Objective  To explore the clinical efficacy and effect of Yinqiao powder combined with Maxing Shigan decoction modified formula on Th1/Th2 and Th17/Treg cytokines on mycoplasma pneumonia (MPP).

Methods  MMP wind heat invading lung children hospitalized in Changshu Hospital Affiliated to Nanjing Universityof Chinese Medicine from October 2021 to June 2023 were selected as the study subjects. According to the random number method, they were divided into TCM group (azithromycin dry suspension + Yinqiao powder combined with Maxing Shigan decoction modified formula) and control group (azithromycin dry suspension). Before and 7 d after treatment, the clinical outcomes, TCM syndrome points (fever, cough, sputum, and wheezing points), lung function [forced vital capacity (FVC), maximum expiratory volume at 1 second (FEV 1), peak expiratory flow rate (PEF)], Th1/Th2 cytokines (IFN-γ and IL-4), and Th17/Treg cytokines (IL^-17 and IL^-10) were compared. The occurrence of adverse reactions during the treatment process were observed and recorded.

Results  A total of 106 MMP patients were included in the study, including 53 patients in each group. Before treatment, there was no significant difference between TCM group and control group in TCM syndrome integration, lung function, serum Th1/Th2 cytokkines and serum Th17/Treg cytokines (P>0.05). After treatment, TCM was significantly better than the control group (P<0.05); fever, asthma, cough, sputum, serum INF-γ levels and serum IL^-17 levels were significantly lower (P<0.05), while FVC, FEV 1, PEF, IL-4 and IL^-10 levels were significantly higher (P<0.05). The incidence of adverse reactions in the TCM group was significantly lower than that in the control group (P<0.05).

Conclusion Yinqiao powder combined with Maxing Shigan decoction modified formula can regulate Th1/Th2 and Th17/Treg cytokine levels, improve lung function, and increase efficacy and safety in children with MMP.

1.党玉兰, 刘会伟, 温慧, 等. 儿童肺炎支原体肺炎中药治疗的研究进展[J]. 医学综述, 2021, 27(5): 982-986. [Dang YL, Liu HW, Wen H, et al. Research progress of traditional Chinese medicine in treatment of children with mycoplasma pneumoniae pneumonia[J]. Medical Review, 2021, 27(5): 982-986.] DOI: 10.3969/j.issn.1006-2084.2021.05.027.

2.刘茹芳, 林晓红, 彭银英, 等. 阿奇霉素序贯疗法联合小儿推拿对儿童肺炎支原体感染后慢性咳嗽疗效观察[J]. 中国药师, 2024, 27(2): 309-316. [Liu RF, Lin XH, Peng YY, et al. Observation on the therapeutic effect of sequential therapy with azithromycin combined with pediatric massage on chronic cough after Mycoplasma pneumoniae infection in children[J]. Chinese Pharmacist, 2024, 27(2): 309-316.] DOI: 10.12173/j.issn.1008-049X.202312150.

3.刘巍. 银翘散合麻杏石甘汤加减配合磷酸奥司他韦治疗甲型H1N1流感临床研究[J]. 医药论坛杂志, 2019, 40(2): 35-37. [Liu W. Clinical study on treatment of HIN1 influenza with Yinqiaosan and Maxing Shigan decoction combined with oseltavir phosphate[J]. Medical Forum, 2019, 40(2): 35-37.] DOI: CNKI:SUN:HYYX.0.2019-02-011.

4.唐菱涓, 李彦, 丁创. 麻杏石甘汤联合银翘散治疗风热闭肺证小儿肺炎喘嗽临床效果评价[J]. 中华中医药学刊, 2020, 38(12): 256-258. [Tang LJ, Li Y, Ding C. Clinical efficacy evaluation of Ma Xing Shi Gan Tang combined with Yin Qiao San in the treatment of pediatric pneumonia and asthma with wind heat closed lung syndrome[J]. Chinese Journal of Traditional Chinese Medicine, 2020, 38(12): 256-258.] DOI: 10.13193/j.issn. 1673-7717.2020.12.066.

