Analysis of therapeutic effect of added flavor of Maxing Shigan Decoction combined with acupoint application in the treatment of Mycoplasma pneumoniae pneumonia in children
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摘要:
目的 探讨联合应用中医内治法、外治法(麻杏石甘汤加味口服联合外用穴位贴敷法)治疗小儿肺炎支原体肺炎的临床疗效及安全性。 方法 回顾性分析2023年1月-2024年5月安徽中医药大学第一附属医院儿科收治的108例肺炎支原体肺炎患儿资料, 按照随机数字表法将患者分为观察组和对照组, 每组各54例。每组患儿均予西医常规治疗, 观察组在对照组的基础上加用麻杏石甘汤加味联合肺俞穴位贴敷治疗, 均治疗7~14 d。评估2组患儿的中医证候积分改善情况、临床症状及体征(咳嗽、发热及肺部啰音)、住院时间、临床疗效、难治性肺炎支原体肺炎(RMPP)和重症肺炎支原体肺炎(SMPP)的发生率及用药不良反应发生情况, 检测血清炎症因子(血清IL-6、CRP及PCT)水平。 结果 观察组中医证候积分低于对照组(P < 0.05)。观察组患儿的咳嗽缓解时间、肺啰音消失时间、发热持续时间及住院时间均短于对照组(P < 0.05)。2组临床疗效比较差异有统计学意义(Z=-2.392, P=0.017)。观察组血清IL-6、CRP及PCT降低程度优于对照组(P < 0.05)。2组RMPP及SMPP发生情况比较, 差异无统计学意义(P>0.05)。2组用药不良反应发生率比较, 差异无统计学意义(P>0.05)。 结论 联合应用麻杏石甘汤加味、穴位贴敷法治疗小儿肺炎支原体肺炎, 可快速减轻机体炎症反应, 改善临床症状, 降低中医证候积分, 治疗效果显著, 且安全性良好。 Abstract:Objective To explore the clinical efficacy and safety of combing traditional Chinese medicine internal treatment and external treatment (Maxing Shigan Decoction combined with acupoint application) in the treatment of Mycoplasma pneumoniae pneumonia in children. Methods A retrospective analysis was conducted on 108 children with Mycoplasma pneumoniae pneumonia admitted to the First Affiliated Hospital of Anhui University of Chinese Medicine between January 2023 and May 2024.The participants were divided into an observation group and a control group using the random number table method, with 54 cases in each group.The children in each group were treated with conventional Western medicine.The observation group was treated with Maxing Shigan Decoction combined with Feishu acupoint application on the basis of the control group for 7-14 days.The study assessed the improvement in traditional Chinese medicine (TCM) syndrome scores, clinical symptoms (cough, fever, and lung rales), length of hospital stay, clinical efficacy, incidence of RMPP and SMPP, adverse drug reactions, and serum inflammatory factor levels. Results The observation group showed a significantly lower TCM syndrome score compared to the control group (P < 0.05).The observation group also showed shorter remission time of cough, disappearance of pulmonary rales, duration of fever, and a shorter length of hospital stay, compared to the control group (P < 0.05).There was significant difference in clinical efficacy between the two groups (Z=-2.392, P=0.017).The observation group showed higher levels of IL-6, CRP, and PCT compared to the control group (P < 0.05).There was no significant difference in the occurrence of RMPP and SMPP between the two groups (P>0.05).No statistically significant difference was observed in the incidence of adverse drug reactions between the two groups (P>0.05). Conclusion The combined application of Maxing Shigan Decoction and acupoint application in the treatment of Mycoplasma pneumoniae pneumonia in children effectively reduces inflammation in the body, improves clinical symptoms, lowers TCM syndrome scores, with a significant therapeutic effect and good safety profile. -
