目的 觀察金振口服液聯(lián)合米諾環(huán)素治療兒童難治性肺炎支原體肺炎（RMPP）的療效及對(duì)血清白細(xì)胞介素6（IL-6）、腫瘤壞死因子α（TNF-α）水平的影響。方法 選取2019年5月—2023年10月在首都醫(yī)科大學(xué)附屬北京兒童醫(yī)院保定醫(yī)院診治的296例RMPP患兒作為研究對(duì)象，隨機(jī)分為聯(lián)合治療組（148例）、單一治療組（148例）。單一治療組進(jìn)行口服鹽酸米諾環(huán)素治療，聯(lián)合治療組進(jìn)行口服金振口服液聯(lián)合鹽酸米諾環(huán)素治療。對(duì)兩組患兒的臨床療效進(jìn)行判定及對(duì)比；評(píng)估并比較2組患兒的臨床中醫(yī)證候積分；記錄并比較治療后2組患兒的癥狀消失時(shí)間，包括發(fā)熱、咳嗽起效時(shí)間及咳嗽消失時(shí)間；檢測(cè)治療前后2組患兒C反應(yīng)蛋白（CRP）、IL-6、TNF-α的水平；比較治療前后2組患兒肺功能指標(biāo)包括最大呼吸中段流量（MMEF）、呼氣峰流速（PEF）及第1秒用力呼氣容積（FEV1）/用力肺活量（FVC）；比較2組不良反應(yīng)情況。結(jié)果 聯(lián)合治療組臨床總有效率高于單一治療組（P＜0.05）；治療后，2組RMPP患兒中醫(yī)證候積分各項(xiàng)指標(biāo)均下降，聯(lián)合治療組各項(xiàng)指標(biāo)均低于單一治療組（P＜0.05），聯(lián)合治療組的患兒各項(xiàng)臨床癥狀平均消失時(shí)間短于單一治療組（P＜0.05），2組患兒的血清CRP、IL-6及TNF-α水平均下降，聯(lián)合治療組各項(xiàng)指標(biāo)下降幅度較大（P＜0.05）； 2組患兒肺功能指標(biāo)MMEF、PEF及FEV1/FVC水平均升高，聯(lián)合治療組各項(xiàng)指標(biāo)均高于單一治療組；聯(lián)合治療組的不良反應(yīng)發(fā)生率較低（P＜0.05）。結(jié)論 金振口服液聯(lián)合米諾環(huán)素治療RMPP患兒的療效較好，能有效降低患兒血清IL-6、TNF-α的水平，安全性強(qiáng)，值得臨床推廣。

Objective To investigate the curative effect of Jinzhen Oral Liquid combined with minocycline in the treatment of refractory mycoplasma pneumoniae pneumonia (RMPP) in children and its effect on the serum levels of interleukin 6 (IL-6), tumor necrosis factor-α (TNF-α) levels. Methods A total of 296 children with RMPP who were treated in Beijing Children's Hospital, Capital Medical University, Baoding Hospital from May 2019 to October 2023 were selected for the study and were randomly divided into a combined treatment group (148 cases), a single treatment group (148 cases). The single treatment group was treated with oral minocycline hydrochloride, and the combined treatment group was treated with oral Jinzhen Oral Liquid combined with minocycline hydrochloride. The clinical efficacy of the two groups of children was determined and compared; The clinical TCM symptom scores of the two groups were evaluated and compared; The time of symptom disappearance, including fever, cough onset time and cough disappearance time of the two groups of children were recorded and compared after treatment; The levels of C-reactive protein (CRP), IL-6 and TNF-α were measured before and after treatment; the lung function indexes including maximum mid-expiratory flow (MMEF), peak flow rate (PEF), and forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) were compared in both groups; And the levels of C-reactive protein (CRP), IL-6 and TNF-α were measured in both groups before and after treatment. The lung function indexes including maximum mid-expiratory flow (MMEF), peak expiratory flow rate (PEF), and forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) were compared between the two groups before and after the treatment. Results Overall clinical efficacy rate was higher in the combined treatment group than in the monotherapy group (P <0.05); After the treatment, all the indicators of the Chinese medicine indexes of the children with RMPP in both groups decreased, and all the indices of the joint training group were smaller than those of the single treatment group (P <0.05). The average disappearance time of all the patients' clinical parameters was shorter than that of the single treatment group (P <0.05). The levels of serum CRP, IL-6, and TNF-α of the patients in both groups decreased, and the decrease of all the indicators was larger in the combined treatment group (P <0.05); The levels of pulmonary function indicators MMEF, PEF, and FEV1/FVC of the children in both groups increased, and the levels of MMEF, PEF, and FEV1/FVC of the children in both groups decreased by a larger margin in the combined treatment group (P <0.05); The levels of pulmonary function indicators MMEF, PEF, and FEV1/FVC of both groups increased. The serum CRP, IL-6 and TNF-α levels of the children in both groups decreased, and the decrease of each index was larger in the combined treatment group (P <0.05); The lung function indexes of MMEF, PEF and FEV1/FVC levels of the children in both groups increased, and the indexes of each index in the combined treatment group were higher than those in the single treatment group; The incidence of adverse reactions was lower in the combination group (P <0.05). Conclusion The efficacy of Jinzhen Oral Liquid combined with minocycline in the treatment of children with RMPP is better, and it can effectively reduce the levels of serum IL-6 and TNF-α in the children, with strong safety, which is worthy of clinical promotion.

R975

保定市科技計(jì)劃項(xiàng)目（2341ZF173）