目的 观察金振口服液联合米诺环素治疗儿童难治性肺炎支原体肺炎（RMPP）的疗效及对血清白细胞介素6（IL-6）、肿瘤坏死因子α（TNF-α）水平的影响。方法 选取2019年5月—2023年10月在首都医科大学附属北京儿童医院保定医院诊治的296例RMPP患儿作为研究对象，随机分为联合治疗组（148例）、单一治疗组（148例）。单一治疗组进行口服盐酸米诺环素治疗，联合治疗组进行口服金振口服液联合盐酸米诺环素治疗。对两组患儿的临床疗效进行判定及对比；评估并比较2组患儿的临床中医证候积分；记录并比较治疗后2组患儿的症状消失时间，包括发热、咳嗽起效时间及咳嗽消失时间；检测治疗前后2组患儿C反应蛋白（CRP）、IL-6、TNF-α的水平；比较治疗前后2组患儿肺功能指标包括最大呼吸中段流量（MMEF）、呼气峰流速（PEF）及第1秒用力呼气容积（FEV1）/用力肺活量（FVC）；比较2组不良反应情况。结果 联合治疗组临床总有效率高于单一治疗组（P＜0.05）；治疗后，2组RMPP患儿中医证候积分各项指标均下降，联合治疗组各项指标均低于单一治疗组（P＜0.05），联合治疗组的患儿各项临床症状平均消失时间短于单一治疗组（P＜0.05），2组患儿的血清CRP、IL-6及TNF-α水平均下降，联合治疗组各项指标下降幅度较大（P＜0.05）； 2组患儿肺功能指标MMEF、PEF及FEV1/FVC水平均升高，联合治疗组各项指标均高于单一治疗组；联合治疗组的不良反应发生率较低（P＜0.05）。结论 金振口服液联合米诺环素治疗RMPP患儿的疗效较好，能有效降低患儿血清IL-6、TNF-α的水平，安全性强，值得临床推广。

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

保定市科技计划项目（2341ZF173）