清肺化痰解毒汤联合雾化吸入用乙酰半胱氨酸溶液治疗小儿肺炎支原体肺炎痰热壅肺证的效果

Effect of Qingfei Huatan Jiedu decoction combined with nebulized inhalation of acetylcysteine in the treatment of phlegm-heat obstructing the lung syndrome of Mycoplasma pneumoniae pneumonia in children

摘要:

目的 观察肺炎支原体肺炎（MPP）痰热壅肺证患儿接受雾化吸入用乙酰半胱氨酸溶液联合清肺化痰解毒汤治疗的效果。方法 选取2023年4月—2025年2月在北京中医药大学东方医院秦皇岛医院就诊的痰热壅肺证MPP患儿94例，采用随机数字表法将其分成对照组、观察组，各47例。对照组采用雾化吸入用乙酰半胱氨酸溶液治疗，观察组在对照组的基础上采用清肺化痰解毒汤治疗。比较两组患儿的中医症候评分、肺功能指标［75%肺活量时呼气流量（PEF₇₅）、用力肺活量（FVC）、第一秒用力呼气容积（FEV₁）］、临床疗效、免疫功能指标［自然杀伤（NK）细胞、免疫球蛋白M（IgM）、免疫球蛋白A（IgA）］、炎症反应指标［降钙素原（PCT）、γ干扰素（IFN-γ）、白细胞介素-13（IL-13）］及不良反应。结果 观察组治疗后中医症候评分低于对照组（P <0.05）；观察组治疗前后中医症候评分的差值大于对照组（P <0.05）。观察组总有效率高于对照组（P <0.05）。观察组治疗后PEF₇₅、FVC、FEV₁高于对照组（P <0.05）；观察组治疗前后PEF₇₅、FVC、FEV₁的差值均大于对照组（P <0.05）。观察组治疗后NK细胞、IgM、IgA高于对照组（P <0.05）；观察组治疗前后NK细胞、IgM、IgA差值均大于对照组（P <0.05）。观察组治疗后PCT、IFN-γ、IL-13水平低于对照组（P <0.05）；观察组治疗前后PCT、IFN-γ、IL-13水平的差值均大于对照组（P <0.05）。两组不良反应总发生率比较，差异无统计学意义（P >0.05）。结论 在雾化吸入乙酰半胱氨酸的基础上，联合清肺化痰解毒汤治疗痰热壅肺证儿童肺炎支原体肺炎，可进一步改善肺功能，调节免疫功能，减轻全身炎症反应，且未增加明显不良反应，显示出良好的疗效与安全性。

Abstract:

Objective To observe the therapeutic effect of nebulized inhalation of acetylcysteine combined with Qingfei Huatan Jiedu Decoction in children with Mycoplasmal pneumoniae pneumonia (MPP) with phlegm-heat obstructing the lung syndrome.Methods A total of 94 children with phlegm-heat obstructing the lung syndrome MPP who were treated at Beijing University of Chinese Medicine Dongfang Hospital Qinhuangdao Hospital from April 2023 to February 2025 were selected. They were divided into a control group and an observation group using a random number table method, with 47 cases in each group. The control group was treated with nebulized inhalation of acetylcysteine, while the observation group was treated with Qingfei Huatan Jiedu Decoction on the basis of the control group. The TCM syndrome scores, lung function, clinical efficacy, immune function, inflammatory response and adverse reactions of the two groups were compared.Results The traditional Chinese medicine (TCM) syndrome score after treatment was lower in the observation group than in the control group (P < 0.05); the differences in TCM syndrome scores before and after treatment were greater in the observation group than in the control group (P < 0.05). The total effective rate in the observation group was higher than that in the control group (P < 0.05). Levels of forced expiratory flow at 75% of forced vital capacity (PEF₇₅), forced vital capacity (FVC), and forced expiratory volume in the first second (FEV₁) after treatment were higher in the observation group than in the control group (P < 0.05); the differences in PEF₇₅, FVC, and FEV₁ levels before and after treatment were greater in the observation group than in the control group (P < 0.05). Levels of natural killer (NK) cells, immunoglobulin M (IgM), and immunoglobulin A (IgA) after treatment were higher in the observation group than in the control group (P < 0.05); the differences in NK cell, IgM, and IgA levels before and after treatment were greater in the observation group than in the control group (P < 0.05). Levels of procalcitonin (PCT), interferon-gamma (IFN-γ), and interleukin-13 (IL-13) after treatment were lower in the observation group than in the control group (P < 0.05); the differences in PCT, IFN-γ, and IL-13 levels before and after treatment were greater in the observation group than in the control group (P < 0.05). There was no statistically significant difference in the total incidence of adverse reactions between the control group and the observation group (P > 0.05).Conclusion For children with MPP syndrome caused by phlegm-heat congestion in the lungs, the treatment of nebulized inhalation of acetylcysteine combined with Qingfei Huatan Jiedu Decoction can significantly improve the lung function and immune function of the children, reduce the inflammatory response of the children, and is safe and reliable.