| Objective:Evidence-based medicine is used to evaluate the correlation between inflammatory factors and Severe mycoplasma pneumonia(SMPP),to understand their expression and prognosis.And observe the effect of Yangyin Qingfei Decoction on the expression of TGF1/Smad3 pathway related factors in the lung tissue of SMPP mice,and explore the possible mechanism of Yangyin Qingfei Decoction on the treatment of SMPP.Material and method:The case-control studies on the relationship between inflammatory factors and SMPP were systematically searched in Medical Abstraction Database(EMBASE),Pub Med,Cochrane Library,Web of Science,China Biomedical Literature Database(CBM),China National Knowledge Network(CNKI),Wanfang Database and VIP Database.Statistical analysis and sensitivity analysis/heterogeneity test were performed using Rev Man 5.6 and Statam P16.120 BALB/c mice were randomly divided into normal group,model group,azithromycin group,Yangyin Qingfei Decoction group and integrated Chinese and Western medicine group.Except for the normal group,1010MP bacterial solution was administered for continuous nasal dripping for 3 days,resulting in severe MP infection in mice.On the 3rd,7th,10th and 14th days after infection,6 mice in each group were randomly killed and samples were collected.The general state of the mice was observed,lung weight was measured and lung index of mice in each group was calculated.The lung pathology of mice was observed by HE staining.The expression of cytokines related to the TGF-?1/Smad3 pathway was detected by quantitative fluorescence PCR(q PCR).The inflammatory cytokine IL-17 was determined by enzyme linked immunosorbent assay(ELISA).Results:1.In this meta-analysis,it was found that the serum level of IL-6 in the severe group was higher than that in the mild group,the acute stage of the severe group was significantly higher than that in the children in the remission stage,and the acute stage of the severe group was significantly higher than that in the healthy children.The serum level of IL-6 in the children in the remission stage was not comparable with that of the healthy children. This suggests that IL-6 is involved in the occurrence and development of SMPP,but it is not clear whether IL-6 can be used to judge the remission of the disease,and further investigation is needed.The serum level of IL-8 in the severe group was significantly higher than that in the mild group.However,the sample size is relatively small,so the stability of the results remains to be judged.The increase or decrease of IL-10 in serum of children with SMPP is still controversial.The overall performance of IL-10 in the severe group is higher than that in the mild group,and the difference is statistically significant.Serum TNF-?level in severe group was higher than that in mild group.It's also significantly greater than health. May be due to include small sample size,and the children diagnosed and hospitalized time,area,severe lung inflammation when performance is different,complications,treatment interventions is different,different collection time,ELISA detection reagent box use,influence is bigger,the result of the inflammatory factors but the overall trend can be observed.2.Daily life activity observation can be found on the groups of mice,model group,azithromycin group,Yin qing lung tonga taste,combine traditional Chinese and western medicine group 3 days after infection with MP part mice appeared different degree of burnout,eating less obviously,appear even piloerection reaction,nose fluid,which combine traditional Chinese and western medicine group reflect the most light,made reflect the heaviest module.The lung tissue morphology of the model group was atrophied with dark red ecchymosis.The lung tissues of the Yangyin Qingfei Decoction group and the azithromycin group were dark red,with obvious congestion and edema.The lung tissue surface of the integrated Chinese and Western medicine group was smooth,with mild edema,but no congestion.Through the evaluation of lung index,it can be found that the lung index of the group after administration is lower than that of the model group,and the combination group has the best effect.Under light microscope,the alveolar septum of model group mice was significantly widened,the alveolar cavity and lung interstitium were full of inflammatory cell infiltration,alveolar wall was broken,alveolar fusion,there were a large number of inflammatory cells,pulmonary congestion was visible;Compared with the model group,the inflammatory exudation in azithromycin group was less,and alveolar wall rupture and alveolar fusion were less.In the modified Yangyin Qingfei Decoction group,there were inflammatory cells,not obvious widening between alveoli,a small amount of congestion and edema in lung tissue,lymphocytes,plasma cells and neutrophils.The improvement was most obvious in the group of integrated traditional Chinese and western medicine,only a small amount of inflammatory cell infiltration was observed.This result was also verified in the pulmonary pathology score.Both the pulmonary index and pathological score reached their peaks on the seventh day,and the MP infection increased in the three groups compared with the normal group(P<0.05).3.Serum IL-17 of mice was detected by ELISA method.Serum IL-17 of mice in the model group showed an increasing trend,reached the peak on the 7th day,and then decreased,which was significantly higher than that in the normal group(P<0.05);Serum IL-17 in each administration group also reached the peak value on the 7th day,and then showed a decreasing trend.Compared with the model group,the serum IL-17 content in each administration group was significantly decreased(P<0.05);On day 3th,7th and 14th,compared with the Yangyin Qingfei Decoction modified group and the azithromycin group,the expression of IL-17 in the integrated traditional Chinese and western medicine group decreased(P<0.05);On the 10th day of administration,there was no significant difference in the ratio reduction between the integrated Chinese and western medicine group and the azithromycin group,and there was significant difference in the ratio reduction between the Yangyin Qingfei Decoction group and the modified Yangyin Qingfei Decoction group (P<0.05);The drug administration group began to show obvious drug administration effect from the 7th day,the best effect on the 14th day,the integrated Chinese and Western medicine group had the best effect,but it was still significant with the normal group(P<0.05).4.The expression levels of TGF-?1 and Smad3 genes in the lung tissues of mice were detected by q PCR method.The expression levels of TGF-?1 and Smad3 genes in the model group increased and decreased after the 7th day,and were significantly higher than those in the normal group at each time point(P<0.05);Compared with model group,TGF-?1 and Smad3 levels in lung tissue of drug administration groups were significantly decreased (P<0.05),the effect was most obvious on the 7th day;On days 3,7,and 10,decreased levels of TGF-?1 and Smad3 in lung tissues were more pronounced in the combination group than in the other monotherapy groups(P<0.05),but there was still a difference between the two groups(P<0.05).The expression trend of TGF-?1 and Smad3 gene in mouse lung tissue was basically consistent.Conclusion:1.The levels of IL-6,IL-8,IL-10 and TNF-?in peripheral blood of children with MPP are correlated with severity.The levels of IL-6,IL-8,IL-10 and TNF-?in peripheral blood of children with SMPP are elevated.The level of a single inflammatory factor cannot be used as an independent criterion for judging the trend of disease severity.The literature included in this study has limitations,and the above conclusions need to be further verified.2.Yangyin Qingfei Decoction may have an effect on TGF-?1/Smad3 signaling pathway and IL-17 factor expression in SMPP BALB/c mouse model induced by high-load MP,both of which are inhibitory regulation.The use of Yangyin Qingfei Decoction and azithromycin combined with traditional Chinese and Western medicine may have a good effect in the treatment of SMPP. |
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