复方甘草酸苷对儿童肺炎支原体肺炎T细胞亚群及HMGB1表达的影响

发布时间：2018-11-18 21:19

【摘要】：目的:探讨儿童MPP中T细胞亚群、HMGB1的表达;探讨复方甘草酸苷对T细胞亚群、HMGB1的调控作用;观察复方甘草酸苷对MPP的疗效及副作用。方法:本研究选取2015年1月至2016年12月在吉林大学第一医院小儿呼吸二科住院就诊的60例符合MPP诊断的患者,按其治疗药物分为对照组、复方甘草酸苷组、激素组3个组,按照入院顺序随机分配进入3个组,每组为20人,所有患者均给予退热、止咳化痰及雾化对症治疗,对照组加用阿奇霉素;复方甘草酸苷组在对照组基础上加用复方甘草酸苷;激素组在对照组基础上加用甲泼尼龙琥珀酸钠,总疗程均为10天。同时选取我院56例健康儿童作为空白组。流式细胞仪检测T细胞亚群,ELISA法检测HMGB1含量,观察患儿5天内发热、呼吸急促、鼻翼煽动、口周发绀等症状及肺部Up音情况,比较治疗后的临床有效率及副作用。运用SPSS Statistics21.0统计软件行统计学分析。结果:1.MPP组与空白组相比,MPP组急性期CD4+降低,CD8+升高,CD4+/CD8+降低,P0.05,两组差异明显。2.复方甘草酸苷组和激素组治疗后,CD4+升高,CD8+降低,CD4+/CD8+升高,P0.05,差异显著,但复方甘草酸苷组治疗后CD4+/CD8+接近正常儿童水平。3.MPP组与空白组相比,MPP急性期HMGB1升高,P0.05,两组比较有差异;治疗后,HMGB1降低,P0.05,差异明显,但仍高于空白组。4.复方甘草酸苷组和激素组治疗后HMGB1水平与对照组相比明显降低,P0.05,差异明显;但复方甘草酸苷组与激素组比较,P0.05,差异不显著。5.临床疗效比较:两治疗组有效率明显高于对照组,P0.05,差异显著;但复方甘草酸苷组与激素组比较,P0.05,差异不明显。复方甘草酸苷组(0)副作用明显低于激素组(20%),P0.05,两组差异明显。结论:1.儿童MPP急性期CD4+降低,CD8+升高,CD4+/CD8+降低,提示T细胞亚群紊乱参与了MPP的发病。2.复方甘草酸苷治疗后CD4+、CD4+/CD8+细胞水平升高,CD8+细胞水平降低,且CD4+/CD8+细胞水平接近正常儿童,说明复方甘草酸苷对T细亚群的紊乱有纠正作用。3.MPP急性期HMGB1升高,治疗后降低,但仍高于正常儿童,说明HMGB1可以作为反应疾病急性期的炎症因子,且持续存在时间长,可以作为晚期炎症因子预测病情变化。4.复方甘草酸苷治疗后HMGB1下降程度与激素组相当,明显高于对照组,说明甘草酸苷可以作为HMGB1抑制剂在儿童MPP中应用。5.在儿童MPP中,复方甘草酸苷的临床有效率与激素相近,但无食欲增强、体重增长等副作用。
[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.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R725.6

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