Observation on the curative effect of tanshinone combined with azithromycin in the treatment of children with mycoplasma pneumonia
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摘要:
目的 观察丹参酮治疗支原体肺炎(MP)小儿的疗效及对患者血清IL-6、TNF-α、TGF-β1及Smad3表达的影响。 方法 选取河南中医药大学第一附属医院2018年1月—2020年9月收治的100例MP小儿，按随机数表法分为观察组和对照组，各50例。对照组采用阿奇霉素治疗，观察组采用阿奇霉素联合丹参酮治疗。比较2组总有效率、症状消失时间、血清IL-6、TNF-α、TGF-β1及Smad3表达情况、不良反应。 结果 观察组总有效率为92.00%，高于对照组的76.00%(P < 0.05)。观察组咳嗽、发热、啰音、哮鸣音消失时间分别为(5.37±0.94)d、(2.71±0.51)d、(4.73±0.84)d、(5.82±1.02)d，短于对照组的(6.89±0.88)d、(3.53±0.72)d、(6.23±0.91)d、(7.11±1.31)d(均P < 0.05)。观察组治疗后血清IL-6、TNF-α、TGF-β1、Smad3表达为(16.16±5.49)pg/mL、(7.18±1.71)pg/mL、(15.22±3.06)μg/L和0.20±0.06，低于对照组的(25.41±6.02)pg/mL、(12.98±2.61)pg/mL、(27.27±5.28)μg/L和0.26±0.07，均P < 0.05。2组不良反应总发生率(14.00%vs.10.00%)差异无统计学意义(P>0.05)。 结论 丹参酮可下调Smad3表达来降低血清TGF-β1、IL-6、TNF-α，治疗小儿MP效果满意，安全性高。 Abstract:Objective To observe the efficacy of tanshinone in the treatment of children with mycoplasma pneumonia (MP) and its effect on the expression of serum IL-6, TNF-α, TGF-β1 and Smad3. Methods A total of 100 children with MP were selected from January 2018 to September 2020, and they were divided into observation group and control group according to the random number table method, with 50 cases in each group. Azithromycin was used in the control group, and azithromycin combined with tanshinone was used in the observation group. The total effective rate, the time of symptom disappearance, the expression of serum IL-6, TNF-α, TGF-β1 and Smad3, and adverse reactions were compared between the two groups. Results The total effective rate in the observation group was 92.00%, which was higher than 76.00% in the control group (P < 0.05). The disappearance time of cough, fever, rales and wheeze in the observation group were (5.37±0.94) d, (2.71±0.51) d, (4.73±0.84) d, (5.82±1.02) d, which were shorter than those in the control group [(6.89±0.88) d, (3.53±0.72) d, (6.23±0.91) d, (7.11±1.31) d, P < 0.05]. The serum levels of IL-6, TNF-α, TGF-β1, and expression of Smad3 after treatment in the observation group were (16.16±5.49) pg/mL, (7.18±1.71) pg/mL, (15.22±3.06) μg/L, 0.20 ± 0.06, which were lower than those in the control group [(25.41±6.0) pg/mL, (12.98±2.61) pg/mL, (27.27±5.28) μg/L, 0.26±0.07, all P < 0.05]. There was no significant difference in total incidence of adverse reactions (14.00% vs 10.00%) between the two groups (P>0.05). Conclusion Tanshinone can down-regulate the expression of Smad3 to reduce serum TGF-β1, IL-6, and TNF-α. It has satisfactory results in the treatment of children with MP and has high safety. -
表 1 2组支原体肺炎患儿治疗总有效率比较
[例(%)] 组别 例数 显效 有效 无效 总有效 观察组 50 28(56.00) 18(36.00) 4(8.00) 46(92.00) 对照组 50 21(42.00) 17(34.00) 12(24.00) 38(76.00) 注：2组总有效率比较，χ2=4.762, P=0.029。 
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表 2 2组支原体肺炎患儿症状和体征消失时间的比较
(x ±s，d) 组别 例数 咳嗽 发热 啰音 哮鸣音 观察组 50 5.37±0.94 2.71±0.51 4.73±0.84 5.82±1.02 对照组 50 6.89±0.88 3.53±0.72 6.23±0.91 7.11±1.31 t值 8.347 6.572 8.564 5.494 P值 < 0.001 < 0.001 < 0.001 < 0.001
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表 3 2组支原体肺炎患儿治疗前后血清IL-6、TNF-α水平的比较
(x ±s，pg/mL) 组别 例数 IL-6 TNF-α 治疗前 治疗后 治疗前 治疗后 观察组 50 55.07±12.89 16.16±5.49a 24.17±7.01 7.18±1.71a 对照组 50 52.71±14.03 25.41±6.02a 22.62±6.38 12.98±2.61a t值 0.876 8.028 1.156 13.144 P值 0.383 < 0.001 0.250 < 0.001 注：与治疗前比较，aP < 0.05。
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表 4 2组支原体肺炎患儿治疗前后血清TGF-β1浓度、Smad3表达的比较
(x ±s) 组别 例数 TGF-β1浓度(μg/L) Smad3表达 治疗前 治疗后 治疗前 治疗后 观察组 50 51.37±8.10 15.22±3.06a 0.33±0.10 0.20±0.06a 对照组 50 53.35±9.08 27.27±5.28a 0.30±0.08 0.26±0.07a t值 1.104 3.536 1.656 3.835 P值 0.272 < 0.001 0.109 < 0.001 注：与治疗前比较，aP < 0.05。
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表 5 2组支原体肺炎患儿不良反应的比较
[例(%)] 组别 例数 皮肤瘙痒 腹痛 恶心呕吐 合计 观察组 50 1(2.00) 4(8.00) 2(4.00) 7(14.00) 对照组 50 1(2.00) 2(4.00) 2(4.00) 5(10.00) 注：2组患儿不良反应总发生率比较，χ2=0.379, P=0.538。
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