支原体肺炎急性期免疫功能变化及中药槐杞黄干预的研究

发布时间：2018-01-18 00:21

  本文关键词：支原体肺炎急性期免疫功能变化及中药槐杞黄干预的研究　出处：《大连医科大学》2017年硕士论文　论文类型：学位论文

  更多相关文章： 肺炎支原体肺炎 免疫功能 槐杞黄颗粒 临床疗效

【摘要】：目的:研究MPP患儿不同影像学表现及其在不同年龄组中的分布;探讨MPP患儿急性期免疫功能变化情况;观察MPP患儿恢复期应用槐杞黄颗粒在辅助治疗该病中的临床疗效。方法:采用前瞻性、随机抽样的方法,选择符合MPP纳入标准的自2016年1月至2016年12月于大连市儿童医院呼吸病房住院的患儿共100例,年龄为0-12岁。将符合纳入标准的患儿根据胸部影像学表现的不同,分为大叶性MPP组和小叶性MPP组,分析MPP患儿的影像学改变,及其在各年龄组中的分布特点。入院后对符合纳入标准的患儿进行免疫功能检查,记录结果并进行描述性分析,从而探讨MP感染后患儿急性期免疫功能状态,及不同胸部影像学表现的MPP患儿的免疫变化特点;采用随机数字表法,将所纳入的MPP患儿分为槐杞黄组及对照组,两组患儿住院期间均给予常规大环内酯类药物抗感染治疗,仅槐杞黄组患儿出院后给予槐杞黄颗粒辅助治疗3个月,并对所有MPP患儿愈后的第1个月及第3个月进行跟踪随访并记录当月患呼吸道感染的总人数,通过比较两组感染率,进而观察槐杞黄对MPP患儿的临床疗效。结果:1.在符合纳入标准的100例MPP患儿中,婴幼儿24例,占24%;学龄前儿童43例,占43%;学龄期儿童33例,占33%;大叶性MPP37例,占37%;小叶性MPP63例,占63%;;其中在37例大叶性MPP患儿中,婴幼儿期患儿为5例,占13.51%;学龄前期患儿为15例,占40.54%;学龄期患儿为17例,占45.94%;在63例小叶性MPP患儿中,婴幼儿期患儿为20例,占31.75%;学龄前期患儿为27例,占42.86%;学龄期患儿为16例,占25.40%。2.在符合纳入标准的并进行免疫功能检查的48例患儿中,免疫功能异常的有35例,占72.92%;其中在免疫功能异常的患儿中,体液免疫功能异常的有23例,异常率占65.71%;细胞免疫功能异常的有5例,异常率占14.29%;体液免疫混合细胞免疫功能异常的有7例,异常率占20%3.在进行免疫功能检查的48例患儿中,大叶性肺炎有18例,其中免疫功能异常的有13例,正常的有5例,异常率为72.22%;小叶性肺炎有30例,其中免疫功能异常的有28例,正常的有2例,异常率为76.67%。经卡方检验,两组患儿在MP感染后免疫功能异常率间的比较,P0.05,差异不显著,无统计学意义。4.在符合纳入标准并进行血清免疫球蛋白检查的48例MPP患儿中,IgG水平升高的有1例,占2.08%,降低的有9例,占18.75%,异常率为20.83%;IgA降低的有19例,占39.58%,升高的有0例;IgM细胞升高的有12例,占25%,降低的有0例,占25%,异常率为25%。5.在符合纳入标准并进行淋巴细胞亚群检查的48例MPP患儿中,CD3细胞比例升高的有5例,占10.4%,降低的有0例;CD4细胞比例升高的有0例,降低的有3例,占6.3%;CD8细胞升高的有0例,降低的有4例,占8.3%;CD4/CD8细胞比值升高的有1例,占2%,降低的有0例;6.在符合纳入标准的100例MPP患儿中,槐杞黄组共有58例,对照组42例。愈后第1个月,槐杞黄组有感染的人数有6人,无感染的有52人,感染率为10.3%;对照组有感染的人数有24人,无感染有18人,感染率为57.1%。槐杞黄组患儿感染率明显低于对照组,经卡方检验,P0.01,差异显著,具有统计学意义。愈后第3个月,槐杞黄组有感染的有3人,无感染的有55人,感染率为5.2%;对照组有感染的有15人,无感染的有27人,感染率为35.7%。槐杞黄组患儿感染率明显低于对照组,经卡方检验,P0.01,差异显著,具有统计学意义。结论:1.MPP的影像学改变与患儿的年龄间存在一定关系,婴幼儿期及学龄前期患儿以小叶性MPP改变为主;学龄期患儿以大叶性MPP改变为主。2.肺炎支原体感染可引起机体特异性免疫功能紊乱,其中急性期主要以体液免疫紊乱为主,细胞免疫亦发生了一定变化。3.中药槐杞黄颗粒在治疗肺炎支原体肺炎的临床疗效上作用明显,可显著的降低肺炎支原体肺炎患儿在恢复期再次发生呼吸道感染的机率,对MPP的预后有着很好的改善作用。
[Abstract]:Objective: To study the MPP children with different imaging appearances and its distribution in different age groups; to investigate the change of immune function in children with acute MPP; observation of children with MPP recovery period using Huaiqihuang granules in the adjuvant treatment of the clinical effect of the disease. Methods: a prospective, random sampling method, in accordance with MPP standard from January 2016 to December 2016 in Dalian city children's hospital respiratory ward in hospital were 100 cases, aged 0-12 years old. In accordance with the standard of children according to the radiographic appearances of different, divided