2019 年第 4 期 第 14 卷

羚羊清肺丸联合阿奇霉素治疗小儿肺炎喘嗽痰热闭肺证的效果及对T淋巴细胞亚群和血清炎性因子水平的影响

Effect of antelope lung-clearing pills combined with azithromycin on T lymphocyte subsets and serum inflammatory factors in pediatric pneumonia with dyspnoea and cough

作者：刘学龙李杨帆章从恩马致洁

英文作者：

单位：100050首都医科大学附属北京友谊医院中药剂科（刘学龙、章从恩、马致洁），中医科（李杨帆）

英文单位：

关键词：肺炎；羚羊清肺丸；阿奇霉素；痰热闭肺证

英文关键词：

• 摘要：

• 【摘要】目的    探究羚羊清肺丸联合阿奇霉素治疗小儿肺炎喘嗽痰热闭肺证的效果，并探讨其对患儿T淋巴细胞亚群和血清炎性因子水平的调节作用。方法    选取2016年8月至2018年8月首都医科大学附属北京友谊医院收治的肺炎喘嗽患儿82例，按随机数字表法分为对照组和观察组，各41例。在采用盐酸氨溴索口服溶液治疗的基础上，对照组另采取阿奇霉素静脉滴注治疗，观察组另采取阿奇霉素静脉滴注联合口服羚羊清肺丸治疗，2组均连续治疗1周。比较2组治疗前后痰热闭肺证症状评分、主要症状体征消失时间、临床疗效和不良反应发生率；检测2组治疗前后T淋巴细胞亚群、血清白细胞介素6（IL-6）和肿瘤坏死因子α（TNF-α）水平。结果    治疗后，2组患儿痰热闭肺证症状评分明显低于治疗前，且观察组明显低于对照组（P＜0.01）。观察组治疗后的CD＋3、CD＋3CD＋4明显高于、CD＋3CD＋8明显低于对照组［（69±7）%比（63±7）%、（40±4）%比（34±4）%、（23.0±2.6）%比（26.7±3.0）%］，血清IL-6、TNF-α水平明显低于对照组［（28±4）ng/L比（41±4）ng/L、（39±4）ng/L比（53±5）ng/L］（均P＜0.01）。观察组喘嗽消失时间、退热时间、肺部湿啰音消失时间、胸部X线片病变吸收时间均明显短于对照组（均P＜0.01）。观察组总有效率明显高于对照组［97.6%（40/41）比78.0%（32/41）］（P＝0.018）。观察组不良反应发生率明显低于对照组［7.3%（3/41）比26.8%（11/41）］（P＝0.040）。结论    羚羊清肺丸联合阿奇霉素治疗小儿肺炎喘嗽痰热闭肺证的临床效果明显，提高患儿免疫功能及下调体内IL-6、TNF-α水平可能是其疗效作用途径之一。

• 【Abstract】Objective    To investigate the curative effect of antelope lung-clearing pills combined with azithromycin on pediatric pneumonia with dyspnoea, cough and syndrome of phlegm-heat obstructing lung and the effect on T lymphocyte subsets and serum inflammatory factors. Methods    Eighty-two children with pneumonia having dyspnoea and cough who were admitted to Beijing Friendship Hospital, Capital Medical University from August 2016 to August of 2018 were randomly divided into control group and observation group, with 41 cases in each group. Both groups took ambroxol hydrochloride oral solution; the control group was given intravenous infusion of azithromycin; the observation group had intravenous azithromycin and took antelope lung-clearing pills; both group were treated for 1 week. Score of phlegm-heat obstructing lung, absence time of major symptoms and signs, clinical efficacy, adverse reactions, levels of T lymphocyte subsets, serum interleukin-6(IL-6) and tumor necrosis factor-α(TNF-α) were analyzed. Results    After treatment, scores of phlegm-heat obstructing lung symptoms significantly decreased and the score in observation group were significantly lower than those in control group(P＜0.01). Levels of CD＋3 and CD＋3CD＋4 were significantly higher and CD＋3CD＋8 level was significantly lower in observation group than those in control group［（69±7）% vs （63±7）%, （40±4）% vs （34±4）%, （23.0±2.6）% vs （26.7±3.0）%］; levels of serum IL-6 and TNF-α in observation group were significantly lower than those in control group［（28±4）ng/L vs （41±4）ng/L, （39±4）ng/L vs （53±5）ng/L］（all P＜0.01）. Dyspnoea and cough disappearing time, antipyretic time, lung moist rales disappearing time and chest X-ray recovery time in observation group were significantly shorter than those in control group（all P＜0.01）. Total effective rate in observation group was significantly higher than that in control group［97.6%（40/41） vs 78.0%（32/41）］（P＝0.018）. Incidence of adverse reactions in observation group was significantly lower than that in control group［7.3%（3/41） vs 26.8%（11/41）］（P＝0.040）. Conclusion    Antelope lung-clearing pills combined with azithromycin is effective in treating pediatric pneumonia with syndrome of phlegm-heat obstructing lung by improving immunologic function and down-regulating serum levels of IL-6 and TNF-α.