加味五虎汤治疗痰热闭肺型小儿支原体肺炎临床及细胞免疫研究
发布时间：2018-08-22 17:28
【摘要】：目的： 研究加味五虎汤对痰热闭肺型小儿支原体肺炎的临床治疗效果及对细胞免疫功能的影响；综合评价加味五虎汤治疗痰热闭肺型小儿支原体肺炎的治疗方案,并为加味五虎汤治疗痰热闭肺型小儿支原体肺炎的推广应用及进一步的研究提供临床依据及细胞免疫水平的相关参数。 方法： 本研究采用前瞻的随机临床对照研究,将60例符合痰热闭肺型小儿支原体肺炎住院患儿随机分为2组：试验A组、试验B组,每组30例。试验B组在基础治疗及硝黄散的基础上加阿奇霉素(希舒美)进行治疗；试验A组在试验B组的基础上予加味五虎汤治疗。分别对治疗前、后症候积分(主要症候、次要症候)进行计算,同时分别检测治疗前后T细胞亚群(CD3+、CD4+、CD8+、CD4+/CD8+)及外周血细胞因子IL-10、IL-17、TGF-β1水平。通过对治疗前后T淋巴细胞亚群、细胞因子IL-17、IL-10、TGF-β1水平的观察,并与同期30例年龄相当健康儿童外周血T细胞亚群、细胞因子IL-10、IL-17、TGF-β1水平测定进行对比分析。观察加味五虎汤对小儿支原体肺炎T淋巴细胞亚群、细胞因子IL-17、IL-10、TGF-β1水平的调节作用。 结果： 1.共观察痰热闭肺型小儿支原体肺炎患儿60例,治疗前,两组患儿在性别、年龄分布、咳嗽时间、发热时间等情况经统计学处理无显著性差异,具有可比性(P0.05)；两组在主要症候、次要症候、总症候积分,经统计学处理均无显著性差异,具有可比性(P0.05)。 2.治疗前,试验A组与试验B组分别与30例健康组儿童T淋巴细胞亚群CD3、CD4+、CD8+、CD4+/CD8+比较,均无统计学差异(P0.05)；与正常组进行IL-10,IL-17, TGF-p1水平比较,两组患儿IL-10, IL-17, TGF-β1水平均明显增高,与健康组相比差异显著(P0.01)。 3.治疗前,两组患儿治疗前T淋巴细胞亚群CD3+、CD4+、CD8+、CD4+/CD8+水平比较,无统计学意义(P0.05),两组患儿IL-10、IL-17、TGF-β1水平比较,经统计学处理均无显著差异(P0.05)。 4.治疗后,对A、B两组临控率、控显率、总有效率进行比较,经统计学处理均无显著性差异(P0.05)；但两组的治疗后积分、症候积分减少、住院发热时间、咳嗽时间、肺部哕音持续时间进行比较,差异显著(P0.01),试验A组临床疗效明显优于试验B组。 5.治疗后,试验A组、试验B组与健康组进行T淋巴细胞亚群CD3+、CD4+、CD8+、 CD4+/CD8+比较,两组患儿与健康组比较均无统计学意义(P0.05)。 6.两组患儿治疗后CD3、CD4+与治疗前的差值经统计学处理均无显著性差异,(P0.05)；两组患儿CD8+、CD4+/CD8+与治疗前的差值相比差异显著(P0.01),试验A组在调节淋巴细胞亚群方面可能优于试验B组。 7.治疗后,试验A组、试验B组分别与健康组进行IL-10、IL-17、TGF-β1水平比较,差异均具有显著性(P0.01)。 8.治疗后,两组患儿IL-10、IL-17、TGF-β1水平与治疗前的差值分别为：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.差值相比差异显著(P0.0l、P0.01)IL-17(-10.88±9.24)pg/ml、(-7.15±8.71)pg、ml；差值相比无显著意义(P0.05)。 结论： 1.支原体肺炎患儿细胞因子IL-10、IL-17、TGF-β1水平升高,提示抗炎性细胞因子和促炎性细胞因子平衡失调,可能导致Treg/Th17平衡失调,机体发生细胞免疫紊乱,引起患儿肺部出现免疫炎症反应、免疫损伤及纤维化,而出现一系列临床表现。 2.恢复期,试验A组、试验B组患儿T淋巴细胞亚群水平都接近正常儿童水平；IL-10、IL-17水平较治疗前下降,但与正常儿童相比,差异显著,且TGFβ1水平仍保持高水平,提示支原体患儿恢复期肺部可能还存在慢性炎症反应,肺纤维化,体内Treg/Th17的免疫平衡仍未完全恢复,患儿仍存在气道高反应性,可能是导致MP感染患儿易反复发作甚至发展为哮喘的机制。 3.试验A组的临床疗效明显优于试验B组；在T淋巴细胞亚群水平的调节方面可能优于试验B组；在调节细胞因子IL-10、TGF-β1水平方面明显优于试验B组。在调节细胞因子IL-17水平方面与试验B组相比无显著差异。试验A组可能是通过加味五虎汤对痰热闭肺型MPP的开肺平喘、清热化痰,化瘀通络作用,减轻了肺部免疫炎症反应及肺部纤维化,调节细胞因子IL-10、IL-17、TGF-β1水平及Treg/Th17平衡,而提高临床疗效。
[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.
【学位授予单位】：广州中医药大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R272
本文编号：2197808
[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.
【学位授予单位】：广州中医药大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R272
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