into lobar MPP group and MPP group of small leaves, changes with MPP image analysis, and the characteristics of the distribution in each in the age group after admission. The patients met the inclusion criteria for the assessment of immune function, and record the results of descriptive analysis, to explore the immune function of children with acute MP infection, and different chest The features of immune changes in MPP children in the Department of Radiology; using the method of random number table, will be included in MPP were divided into Huaiqihuang group and control group, two groups of children during hospitalization were given conventional macrolide antibiotic therapy, only Huaiqihuang group were discharged after Huaiqihuang granules adjuvant therapy for 3 months, and all the children with MPP after first months and 3 months were followed up and recorded the total number of patients with respiratory tract infection, compared with two groups of infection, and to observe the clinical efficacy of Huaiqihuang on patients with MPP. Results: 1. in 100 patients with MPP were included in the the standard, 24 infants, accounted for 24%; 43 preschool children, accounting for 43% of school-age children; in 33 cases, accounting for 33%; lobar MPP37 cases, accounting for 37%; lobular MPP63 cases, which accounted for 63%;; in 37 cases of lobar MPP children, infants were 5 cases, accounting for 13.51% preschool children was 15; For example, 40.54% of school-age children; in 17 cases, accounting for 45.94%; in 63 cases of lobular MPP children, infants were 20 cases, accounting for 31.75%; preschool children were 27 cases, accounting for 42.86%; 16 cases of school-age children, accounting for 25.40%.2. and immune function in the examination in accordance with the inclusion criteria in 48 cases, immune dysfunction in 35 cases, accounting for 72.92%; the abnormal immune function in children with humoral immune function were abnormal in 23 cases, the abnormal rate was 65.71%; cellular immune function abnormalities in 5 cases, the abnormal rate was 14.29%; humoral immune hybrid cellular immune function abnormalities in 7 cases and the abnormal rate was 20%3. in 48 cases of children with immune function tests, lobar pneumonia in 18 cases, the immune dysfunction in 13 cases, normal 5 cases, the abnormal rate was 72.22%; 30 cases of lobular pneumonia, including immune function abnormalities in 28 cases, normal 2 cases the abnormal rate was 76.. 67%.缁忓崱鏂规��楠，

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