| Objective:To evaluate the clinical effect of detoxification,heat clearing and lung promoting method in the treatment of Mycoplasma pneumoniae pneumonia(toxic heat and closed lung syndrome)in children and its influence on immune function.Methods:A total of 87 children with Severe Mycoplasma pneumoniae pneumonia were included in this study.They were from the Department of traditional Chinese medicine and respiratory ward of Beijing Children’s Hospital,and met the diagnostic criteria of severe Mycoplasma pneumoniae pneumonia in western medicine.They were divided into experimental group and control group by random number table.Among them,44 cases in the experimental group were treated with Yindai Decoction on the basis of conventional western medicine;43 cases in the control group were treated with conventional western medicine.The total course of treatment was 4 weeks.Before treatment,1 week after treatment,4 weeks after treatment,8 weeks after treatment and 12 weeks after treatment,the main symptoms and secondary symptoms scores of the two groups were compared,and the total efficacy was evaluated.The changes of inflammatory indexes before treatment,1 week after treatment and 2 weeks after treatment were compared.The changes of immune function before and 4 weeks after treatment were compared.Fiberoptic bronchoscopy was performed 3 days after treatment to observe the changes of bronchial mucosa in the two groups.The children who needed the second fiberoptic bronchoscopy were performed the second fiberoptic bronchoscopy 10 days after treatment.The changes of bronchial mucosa before and after treatment in the two groups were compared.The complications and sequelae of the two groups were observed.Results:The incidence rate of girls was higher than that of boys-Among the 87 cases,most of them were school-age and preschool children.There was no significant difference in the time of fever regression between the two groups.Observation of the two groups of children with lesions involving the lobes found that the right lower lung was the main lesion lobes,followed by the left lower lung,left upper lung and right upper lung.The total effective rate and recovery rate of the experimental group were better than those of the control group at 1 week and 4 weeks after treatment.At 8 weeks and 12 weeks after treatment,the total effective rate and recovery rate of the two groups were 100%.In the main symptom score,the two groups before and after treatment in reducing fever,cough,expectoration,asthma,rales reduction and chest imaging film absorption,have curative effect.In the comparison between the two groups,the experimental group was better than the control group in the reduction of rales and the absorption of film shadow at 1 week,4 weeks,8 weeks and 12 weeks after treatment,with statistical difference between the two groups(P<0.05).At 4 weeks and 8 weeks after treatment,the effect of the experimental group was better than that of the control group in relieving cough.At 8 weeks and 12 weeks after treatment,the difference of main symptom score between the two groups was statistically significant,and the score of the experimental group was lower than that of the control group.In the secondary symptom score,the two groups had certain effect in improving sore throat,dry nostrils,red complexion,irritability,thirst,dizziness,less urine and constipation.After 1 week,4 weeks,8 weeks and 12 weeks of treatment,the symptom scores of the experimental group were better than those of the control group.One week after the treatment,the curative effect was significant in relieving thirst,drinking,anorexia and less urine.At 4 weeks and 8 weeks after treatment,the improvement of secondary symptoms was mainly in constipation.In terms of inflammatory indexes,the WBC,LDH,ESR,SF and CRP of the two groups were compared before treatment(P>0.05),with no statistical significance and comparability.CRP and ESR of the two groups decreased significantly at 1 week and 2 weeks after treatment,with statistical difference.There was no significant difference in CRP and ESR between the two groups.LDH levels in the two groups after treatment were significantly lower than before treatment,with statistical difference.In the comparison between the two groups,the decrease level of LDH in the experimental group was better than that in the control group one week after treatment,and the difference was statistically significant(P<0.05).There was no significant difference in SF between the two groups,but in the intra group comparison,the SF in the experimental group decreased significantly 1 week and 2 weeks after treatment compared with that before treatment,and the difference was statistically significant.The difference was statistically significant in the control group only 2 weeks after treatment and before treatment.The white blood cell levels of the two groups were higher than those before treatment at 1 week and 2 weeks after treatment,with statistical difference.There was no significant difference in WBC between the two groups before and after treatment.In terms of D-dimer,the D-dimer of the two groups decreased in varying degrees before and after treatment.The effect of the experimental group on the decrease of D-dimer 2 weeks after treatment was better than that of the simple western medicine group,with statistical difference,P<0.05.Intra group comparison found that the experimental group in the treatment of three nodes compared with each other were statistically significant,the control group in the treatment of one week before and after the comparison was not statistically significant,the other two nodes were statistically significant.In terms of immune function,in humoral immunity,the levels of IgA and IgG were low before treatment,and the levels of IgM were increased.After treatment,the levels of IgA and IgG were increased,while the levels of IgM were decreased.There were significant differences in the changes of IgA between the experimental group and the control group before and after treatment.There was no significant difference in IgA,IgG,IgM and IgE between the two groups before and after treatment.In cellular immunity,compared with that before treatment,the levels of CD4+T and CD4+/CD8+in the two groups increased at 4 weeks after treatment,while the level of CD8+T decreased.The differences of CD4+T and CD4+/CD8+levels were statistically significant(P<0.05).In the experimental group,the level of CD4+/CD8+after treatment was higher than that before treatment,and the level of CD8+T was lower than that before treatment.In the control group,there was no significant difference in CD4+T,CD8+T,CD4+/CD8+before and after treatment.In terms of cytokines,the levels of IL-6 and IL-10 were normal or increased in acute phase,while the levels of IL-2,IL-4,TNF-α and IFN-γ were normal or low.In terms of fiberoptic bronchoscopy,there was no significant difference in the quantitative scores between the two groups before treatment,and the two groups were comparable.After treatment,there was statistical difference between the experimental group and the control group(P<0.05).In the intra group comparison,the scores of the experimental group and the control group after treatment were decreased compared with those before treatment,and there was statistical difference between the two groups before and after treatment,P<0.05.The main pulmonary complications were pleural effusion,bronchitis obliterans,necrotizing pneumonia,atelectasis and pneumonia.In terms of extrapulmonary complications,the main manifestations are cardiovascular system diseases,blood system diseases,digestive system diseases,skin damage and nervous system diseases.In terms of sequelae,87 children with SMPP in the two groups were followed up for 12 weeks.31 children(8 cases in the experimental group and 23 cases in the control group)had incomplete absorption of pulmonary lesions.The incidence of sequelae was 13.6%in the experimental group and 30.2%in the control group.The effect of the experimental group was better than that of the control group in the absorption of lung lesions and the reduction of sequelae.Conclusion:For the children with severe Mycoplasma pneumoniae pneumonia with toxic heat and lung shut syndrome,the clinical effect of detoxification,heat clearing and lung promotion combined with western medicine is positive,and the effect is obvious in improving cough,Rale absorption of lung and improvement of chest imaging film.For the secondary disease change,to alleviate thirst and drink,Na daze,urination yellow less,constipation.In laboratory indicators,the effect of LDH and D-dimer level is better,which can reduce inflammation,improve the hypercoagulable state of blood,and promote the absorption of pneumonia.In terms of immune function,the treatment of SMPP with Yindai decoction can reduce the immune dysfunction by improving the function of CD4+T,which is conducive to the recovery of disease and the absorption of inflammation.Yindai decoction combined with western medicine can improve the condition of airway mucosa and reduce the occurrence of sequelae.It is worth popularizing in clinic,which is helpful to improve the clinical effect. |
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