董秀兰 许华 张雪丽 刘华 叶竟妍 陈亚宾

摘要 目的：研究加味五虎湯对痰热闭肺型小儿支原体肺炎（Mycoplasma Pneumonia，MP）的临床疗效及T细胞亚群（CD3+、CD4+、CD8+、CD4+/CD8+）的变化。方法：选取2014年5月至2015年9月在广州中医药大学第一附属医院收治的支原体肺炎患儿60例作为研究对象，按照随机数字表法随机分为观察组与对照组，对照组给予阿奇霉素（希舒美）治疗;观察组给予阿奇霉素联合加味五虎汤治疗。比较2组患儿治疗前、后症候积分、T细胞亚群（CD3+、CD4+、CD8+、CD4+/CD8+）水平差异。结果：2组患儿临控率、控显率、总有效率差异无统计学意义（P>0.05）;2组患儿治疗后积分、症候积分、发热时间、咳嗽时间、肺部啰音持续时间均较治疗前改善，差异有统计学意义（P<0.01），且观察组优于对照组。2组患儿治疗后CD8+、CD4+/CD8+的差值差异有统计学意义（P<0.01）。结论：阿奇霉素联合加味五虎汤治疗MMP患儿疗效确切，尤其在改善临床症状及体征方面优于单纯使用阿奇霉素组，可能与调节T淋巴细胞亚群因子水平，减轻肺部免疫炎性反应有关。

关键词 小儿;支原体肺炎;痰热闭肺型;加味五虎汤;阿奇霉素;中西医结合;临床疗效;T淋巴细胞亚群

Effect of Modified Jiawei Wuhu Decoction on Clinical Curative Effect and T Cell Subsets in Children with Mycoplasma Pneumonia

DONG Xiulan，XU Hua，ZHANG Xueli，LIU Hua，YE Jingyan，CHEN Yabin

（The First Affiliated Hospital to Guangzhou University of Chinese Medicine，Guangzhou 510405，China）

Abstract Objective：To study the effect of modified Wuhu Decoction on children with mycoplasma pneumonia of phlegm-heat obstructing lungs and the changes of T-lymphocyte subsets （CD3+、CD4+、CD8+、CD4+/CD8+）.Methods：A total of 60 cases of children with mycoplasma pneumonia of phlegm-heat obstructing lungs admitted to the First Affiliated Hospital to Guangzhou University of Chinese Medicine were randomly divided into an observation group and a control group.The control group were treated with azithromycin （Zithromax）and the observation group were treated with modified Wuhu Decoction and azithromycin.Symptom Integral score，the level of T-lymphocyte subsets （CD3+、CD4+、CD8+、CD4+/CD8+）before and after treatment were compared.Results：There was no significant difference in the clinical control rate，control display rate，and total effective rate between the 2 groups （P>0.05）.The scores，symptom scores，fever time，cough time，and lung rales duration after treatment in the 2 groups were improved compared with those before treatment，and the difference was statistically significant （P<0.01），and the observation group was superior to the control group.There was a significant difference in CD8+ and CD4+/CD8+ between the 2 groups （P<0.01）.Conclusion：Azithromycin combined with modifed Wuhu Decoction was effective in the treatment of children with MMP.In improving the clinical symptoms and signs，especially in improving clinical symptoms and signs，it is better than the azithromycin group alone.It may be related to the regulation of T lymphocyte and the reduction of pulmonary immune inflammatory response.

Keywords Children; Mycoplasma pneumonia; Phlegm-heat obstructing lungs; Modified Wuhu Decoction;Azithromycin; Integrated Traditional Chinese and Western medicine; Clinical effect; T-lymphocyte subsets

中图分类号：R289.5;R259;R2-031;R272;R375+2文献标识码：Adoi：10.3969/j.issn.1673-7202.2021.03.017

肺炎支原体肺炎（Mycoplasma Pneumoniae Pneumonia，MPP），是儿童肺系疾病常见的重要病种之一，占儿童社区获得性肺炎的40%以上[1-2]。MPP往往合并其他的肺外病变，造成患儿病情加重，缠绵难愈，引起家庭及社会经济损失和社会后果[3]。成为导致发展中国家儿童死亡的主要病种[4]。国内外诸多学者认为免疫素是导致MPP发生与发展的关键因素，T细胞有免疫致病及免疫保护的双重作用，因此其动态平衡对维持机体正常免疫应答至关重要[5]。临床实践证明中西医结合治疗MPP比较单纯西药治疗优势显著[6-7]。本研究通过观察加味五虎汤的临床疗效及治疗前后T淋巴细胞亚群水平的变化，旨在为加味五虎汤治疗MPP（痰热闭肺证）提供相关细胞免疫水平的依据。