麻杏石甘汤灌肠治疗婴幼儿肺炎喘嗽的临床疗效及肺-肠微环境干预机制  

Clinical Efficacy of Maxingshigantang Enema in Treating Infants with Pneumonia and Asthma and Intervention Mechanism of Lung-intestine Microenvironment

作　　者：李晓丹[1] 崔子朋 陈慧[1] 郭素香[1] 何风丽 LI Xiao-dan;CUI Zi-peng;CHEN Hui;GUO Su-xiang;HE Feng-li(Second Teaching Hospital of Tianjin University of Traditional Chinese Medicine(TCM),Tianjin 300150,China;Graduate School,Tianjin University of TCM,Tianjin 300193,China)

机构地区：[1]天津中医药大学第二附属医院,天津300150 [2]天津中医药大学研究生院,天津300193

出　　处：《中国实验方剂学杂志》2022年第7期127-133,共7页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：天津市教委科研计划项目(2019KJ045)。

摘　　要：目的:观察麻杏石甘汤灌肠治疗婴幼儿风热闭肺型肺炎喘嗽(病毒性肺炎)的临床疗效,对比患儿肠道菌群、唾液中分泌型免疫球蛋白A(sIgA)、人β-防御素2(hBD2)及粪便中钙卫蛋白(CALP)浓度的变化,综合评价中药灌肠对婴幼儿肠道微环境的影响作用,进一步明确灌肠疗法治疗肺炎喘嗽的作用机制。方法:选取病毒性肺炎婴幼儿60例,随机分为3组,中药2组灌肠药物剂量一致(3.5 g/次),中药高浓度组以高浓度灌肠液灌肠(0.117 g·mL^(-1)),中药低浓度组以低浓度灌肠液灌肠(0.07 g·mL^(-1));对照组灌肠适温生理盐水,每日1次,疗程7 d。观察各组的疗效、总症状积分、唾液sIgA、hBD2和粪便CALP水平,综合评估中药灌肠治疗肺炎喘嗽患儿的临床疗效。结果:中药高浓度组总有效率100%(20/20),与中药低浓度组总有效率95%(19/20),两组疗效相当,且两组均高于对照组的70%(14/20),差异具有统计学意义(高浓度组χ^(2)=7.059、低浓度组χ^(2)=4.329,P<0.017)。治疗后,与对照组和中药低浓度组比较,中药高浓度组患儿症状积分明显升高(P<0.05,P<0.01)。3组患儿经治疗后均可降低肠道菌群球杆比值且高浓度组和低浓度组的肠道菌群球杆比值均低于对照组(P<0.05)。3组治疗后均可提高唾液sIgA浓度(P<0.05),且与对照组、中药低浓度组比较,中药高浓度组sIgA浓度显著升高(P<0.01)。治疗后3组均可降低唾液hBD2浓度,与对照组比较,中药低、高浓度组hBD2浓度均明显降低(P<0.05)。治疗后3组均可降低粪便CALP浓度(P<0.05);与对照组比较,中药低、高浓度组CALP浓度显著降低(P<0.01);与低浓度组比较,高浓度组CALP浓度显著降低(P<0.01)。结论:麻杏石甘汤灌肠和西药对症治疗均对肺炎喘嗽患儿的临床症状有改善作用,且麻杏石甘汤灌肠明显优于西药对症治疗。麻杏石甘汤灌肠和西药对症治疗均可改善肠道菌群、降低患儿机体炎症,且麻杏石甘汤灌Objective:To observe the clinical efficacy of Maxingshigantang enema in the treatment of infant viral pneumonia by comparing related indicators,and comprehensively evaluate the effect of traditional Chinese medicine(TCM)enema on the intestinal microenvironment.Method:Sixty infants with viral pneumonia were selected and randomly divided into 3 groups.The dosage of enema drugs in high-(0.117 g·mL^(-1))and low-concentration(0.07 g·mL^(-1))TCM enema groups was same(3.5 g per time),and the control group received normal saline enema,once a day for 7 days.Finally,the curative effect,total symptom score,salivary secretory immunoglobulin A(sIgA),human beta defensin 2(hBD2)and fecal calprotectin(CALP)of each group were statistically analyzed by SPSS 21.0,and the clinical efficacy of TCM enema in treating children with pneumonia and asthma was comprehensively evaluated.Result:The curative effect of high-concentration TCM enema group(total effective rate 100%,χ^(2)=7.059)was equivalent to that of lowconcentration TCM enema group(total effective rate 95%,χ^(2)=4.329),higher than that of control group(total effective rate 70%)(P<0.017).After treatment,compared with control group and low-concentration TCM enema group,high-concentration TCM enema group had higher total symptom score of children(P<0.05,P<0.01).The proportion of coccobacillus was reduced in three groups,with high-and low-concentration TCM enema groups lower than control group(P<0.05).The salivary sIgA concentration was increased in three groups(P<0.05),with high-concentration TCM enema group higher than the other groups(P<0.01).The hBD2 concentration was decreased in three groups,with high-and low-concentration TCM enema groups lower than control group(P<0.05).The three groups reduced the fecal CALP concentration,and high-concentration TCM enema group had the highest reduction,followed by low-concentration TCM enema group(P<0.01).Conclusion:TCM enema outweighs western medicine in improving clinical symptoms,intestinal flora,and mucosal immune function,and redu

关 键 词：麻杏石甘汤 肺炎喘嗽 肠道菌群 分泌型免疫球蛋白A(sIgA) 人β-防御素2(hBD2) 钙卫蛋白(CALP) 

分 类 号：R242[医药卫生—中医临床基础] R285.5[医药卫生—中医学]