。
[Abstract]:Objective: to observe the time of recovery of body temperature and the change of cytokine concentration in children with bronchopneumonia treated with andrographolide, and to explore the possible mechanism of andrographolide on warming. To provide some basis for the clinical application of andrographolide in pediatrics. Methods: a prospective, random sampling method was used to select the respiratory ward in Dalian Children's Hospital in March, 2011 and March 2012, with the exception of previous history of recurrent respiratory tract infection, with the age of 12 years old. Children with congenital hypoimmunity, who were diagnosed with bronchopneumonia by hormone or immunosuppressant, were randomly divided into observation group and control group. Andrographis lactone injection was injected intravenously on the basis of routine treatment in the observation group, while in the control group, routine therapy was given only for 7-10 days as a course of treatment. In each group, 20 serum samples were randomly selected before treatment and 24 hours after body temperature. Serum prostaglandin E 2 (PGE2), interleukin-1 尾 (IL-1 尾), interleukin-6 (IL-6) were measured by ELISA assay. The concentrations of interferon- 緯 (IFN- 緯) and tumor necrosis factor- 偽 (TNF- 偽) were observed. The changes of serum PGE2,IL-1 尾, IL-6,IFN- 緯 and TNF- 偽 levels before and after treatment were observed. Results: 1. General conditions: there were 73 patients who met the inclusion criteria, including 33 males and 40 females, with an average age of 3.22 鹵0.199 years. There were 41 cases in the observation group, 19 males and 22 females, with an average age of 3.43 鹵0.30 years, while in the control group, there were 32 cases, 14 males and 18 females, with an average age of 2.95 鹵0.24 years. The results of homogeneity test showed that there was no significant difference in sex, age and course of disease between the two groups (P 0.05). 2. The effect of intravenous andrographolide on clinical symptoms and outcome: the body temperature of observation group treated with andrographolide was 3.10 鹵0.25 days, and that of control group was 4.16 鹵0.23 days. The stable time of body temperature in observation group was shorter than that in control group. There was statistical significance (P0.01). The time of cough relief was 3.20 鹵1.01 days in the observation group and 5.22 鹵1.13 days in the control group, which was significantly shorter than that in the control group (P0.01). The total effective rate in both groups was 100. In the observation group, 36 cases were cured and 5 cases were effective. The cure rate was 87.8%. In the control group, 32 cases were cured, 22 cases were cured, 10 cases were effective, and the cure rate was 68.8%. Within 7 days, the cure rate of the observation group was higher than that of the control group, and the clinical outcome degree of the observation group was better than that of the control group (蠂 ~ 2 = 3.99, 蠂 ~ 2 = 3.99). P0.05). 3. The change and comparison of cytokine concentration: before and after the application of andrographolide, the concentration of IL-6,IFN- 緯 in serum in the observation group was significantly different (P0.05); The serum PGE2 and IFN- 緯 levels in the observation group and control group were significantly different (P0.05). Conclusion: 1. Andrographolide can shorten the time of fever and cough in children with bronchopneumonia. 2. Andrographolide can directly act on the important mediators of regulating body temperature center-PGE2, can reduce the release of PGE2, regulate body temperature, make the temperature of febrile children drop to normal, and achieve the effect of levelling temperature. 3. Andrographolide can regulate body temperature by inhibiting endogenous heat source IFN- 緯 and IL-6, thus reducing the release of PGE2, from hypothalamus, and making the temperature return to normal steadily. 4. Andrographolide had no significant effect on the concentration of IL-1 尾 and TNF- 偽 in serum.
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2012
【分類號】：R725.6

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