儿童重症肺炎支原体肺炎中医证型与支气管镜镜下气道黏膜改变的关系  

Relationship between traditional Chinese medicine syndrome types and changes in airway mucosa under bronchoscopy in children with severe mycoplasma pneumoniae pneumonia

作　　者：侯月[1] 耿梗 郝静[1] 何强[1] 陈芳[1] 刘畅[1] 胡艳[1] HOU Yue;GENG Geng;HAO Jing;HE Qiang;CHEN Fang;LIU Chang;HU Yang(Department of Traditional Chinese Medicine,Beijing Children's Hospital Affiliated to the Capital Medical University,Beijing 100045,China)

机构地区：[1]国家儿童医学中心、首都医科大学附属北京儿童医院中医科,北京100045

出　　处：《北京中医药》2023年第12期1290-1293,共4页Beijing Journal of Traditional Chinese Medicine

基　　金：北京市医管中心培育计划项目(PZ2021026)。

摘　　要：目的探讨儿童重症肺炎支原体肺炎(SMPP)中医证型的特点以及与支气管镜镜下气道黏膜改变的关系。方法选择2023年9月—11月,首都医科大学附属北京儿童医院中医科收治住院的SMPP患儿106例,入院后进行中医辨证分型及电子支气管镜检查,观察各证型支气管镜镜下气道黏膜改变的表现特点。结果SMPP证型分布以痰湿闭肺证最多见,其次是痰热闭肺证、正虚邪恋证、肺脾两虚证。痰热闭肺证患儿病程最短,肺脾两虚证患儿病程最长。痰热闭肺证、痰湿闭肺证、正虚邪恋证中支气管下气道表现以重型为主,肺脾两虚证则以普通型为主。各证型镜下均可见气道黏膜粗糙肿胀、分泌物增多。正虚邪恋证黏膜改变以黏膜糜烂、炎性狭窄、亚支通气不良、管腔闭塞为主。痰湿闭肺证纵行皱褶在各组中最高。肺脾气虚证则以气道黏液栓阻塞、黏膜坏死上皮附壁、脱落表现为主。结论SMPP患儿中医证型分布以痰湿闭肺证最为多见。痰热闭肺证、痰湿闭肺证、正虚邪恋证中支气管下气道表现以重型为主。痰湿闭肺证、正虚邪恋证镜下表现可见管腔闭塞,后期遗留闭塞性细支气管炎的风险增高。Objective To explore the characteristics of traditional Chinese medicine syndrome types of severe mycoplasma pneumoniae pneumonia(SMPP)in children and its relationship with changes in airway mucosa under bronchoscopy.Method From September 2023 to November 2023,106 hospitalized children with SMPP were admitted to the Traditional Chinese Medicine Department of Beijing Children's Hospital affiliated to the Capital Medical University.After admission,electronic bronchoscopy examination and traditional Chinese medicine syndrome differentiation were performed to observe the characteristics of airway mucosal changes under bronchoscopy for each syndrome type.Result(1)In the distribution of SMPP syndrome types,syndrome of phlegm dampness blocking the lung is the most common one,followed by syndrome of phlegm heat blocking the lung,syndrome of antipathogenic qi deficiency and retention of pathogenic factors and syndrome of lung and spleen deficiency.Children with syndrome of phlegm heat blocking the lung have the shortest course of disease,while those with lung and spleen deficiency syndrome have the longest course of disease.(2)In the syndrome of phlegm heat blocking the lung,phlegm dampness blocking the lung,and positive deficiency and evil affection,the manifestation of the bronchial lower airway is manifested as severe type,while the syndrome of lung and spleen deficiency is mainly as common type.(3)Under the microscope,rough sweling and increased secretion of the airway mucosa can be seen in all types of syndromes.The mucosal changes in the syndrome of anti-pathogenic qi deficiency and retention of pathogenic factors are mainly characterized by mucosal erosion,inflammatory stenosis,poor sub branch ventilation,and lumen occlusion.The vertical folds in the syndrome of phlegm dampness blocking the lung are the most seen among all groups.In the lung spleen qi deficiency syndrome,the main manifestations are airway mucus blockage,mucosal necrosis,epithelial attachment,and detachment.Conclusion The most common syndrome types

关 键 词：儿童重症肺炎支原体肺炎 肺炎喘嗽 中医证型 电子支气管镜检查 

分 类 号：R272[医药卫生—中医儿科学]