5.董艳, 渠爱香, 雒江妮, 等. 麻杏石甘汤合银翘散治疗儿童支原体肺炎(风热闭肺证)的临床效果[J]. 中国医药科学, 2021, 11(15): 88-91. [Dong Y, Qu AX, Luo JN, et al. The clinical effect of Ma Xing Shi Gan Tang combined with Yin Qiao San in the treatment of childhood mycoplasma pneumonia (wind heat closed lung syndrome)[J]. Chinese Medical Science, 2021, 11(15): 88-91.] DOI: 10.3969/j.issn.2095-0616.2021.15.023.

6.沈小芳. 支炎合剂对肺炎支原体肺炎模型大鼠CD4+T、CD8+T细胞的影响[D]. 长沙: 湖南中医药大学, 2022.

7.白辰, 刘铁钢, 徐竞男, 等. 基于网络药理学的银翘散合桑菊饮加减方、麻杏石甘汤加减方与抗病毒西药作用机制比较——以2018初冬流行性感冒轻症为例[J]. 中医杂志, 2019, 60(11): 928-934. [Bai C, Liu TG, Xu JN, et al. Comparative study on mechanism of action between Yinqiaosan Maxing Shigan decoction and antiviral western medicine based on network pharmacology-taking the 2018 early winter influenza as an example[J]. Journal of Traditional Chinese Medicine, 2019, 60(11): 928-934.] DOI: 10.13288/j.11-2166/r.2019.11.007.

8.胡亚美, 江载芳, 主编. 诸福棠实用儿科学[M]. 7版. 北京: 人民卫生出版社, 2002: 1204-1205.

9.汪受传, 赵霞, 韩新民, 等. 小儿肺炎喘嗽中医诊疗指南[J]. 中医儿科杂志, 2008, 4(3): 1-3. [Wang SC, Zhao X, Han XM, et al. Pediatric guidelines for diagnosis and treatment of lung-cold cough[J]. Pediatrics of Traditional Chinese Medicine, 2008, 4(3): 1-3.] DOI: 10.3969/j.issn. 1673-4297.2008.03.001.

10.马融, 胡思源, 主编. 儿科疾病中医药临床研究技术要点[M]. 北京: 中国医药科技出版社, 2011: 51.

11.郑筱萸, 主编. 中药新药临床研究指导原则[M]. 北京: 中国医药科技出版社, 2002: 54-60.

12.Jin Y, Xue J, Ruan MR, et al. Expression of serum miR-155 in Children with mycoplasma pneumoniae pneumonia and its role in immunity to mycoplasma pneumoniae[J]. Infection and Drug Resistance, 2021, 14: 1273-1281. DOI: 10.2147/IDR.S273423.

13.张文涵, 吴振起. 基于"流津润燥"论治小儿肺炎支原体肺炎[J]. 北京中医药大学学报, 2023, 46(2): 252-256. [Zhang WH, Wu ZQ. Treatment of pediatric mycoplasma pneumoniae pneumonia based on the theory of “flowing fluid to moisten dryness”[J]. Journal of Beijing University of Traditional Chinese Medicine, 2023, 46(2): 252-256.] DOI: 10.3969/j.issn.1006-2157.2023.02.017.

14.孔莎莎. 利湿活血法配合针刺治疗小儿单纯性肥胖症[J]. 医学新知, 2019, 29(1): 98-99. [Kong SS. Acupuncture combined with dampness-removing and blood-activating method for simple obesity in children[J]. Yixue Xinzhi Zazhi, 2019, 29(1): 98-99.] DOI: 10.3969/j.issn. 1004-5511.2019.01.034.