表 1 2组肺炎支原体肺炎患儿基本资料比较
Table 1. Comparison of basic data of 2 groups of children with mycoplasma pneumoniae pneumonia
组别 例数 性别[例(%)] 年龄
[M(P25, P75), 岁]体重
[M(P25, P75), kg]发热时间
[M(P25, P75), d]咳嗽时间
[M(P25, P75), d]女 男 观察组 54 32(59.26) 22(40.74) 6.00(4.00, 8.00) 21.00(18.00, 29.00) 3.00(0.75，4.00) 7.00(5.00，9.00) 对照组 54 26(48.15) 28(51.85) 6.00(4.00, 7.00) 21.25(17.00, 26.62) 2.00(1.00，4.00) 7.00(5.00，9.25) 统计量 1.341a -0.462b -0.744b -0.530b -0.356b P值 0.247 0.644 0.457 0.596 0.722 注：a为χ2值，b为Z值。 
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表 2 2组肺炎支原体肺炎患儿中医证候积分比较[M(P25, P75), 分]
Table 2. Comparison of TCM syndrome scores in 2 groups of children with mycoplasma pneumoniae pneumonia[M(P25, P75), points]
组别 例数 中医证候积分 差值 治疗前 治疗后 观察组 54 8.00(7.00，10.00) 2.50(1.75，3.00)a -6.00(-8.00，-5.00) 对照组 54 8.00(7.00，9.00) 4.00(3.00，5.00)a -4.00(-5.00，-3.00) Z值 -1.146 -5.317 -4.716 P值 0.252 ＜0.001 ＜0.001 注：与同组治疗前比较，aP＜0.05。
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表 3 2组肺炎支原体肺炎患儿临床症状及体征及住院时间比较[M(P25, P75)，d]
Table 3. Comparison of clinical symptoms, signs, and length of hospital stay of children with mycoplasma pneumoniae pneumonia in 2 groups[M(P25, P75), d]
组别 例数 咳嗽缓解时间 肺啰音消失时间 发热持续时间 住院时间 观察组 54 6.00(5.00，7.00) 5.00(4.00，5.00) 2.00(0.00，3.00) 10.00(8.00, 12.25) 对照组 54 7.00(6.00，8.00) 6.00(5.00，7.00) 3.00(2.00，4.00) 11.00(10.00, 13.00) Z值 -4.022 -4.671 -2.639 -2.152 P值 ＜0.001 ＜0.001 0.008 0.031
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表 4 2组肺炎支原体肺炎患儿临床总疗效比较[例(%)]
Table 4. Comparison of the overall clinical efficacy between two groups of children with mycoplasma pneumoniae pneumonia[cases (%)]
组别 例数 痊愈 显效 有效 无效 总有效 观察组 54 25(46.30) 20(37.04) 5(9.25) 4(7.41) 50(92.59) 对照组 54 15(27.78) 20(37.04) 11(20.37) 8(14.81) 46(85.19) 注：2组疗效比较，Z=-2.392, P=0.017。
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表 5 2组肺炎支原体肺炎患儿血清炎症因子比较[M(P25, P75)]
Table 5. Comparison of serum inflammatory factors in 2 groups of children with mycoplasma pneumoniae pneumonia[M(P25, P75)]
组别 例数 IL-6(pg/mL) 治疗前 治疗后 差值 观察组 54 19.48(12.71, 25.92) 4.07(2.92, 6.10)a -13.47(-21.23, -7.54) 对照组 54 17.58(10.13, 24.53) 8.19(5.24, 11.29)a -7.18(-16.79, -1.46) Z值 -0.851 -4.987 -2.992 P值 0.395 ＜0.001 0.003 组别 例数 CRP(mg/L) 治疗前 治疗后 差值 观察组 54 21.94(15.27, 31.71) 1.22(0.40, 2.11)a -20.35(-28.78, -13.76) 对照组 54 23.80(15.28, 29.12) 5.88(5.12, 7.54)a -15.25(-23.18, -9.03) Z值 -0.058 -7.887 -2.267 P值 0.953 ＜0.001 0.023 组别 例数 PCT(ng/mL) 治疗前 治疗后 差值 观察组 54 0.18(0.12, 0.25) 0.03(0.02, 0.05)a -0.15(-0.23, -0.08) 对照组 54 0.23(0.15, 0.34) 0.11(0.08, 0.14)a -0.11(-0.18, -0.05) Z值 -1.492 -7.578 -1.971 P值 0.136 ＜0.001 0.049 注：与同组治疗前比较，aP＜0.05。
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表 6 2组肺炎支原体肺炎患儿RMPP及SMPP发生情况比较[例(%)]
Table 6. Comparison of RMPP and SMPP in children with mycoplasma pneumoniae pneumonia in 2 groups[cases (%)]
组别 例数 RMPP SMPP 合计 观察组 54 0 0 0 对照组 54 1(1.85) 3(5.56) 4(7.41) 注：2组RMPP及SMPP总发生率比较，χ2=2.337，P=0.126。
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