摘要
目的探究盐酸氨溴索纤维支气管镜(简称“纤支镜”)肺泡灌洗(BAL)治疗对肺炎支原体肺炎(MPP)伴气道内黏液栓患儿临床症状、肺实变吸收及支气管肺泡灌洗液(BALF)内黏蛋白5AC(MUC5AC)、磷脂酰肌醇3-激酶(PI3K)与可溶性程序性死亡因子配体-2(sPD-L2)水平的影响。方法随机数字表法将康复大学青岛中心医院医院2024年6月至2025年10月收治的102例MPP伴气道内黏液栓患儿分为观察组与对照组,每组51例。两组患儿均接受常规综合治疗,此外对照组给予单纯生理盐水纤支镜BAL治疗,观察组则给予盐酸氨溴索混合生理盐水纤支镜BAL治疗。对比两组高热/咳嗽/肺部啰音/黏液栓消失时间、住院时间及肺实变吸收情况;治疗前、治疗10 d后(治疗后)检测对比两组患儿呼吸力学[肺容积(LV)、肺静态顺应性(Cstat)、气道平台压(Pplat)]及血清C反应蛋白(CRP)、白细胞计数(WBC)、白细胞介素-6(IL-6)、干扰素-γ(IFN-γ)水平;首次纤支镜BAL时、末次BAL治疗后第3天采集BALF,测定对比两组BALF内MUC5AC、PI3K、sPD-L2水平。同时统计两组治疗期间不良反应率。结果观察组高热/咳嗽/肺部啰音/黏液栓消失时间、住院时间均短于对照组(P<0.05)。观察组肺实变吸收面积分级优于对照组(P<0.05)。对比治疗前,两组治疗后LV、Cstat均上升(P<0.05),Pplat、血清CRP、WBC、IL-6、IFN-γ水平均下降(P<0.05);对比首次纤支镜BAL时,两组末次BAL治疗后第3 d BALF内MUC5AC、PI3K、sPD-L2水平均下降(P<0.05),且观察组上述指标下降或上升程度均大于对照组(P<0.05)。两组不良反应率(15.69%vs.21.57%)对比差异无统计学意义(P>0.05)。结论盐酸氨溴索纤支镜BAL能有效促进MPP伴气道内黏液栓患儿临床症状体征缓解及肺实变吸收,改善其呼吸力学,其作用机制可能与BALF内MUC5AC、PI3K、sPD-L2水平下调有关。
Objective To explore the influence of ambroxol hydrochloride combined with fiberoptic bron⁃choscopy alveolar lavage(BAL)on the clinical symptoms,the absorption of lung consolidation,and the levels of mucin 5AC(MUC5AC),phosphatidylinositol 3-kinase(PI3K),and soluble programmatic death factor ligand-2(sPD-L2)in children with mycoplasma pneumoniae pneumonia(MPP)accompanied by mucus thrombus in the airway.Methods A total of 102 children diagnosed with MPP accompanied by airway mucus thrombus,who were admitted to the hospital from June 2024 to October 2025,were randomly assigned to the study group(n=51,receiving conventional comprehensive treatment plus bronchoscopy BAL with ambroxol hydrochloride mixed in nor⁃mal saline)and the control group(n=51,receiving conventional comprehensive treatment plus bronchoscopy BAL with simple normal saline)using the random number table method.The disappearance time of high fever,cough,pulmonary rales,and mucus plugs,the length of hospital stay,and the absorption of pulmonary consolidation were compared between the two groups.Respiratory mechanics,including lung volume(LV),lung static compliance(Cstat),and airway plateau pressure(Pplat),as well as the levels of serum C-reactive protein(CRP),white blood cell count(WBC),interleukin-6(IL-6),and interferon-γ(IFN-γ)were detected and compared between the two groups before treatment and 10 days after treatment(post-treatment).Bronchoalveolar lavage fluid(BALF)was collected during the first bronchoscopy BAL and on the 3rd day after the last BAL treatment,and the levels of MUC5AC,PI3K,and sPD-L2 in the BALF of the two groups were measured and compared.Meanwhile,the adverse reaction rates during the treatment period in both groups were statistically analyzed.Results The disap⁃pearance times of high fever,cough,pulmonary rales,and mucus plugs,as well as the length of hospital stay,were all shorter in the study group than those in the control group(P<0.05).Moreover,the classification of lung consolidation absorption area was more favorable(P<0.05).In comparison with the pre-treatment status,both LV and Cstat increased in both groups after treatment(P<0.05),whereas the levels of Pplat,serum CRP,WBC,IL-6,and IFN-γdecreased(P<0.05).When compared with the results of the first bronchoscopy BAL,the levels of MUC5AC,PI3K,and sPD-L2 in the BALF of both groups decreased on the 3rd day after the last BAL treatment(P<0.05).Additionally,the extent of decrease or increase of the above-mentioned indicators was greater in the study group than that in the control group(P<0.05).There was no statistically significant difference in the adverse reaction rates between the two groups(15.69%vs.21.57%)(P>0.05).Conclusions Ambroxol hydrochloride combined with bronchoscopy BAL can effectively promote the relief of clinical symptoms and signs and the absorp⁃tion of lung consolidation in children with MPP accompanied by mucus thrombus in the airway,and improve their respiratory mechanics.The mechanism of action may be related to the down-regulation of MUC5AC,PI3K,and sPD-L2 levels in BALF.
作者
董健
曾鹏
李斐斐
王小虎
宫蕾
DONG Jian;ZENG Peng;LI Feifei;WANG Xiaohu;GONG Lei(Department of Pediatrics,Qingdao Central Hospital,University of Health and Rehabilitation Sciences,Qingdao 266042,Shandong,China;Department of Neonatology,Shandong Provincial Maternal and Child Health Hospital,Jinan 250013,Shandong,China)
出处
《实用医学杂志》
北大核心
2026年第6期909-915,共7页
The Journal of Practical Medicine
基金
国家卫健委能力建设和继续教育中心专项课题项目(编号:GWJJMB202510023051)。
关键词
肺炎支原体肺炎
气道内黏液栓
盐酸氨溴索
纤维支气管镜肺泡灌洗术
mycoplasma pneumoniae pneumonia
mucus thrombus in the airway
ambroxol hydrochlo⁃ride
fiberoptic bronchoscopy alveolar lavage
