目的 探讨清肺解毒汤联合多西环素治疗儿童耐药肺炎支原体肺炎（MPP）的疗效及安全性。方法 回顾性选取2024年1月1日—2024年6月1日河南中医药大学第一附属医院收治的106例8～15岁耐药MPP住院患儿作为研究对象，按治疗方案分为清肺解毒汤联合多西环素组（联合组，n＝53）与多西环素单药组（多西环素组，n＝53）。观察指标包括体温恢复正常时间、咳嗽明显缓解时间、肺部影像学吸收情况、治疗有效率及不良反应。采用单因素分析，并进一步运用多因素分析，以控制病情严重程度等混杂因素。结果 联合组在主要疗效指标均显著优于多西环素组：体温恢复正常时间（1 d vs 2 d，P＜0.001）、咳嗽明显缓解时间（4 d vs 5 d，P＝0.002）及住院时间（6 d vs 7 d，P＜0.001）均显著缩短。联合组的肺部影像学明显吸收率（96.23% vs 83.02%，P＝0.042）与临床总有效率（98.11% vs 86.79%，P＝0.042）亦显著升高。多因素分析进一步证实，接受联合治疗是患儿获得临床有效的独立正向预测因素[比值比（OR） ＝8.15，95%置信区间（CI）： 1.02～65.27，P＝0.048]。安全性方面，两组不良反应总发生率无显著差异（7.55% vs 9.43%，P＞0.05），且均为轻微反应。结论 清肺解毒汤联合多西环素治疗儿童耐药MPP疗效显著，其在促进症状缓解、加速肺部炎症吸收及缩短住院时间方面均优于多西环素多西环素治疗，且未增加不良反应风险。该联合方案可作为临床治疗儿童耐药MPP，尤其是常规治疗效果不佳者的有效与安全选择。

Objective To investigate the clinical characteristics and treatment outcomes of drug-resistant mycoplasma pneumoniae pneumonia (MPP) in children, and to evaluate the efficacy and safety of Qingfei Jiedu Decoction combined with doxycycline. Methods A retrospective analysis was conducted on 106 hospitalized children with drug-resistant MPP treated with doxycycline at the First Affiliated Hospital of Henan University of Chinese Medicine from June 1st to December 1st, 2023. Patients were divided into two groups based on treatment regimen: The combination therapy group and the doxycycline monotherapy group. Observational indicators included time to fever resolution, time to significant cough relief, radiographic improvement, treatment efficacy, and adverse reactions. Univariate analyses were performed, followed by multivariate analyses to adjust for confounding factors such as disease severity. Results A total of 106 children aged eight years and older with drug-resistant MPP were included and divided into the Qingfei Jiedu Decoction plus doxycycline group (combination group, n = 53) and the doxycycline monotherapy group (monotherapy group, n = 53). The baseline characteristics were comparable between the two groups (P > 0.05). The combination group showed significantly better outcomes in all primary efficacy indicators compared to the monotherapy group: time to fever resolution (1 d vs 2 d, P < 0.001), time to significant cough relief (4 d vs 5 d, P = 0.002), and hospitalization duration (6 d vs 7 d, P <0.001) were all significantly shorter. The combination group also had significantly higher rates of significant radiographic absorption (96.23% vs 83.02%, P = 0.042) and overall clinical efficacy (98.11% vs 86.79%, P = 0.042). Multivariate analysis confirmed that receiving combination therapy was an independent positive predictor of clinical effectiveness (OR = 8.15, 95% CI: 1.02—65.27, P = 0.048). Regarding safety, there was no significant difference in the overall incidence of adverse reactions between the two groups (7.55% vs 9.43%, P > 0.05), and all reactions were mild. Conclusion Qingfei Jiedu Decoction combined with doxycycline is significantly effective in treating drug-resistant MPP in children. It is superior to doxycycline monotherapy in alleviating symptoms, promoting radiographic resolution, and shortening hospital stay, without increasing the risk of adverse reactions. This combination regimen can be considered an effective and safe option for treating drug-resistant MPP in children, especially for cases refractory to conventional therapy.

R974

河南省中医药科学研究专项课题（20-21ZY2040）；河南省中医药学科领军人才培养项目（豫卫中医函［2021］ 8号)；河南省中医药科学研究专项课题（2018JDZX117）