儿童肺炎支原体肺炎不同中医证型的临床比较研究

Clinical comparative study on different traditional Chinese medicine syndromes of mycoplasma pneumoniae pneumonia in children

关键词:  肺炎支原体肺炎  儿童  风热闭肺证  痰热闭肺证  毒热闭肺证  湿热闭肺证

Key words:  mycoplasma pneumoniae pneumonia  children  wind-heat obstructing the lung syndrome  phlegm-heat obstructing the lung syndrome  toxic-heat obstructing the lung syndrome  damp-heat obstructing the lung syndrome

摘要:

[目的] 比较不同中医证型的肺炎支原体肺炎（MPP）患儿的症状、体征及实验室检查等是否存在差异，以期为临床精准辨治MPP提供参考与依据。[方法] 收集2023年11月—2024年9月就诊于天津市中西医结合医院儿科并诊断为MPP的患儿156例作为研究对象，根据中医辨证具体分为风热闭肺证、痰热闭肺证、毒热闭肺证、湿热闭肺证，分别比较各个证型患儿之间的一般情况（包括性别、年龄、身高、体质量、病程等）、症状及体征[包括发热天数、咳嗽天数、是否耐药、呼吸音是否增强、是否使用糖皮质激素治疗、胸部电子计算机断层扫描（CT）检查结果等]、实验室检查指标（包括血常规情况、C反应蛋白、免疫学检查、肝肾功能、血清淀粉样蛋白A、D-二聚体、乳酸脱氢酶等）是否存在差异。[结果] 在纳入的156例MPP患儿中，风热闭肺证47例，痰热闭肺证60例，毒热闭肺证34例，湿热闭肺证15例。湿热闭肺证患儿的病程最长，与其他3组比较，差异有统计学意义（P＜0.05或P＜0.01）。痰热闭肺证、毒热闭肺证、湿热闭肺证患儿的发热时间均较风热闭肺证患儿长，毒热闭肺证长于痰热闭肺证（P＜0.05或P＜0.01）。湿热闭肺证患儿的咳嗽时间长于其他3组（P＜0.05或P＜0.01）。痰热闭肺证、毒热闭肺证、湿热闭肺证患儿糖皮质激素的使用率高于风热闭肺证（P＜0.05）。风热闭肺证患儿的电子计算机断层扫描（CT）结果中，肺纹理增厚人数多于毒热闭肺证（P＜0.05）。湿热闭肺证MPP患儿杀伤性T细胞计数较其余3组升高（P＜0.05或P＜0.01）。毒热闭肺证患儿NK细胞计数高于痰热闭肺证（P＜0.05）。毒热闭肺证患儿中性粒细胞计数高于痰热闭肺证（P＜0.05）。湿热闭肺证患儿的免疫球蛋白G低于风热闭肺证及痰热闭肺证（P＜0.05）。毒热闭肺证患儿C反应蛋白高于痰热闭肺证且低于湿热闭肺证（P＜0.05）。毒热闭肺证患儿血清淀粉样蛋白A高于风热闭肺证、湿热闭肺证（P＜0.05）。痰热闭肺证组患儿CD4⁺/CD8⁺高于风热闭肺证（P＜0.05）。[结论] 不同中医证型的MPP患儿在病程、发热时长、咳嗽时长、糖皮质激素使用率、CT报告、杀伤性T细胞计数、NK细胞计数、中性粒细胞计数、免疫球蛋白G、C反应蛋白、血清淀粉样蛋白A、CD4⁺/CD8⁺方面存在统计学差异，提示临床可以根据以上症状、体征或实验室指标结合中医传统辨证方法精准施治，提高辨证效率、准确率及治疗效果。

Abstract:

[Objective] To compare the differences in symptoms，signs and laboratory tests of children with mycoplasma pneumoniae pneumonia（MPP） with different traditional Chinese medicine（TCM） syndromes，so as to provide reference and basis for clinical accurate differentiation and treatment of MPP. [Methods] A total of 156 children with MPP who were diagnosed in the Department of Pediatrics of Tianjin Hospital of ITCWM Nankai Hospital from November 2023 to September 2024 were collected as subjects. According to TCM syndrome differentiation，they were divided into wind-heat obstructing the lung syndrome，phlegm-heat obstructing the lung syndrome，toxic-heat obstructing the lung syndrome，and damp-heat obstructing the lung syndrome. General information（gender，age，height，weight，disease course，etc.），symptoms and signs [days of fever and cough，drug resistance，enhanced respiratory sounds，glucocorticoid use，chest computed tomography（CT） findings，etc.]，and laboratory parameters（complete blood count，C-reactive protein，immunological tests，liver and kidney function，serum amyloid A，D-dimer，lactate dehydrogenase，etc.） were compared across these syndrome groups. [Results] Among the 156 children with MPP，there were 47 cases of wind-heat obstructing the lung syndrome，60 cases of phlegm-heat obstructing the lung syndrome，34 cases of toxic heat obstructing the lung syndrome and 15 cases of damp-heat obstructing the lung syndrome. The course of disease in children with damp-heat obstructing the lung syndrome was the longest，and the difference was statistically significant compared with the other three groups（P＜0.05 or P＜0.01）. The fever time of children with phlegm-heat obstructing the lung syndrome，toxic-heat obstructing the lung syndrome and damp-heat obstructing the lung syndrome was longer than that of children with wind-heat obstructing the lung syndrome，and toxic-heat obstructing the lung syndrome was longer than that of phlegm-heat obstructing the lung syndrome（P＜0.05 or P＜0.01）. The cough time of children with damp-heat obstructing the lung syndrome was longer than that of the other three groups（P＜0.05 or P＜0.01）. The use rate of glucocorticoids in children with phlegm-heat obstructing the lung syndrome，toxic heat obstructing the lung syndrome and damp-heat obstructing the lung syndrome was higher than that in wind-heat obstructing the lung syndrome（P＜0.05）. In the results of CT in children with wind-heat obstructing the lung syndrome，the number of lung texture thickening was more than that of toxic-heat obstructing the lung syndrome（P＜0.05）. The count of killer T cells in MPP children with damp-heat obstructing the lung syndrome was higher than that in the other three groups（P＜0.05 or P＜0.01）. The NK cell count in children with toxic heat obstructing the lung syndrome was higher than that in children with phlegm heat obstructing the lung syndrome（P＜0.05）. The neutrophil count in children with toxic heat obstructing the lung syndrome was higher than that in children with phlegm heat obstructing the lung syndrome（P＜0.05）. The immunoglobulin G of children with damp-heat obstructing the lung syndrome was lower than that of wind-heat obstructing the lung syndrome and phlegm-heat obstructing the lung syndrome（P＜0.05）. The C-reactive protein in children with toxic heat obstructing the lung syndrome was higher than that in phlegm-heat obstructing the lung syndrome and lower than that in damp-heat obstructing the lung syndrome（P＜0.05）. Serum amyloid A in children with toxic heat obstructing the lung syndrome was higher than that in wind-heat obstructing the lung syndrome and damp-heat obstructing the lung syndrome（P＜0.05）. The CD4⁺/CD8⁺ in the phlegm-heat obstructing the lung syndrome group was higher than that in the wind-heat obstructing the lung syndrome group（P＜0.05）. [Conclusion] MPP children with different TCM syndromes have differences in course of disease，duration of fever，duration of cough，glucocorticoid use rate，CT reports，killer T cell count，NK cell count，neutrophil count，immunoglobulin G，C-reactive protein，serum amyloid A，CD4⁺/CD8⁺，suggesting that clinical treatment can be based on the above symptoms，signs or laboratory indicators combined with traditional Chinese medicine syndrome differentiation methods to improve the efficiency，accuracy and therapeutic effect of syndrome differentiation.