15.Li WQ, Liu T, Yao M, et al. Effect of interesting respiratory rehabilitation training for the treatment of refractory Mycoplasma pneumoniae pneumonia in children[J]. BMC Infect Dis, 2023, 23(1): 561. DOI: 10.1186/s12879-023-08513-4.

16.荆瑶瑶, 邢龄艺, 李想, 等. 麻杏石甘汤现代研究概述 [J]. 天津中医药大学学报, 2023, 42(2): 264-272. [Jing YY, Xing LY, Li X, et al. Overview of modern research on Maxing Shigan Decoction[J]. Journal of Tianjin University of Traditional Chinese Medicine, 2023, 42(2): 264-272.] DOI: 10.11656/j.issn.1673-9043.2023.02.22.

17.李冀, 徐佳悦, 宋一婵, 等. 银翘散君药之辨[J]. 中医药学报, 2021, 49(3): 69-71. [Li J, Xu JY, Song YC, et al. Differentiation of monarch drug in Yinqiao Powder[J]. Journal of Traditional Chinese Medicine, 2021, 49(3): 69-71.] DOI: 10.19664/j.cnki.1002-2392.210065.

18.Yang MY, Meng FZ, Gao M, et al. Cytokine signatures associate with disease severity in children with mycoplasma pneumoniae pneumonia[J]. Sci Rep, 2019, 9: 17853. DOI: 10.1038/s41598-019-54313-9.

19.Zu DM, Zhang L. Assessment of mechanisms of infectious pneumonia based on expression of fibrinogen, procalcitonin, high-sensitivity C-reactive protein expression, T helper17cells, regulatory T cells interleukin-10, and interleukin-17[J]. Transl Pediatr, 2022, 11(1): 73-84. DOI: 10.21037/tp-21-565.

20.Ye Q, Xu XJ, Shao WX, et al. Mycoplasma pneumoniae infection in children is a risk factor for developing allergic diseases[J]. Scientific World Journal, 2014, 2014: 986527. DOI: 10.1155/2014/986527.

21.Sadeghi A, Tahmasebi S, Mahmood A, et al. Th17 and Treg cells function in SARS-CoV2 patients compared with healthy controls[J]. J Cell Physiol, 2021, 236(4): 2829-2839. DOI: 10.1002/jcp.30047.

22.李琳苹, 李伟林, 孙波, 等. 小儿推拿结合麻杏银翘散加减治疗缓解期肺炎患儿的疗效[J]. 中华全科医学, 2021, 19(7): 1150-1154. [Li LP, Li WL, Sun B, et al. Clinical effects of infantile massage combined with modified Maxing Yinqiao powder on the treatment of children with pneumonia during remission[J]. Chinese Journal of General Practice, 2021, 19(7): 1150-1154.] DOI: 10.16766/j.cnki.issn.1674-4152.002008.

23.夏云, 田锋, 王丽娟. 麻杏石甘汤治疗支原体肺炎临床疗效及对IgG、IgM、IgA水平的影响[J]. 湖北中医药大学学报, 2023, 25(1): 24-27. [Xia Y, Tian F, Wang LJ. Effect of Maxing Shigan decoction on clinical efficacy and IgG, IgM and IgA levels in patients with mycoplasma pneumonia[J]. Journal of Hubei University of Chinese Medicine, 2023, 25(1): 24-27.] DOI: 10.3969/j.issn.1008-987x.2023.01.05.

24.杨靖, 申娟, 张旭, 等. 麦粒灸联合中药治疗肺癌放疗后白细胞减少症的疗效观察[J]. 上海针灸杂志, 2024, 43(3): 289-294. [Yang J, Shen J, Zhang X, et, al. Observation on the therapeutic effect of wheat grain moxibustion combined with traditional Chinese medicine in the treatment of leukopenia after radiotherapy for lung cancer[J]. Shanghai Journal of Acupuncture and Moxibustion, 2024, 43(3): 289-294.] DOI: 10.13460/j.issn. 1005-0957.2024.03.0289.