静脉应用穿心莲内酯对急性支气管肺炎患儿平温作用的研究

发布时间：2018-11-22 07:32

【摘要】：目的：观察支气管肺炎患儿应用穿心莲内酯治疗后体温恢复正常的时间及相关细胞因子浓度的变化，探讨穿心莲内酯平温作用的可能机制，为穿心莲内酯在儿科的临床应用提供一定的依据。方法：采用前瞻性、随机抽样的方法，选择符合纳入标准的2011年10月 2012年3月在大连市儿童医院呼吸科病房住院，年龄为2月 12岁，除外既往反复呼吸道感染史、先天性免疫功能低下、应用激素或免疫抑制剂、临床诊断为支气管肺炎的患儿，随机分为观察组和对照组。观察组在常规治疗的基础上静脉滴注穿心莲内酯注射液；对照组只给与常规治疗，7-10天为1个疗程。每组随机抽取20例患儿于治疗前和体温平稳24小时后的血清，采用ELISA法检测血清前列腺素E2（PGE2）、白细胞介素-1β（IL-1β）、白细胞介素-6（IL-6）、干扰素-γ（IFN-γ）和肿瘤坏死因子-α（TNF-α）浓度。观察两组患儿平温时间和咳嗽减轻的时间及治疗前、后血清中PGE2、IL-1β、IL-6、IFN-γ和TNF-α浓度的变化。结果： 1.一般情况：符合纳入标准的患者共73例，男33例，女40例，平均年龄为3.22±0.199岁。其中观察组41例，男19例，，女22例，平均年龄为3.43±0.30岁；对照组32例，男14例，女18例，平均年龄为2.95±0.24岁。经方差齐性检验，两组性别、年龄、病程比较P0.05，无显著差异，具有可比性。 2.静脉应用穿心莲内酯对临床症状及转归的影响：应用穿心莲内酯治疗的观察组体温平稳的时间为3.10±0.25天，对照组为4.16±0.23天，观察组体温平稳时间较对照组缩短，有统计学意义（P0.01）；观察组咳嗽明显减轻的时间为3.20±1.01天，对照组为5.22±1.13天，观察组咳嗽明显减轻的时间少于对照组，有统计学意义（P0.01）；两组临床总有效率为100%，观察组41例，治愈36例，有效5例，治愈率为87.8%；对照组32例，治愈22例，有效10例，治愈率为68.8%，在所观察7天内，观察组的治愈率高于对照组，观察组的临床转归程度优于对照组，有统计学意义（χ~2=3.99，P0.05）。 3.细胞因子浓度的变化及比较：观察组应用穿心莲内酯前、后血清中IL-6、IFN-γ的浓度差异显著，有统计学意义（P0.05）；观察组和对照组药后血清中PGE2和IFN-γ浓度差异显著，有统计学意义（P0.05）。结论： 1.穿心莲内酯能缩短支气管肺炎患儿的发热和咳嗽时间，且临床转归程度较好。 2.穿心莲内酯能够直接作用于调节体温中枢的重要介质——PGE2，减少PGE2的释放，调节体温，使发热患儿体温降至正常，达到平温效果。 3.穿心莲内酯可以通过抑制内源性致热源IFN-γ和IL-6，从而减少下丘脑释放PGE2，达到调节体温作用，使患儿体温平稳恢复正常。 4.穿心莲内酯对血清中的IL-1β和TNF-α的浓度在观察例数内影响不明显。
[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- 纬 (IFN- 纬) and tumor necrosis factor- 伪 (TNF- 伪) were observed. The changes of serum PGE2,IL-1 尾, IL-6,IFN- 纬 and TNF- 伪 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 卤0.199 years. There were 41 cases in the observation group, 19 males and 22 females, with an average age of 3.43 卤0.30 years, while in the control group, there were 32 cases, 14 males and 18 females, with an average age of 2.95 卤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 卤0.25 days, and that of control group was 4.16 卤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 卤1.01 days in the observation group and 5.22 卤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- 纬 in serum in the observation group was significantly different (P0.05); The serum PGE2 and IFN- 纬 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- 纬 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- 伪 in serum.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R725.6

【参考文献】