Efficacy Of Qingxuan Tongluo Prescription Combined With Azithromycin In The Treatment Of Severe Mycoplasma Pneumoniae Pneumonia And Analysis Of Related Inflammatory Indexes

Objective:1.To explore the inflammatory indicators related to severe mycoplasma pneumoniae pneumonia in children through clinical trials;2.Observed the clinical efficacy of Qingxuan Tongluo prescription in the treatment of severe mycoplasma pneumoniae pneumonia in children through clinical trials;3.It was verified by in vitro experiments that the mechanism of Qingxuan tongluo prescription in the treatment of Mycoplasma pneumoniae pneumonia might be through inhibiting the expression of CARDS TX.Methods:1.A randomized controlled trial was used to randomly select 30 children with severe mycoplasma pneumoniae pneumonia(14 boys,16 girls)and 30 children with non-severe mycoplasma pneumoniae pneumonia(15 boys,15 girls)who met the inclusion criteria during the same period as the severe group and normal group.Application of SPSS 21.0 to statistical data,analysis of two groups of data,the pre-hospital course,pre-hospital highest body temperature,blood routine,C-reactive protein,calcitonin,iron,protein and blood sedimentation,coagulation four,D-dimer,myocardial enzyme,D-dimer,CARDS TX expression quantity,chest X-ray,CT,indicators such as mycoplasma Ig M antibody,associated the inflammatory indicators,using all participants working curves(ROC)analysis indicators,and calculate the area under the curve of every index,it is concluded that the sensitivity and specificity,calculate the optimal threshold,Therefore,the inflammatory indicators of severe pneumonia and their predictive diagnostic value were obtained,and the mechanism of action was speculated.2.Using the research method of randomized controlled trials,we selected 60 children with severe Mycoplasma pneumoniae pneumonia(33 boys and 27 girls)who met the inclusion criteria,and were randomly divided into the experimental group(30 cases)and the control group(30 cases).The two groups were treated with conventional Western medicine.The experimental group was treated with Qingxuan Tongluo prescription,and the control group was treated with Yinqiao Powder and Maxing Ganshi prescription.The course of treatment was 14 days.If the disease progresses or clinically heals,it can be ended at any time.Application of SPSS 21.0 to statistical data,analysis of two groups of disease curative effect,completely antifebrile time,cough reduce time,complications,hospitalization days,TCM syndrome score,and to record routine blood,C-reactive protein(CRP),calcitonin(PCT),serum ferritin(SF),blood sedimentation(ESR),blood coagulation four,D-dimer(D-D),myocardial enzyme,the immune all tems,such as CARDS TX expression before and after treatment.3.The mouse model of Mycoplasma pneumoniae pneumonia was established and divided into 4 groups(Qingxuan Tongluo prescription group,Control group,MPP model group and Azithromycin group).After 5 days of drug intervention,peripheral blood serum and alveolar lavage fluid were collected,and the expression level of CARDS TX in serum and alveolar lavage fluid was detected by ELISA.It was further verified that reducing the expression of CARDS TX may be the mechanism of Qingxuan Tongluo prescription in the treatment of Mycoplasma pneumonia.Results:1.The study showed that there were significant differences in CRP,PCT,SF,LDH,PLT and D-D between the severe group and the ordinary group,P<0.05,and the severe group was generally higher than the ordinary group,which is statistically significant.The expression of CARDS TX in the severe group was significantly higher than that in the normal group,P<0.05,which was statistically significant.There were no significant differences in gender,age,admission maximum body temperature and prehospital course(P > 0.05).There were no significant differences in WBC,N%,ESR,PLT,PT and APTT(P > 0.05).CRP,PCT,LDH,SF,D-D and CARDS TX were taken as risk factors,and the ROC curve was drawn by classification according to the severity of the disease.The analysis of ROC curve showed that the AUC was 0.75,0.79,0.95,0.89,0.97 and 0.96 respectively,all greater than 0.6,and the critical values were 19.14mg/L,0.135ng/ m L,313.9U/L,135.74ng/m L,1.23mg/L and 42.31pg/ m L,respectively.The D-D sensitivity and specificity were0.967 and 0.934,respectively,which had the highest predictive value and extremely high diagnostic value.2.The clinical study showed that the efficacy of the experimental group was better than that of the control group,and the total antipyretic time,cough relief time,hospital stay,incidence of complications and TCM syndrome score were significantly better than that of the control group,with statistical significance(P < 0.05);In the analysis of related indicators in the laboratory,the white blood cells and platelets in the experimental group and the control group increased after treatment,but there was no significant difference between the two groups.N%,CRP,PCT,ESR,SF,lactate dehydrogenase(LDH),D-D,prothrombin time(PT)and activated partial prothrombin time(APTT)were all decreased,and there were no significant differences between N%,ESR,PT and APTT groups.The decreases in CRP,PCT,SF,LDH and D-D groups were significantly higher than those in the control group(P<0.05),which was statistically significant.In the ELISA detection experiment,the expression of CARDS TX in the test group and the control group decreased after treatment,and the expression of CARDS TX in the test group decreased significantly compared with the control group,P<0.05,which was statistically significant.3.Animal experiments showed that compared with the model group,Qingxuan Tongluo prescription group and the azithromycin group had significant effects on fever,cough frequency,cough latency and other clinical symptoms(P <0.05),and could significantly improve the pathological condition of lung tissue and reduce pathological score(P <0.05).There was no significant difference in the therapeutic effect between the Qingxuantongluo prescription group and the azithromycin group(P >0.05);And the animal experiment showed that compared with the blank group,model group mice serum,alveolar lavage CARDS TX expression quantity increased(p < 0.05),compared with model group,serum azithromycin,Qingxuan Tongluo prescription group mice,alveolar lavage CARDS TX content reduced(p < 0.01,p < 0.01),compared with azithromycin group,Qingxuan Tongluo prescription group serum,alveolar lavage CARDS TX content had no significant change(p > 0.05).Conclusion:1.CRP,PCT,SF,LDH,D-D and CARDS TX are related factors of severe Mycoplasma pneumoniae pneumonia in children,which have important clinical significance in the early diagnosis and prevention of severe Mycoplasma pneumoniae pneumonia in children.2.Qingxuan Tongluo Prescription combined with western medicine in the treatment of severe mycoplasma pneumoniae pneumonia in children has a definite clinical effect,which is outstanding in terms of disease efficacy,complete antipyretic,relieving cough,shortening the course of disease and reducing complications;It has a significant effect on the reduction of CRP,PCT,ferritin,LDH,D-D and CARDS TX,which may be related to the mechanism of reducing the expression of CARDS TX.3.The high expression of CARDS TX in serum and alveolar lavage of mice with Mycoplasma pneumoniae pneumonia proved that CARDS TX was one of the pathogenic factors of MP.Azithromycin and Qingxuan Tongluo prescription could decrease the expression of CARDS TX.Regulation of the expression of CARDS TX may be the mechanism of Qingxuan Tongluo prescription in the treatment of Mycoplasma pneumoniae pneumonia.