Effects of azithromycin combined with high-dose vitamin C in children with <i>Mycoplasma pneumoniae</i> pneumonia and its influences on peripheral blood T lymphocyte subsets, inflammatory factors and related proteins

DING Jie; ZHANG Bing; SONG Aiqin

doi:10.7619/jcmp.20240477

Journal of Clinical Medicine in Practice > 2024 > 28(14): 54-59, 66. > DOI: 10.7619/jcmp.20240477

DING Jie, ZHANG Bing, SONG Aiqin. Effects of azithromycin combined with high-dose vitamin C in children with Mycoplasma pneumoniae pneumonia and its influences on peripheral blood T lymphocyte subsets, inflammatory factors and related proteins[J]. Journal of Clinical Medicine in Practice, 2024, 28(14): 54-59, 66. DOI: 10.7619/jcmp.20240477

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Effects of azithromycin combined with high-dose vitamin C in children with Mycoplasma pneumoniae pneumonia and its influences on peripheral blood T lymphocyte subsets, inflammatory factors and related proteins

1.
Department of Pediatric Critical Care Medicine, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266003
2.
Department of Pediatrics, Weihai Municipal Hospital of Shandong Province, Weihai, Shandong, 264200

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Received Date: January 25, 2024
Revised Date: March 24, 2024
Available Online: July 19, 2024

Graphical Abstract

Abstract

Abstract

Objective
To explore the clinical curative effect of azithromycin combined with high-dose vitamin C (VC) in children with Mycoplasma pneumoniae pneumonia (MPP)and its influences on peripheral blood T lymphocyte subsets, serum interleukin (IL)-17, high-sensitivity C-reactive protein (hs-CRP), E2-associated factor 2 (Nrf2) in peripheral blood mononuclear cells and P1 proteins in throat swab.
Methods
A total of 240 children with MPP confirmed in the hospital were enrolled as observation objects between June 2020 and June 2023. They were randomly divided into high-dose VC group, low-dose VC group and control group, with 80 cases in each group. The control group was treated with azithromycin, low-dose VC group was treated with azithromycin plus low-dose VC, and high-dose VC group was treated with azithromycin plus high-dose VC, the three groups all treated for 2 weeks. The clinical curative effect and duration of clinical symptoms in the three groups were recorded. Before and after treatment, fasting venous blood and throat swabs were collected in the three groups. T lymphocyte subsets (CD3⁺, CD4⁺, CD8⁺, CD4⁺/CD8⁺) in peripheral blood were detected by flow cytometry. The levels of serum IL-17, hs-CRP and VC were detected by enzyme-linked immunosorbent assay (ELISA). The mRNA levels of Nrf2 protein in peripheral blood mononuclear cells and P1 protein in throat swabs were detected by real-time fluorescence quantitative polymerase chain reaction (qRT-PCR). The adverse reactions during treatment in the three groups were recorded and compared.
Results
After treatment, time of fever, cough, expectoration and lung moist rale, and length of hospital stay were shorten in high-dose VC group and low-dose VC group when compared with those in the control group (P < 0.05), and were shorten in the high-dose VC group when compared with those in the low-dose VC group (P < 0.05). After treatment, levels of peripheral blood T lymphocyte subsets (CD3⁺, CD4⁺, CD4⁺/CD8⁺) were increased when compared with those before treatment in the three groups (P < 0.05). The levels of CD3⁺, CD4⁺ and CD4⁺/CD8⁺ in the high-dose VC group were higher than those in the low-dose VC group and control group (P < 0.05), and CD4⁺ level in the low-dose VC group was higher than that in the control group (P < 0.05). After treatment, levels of serum IL-17 and hs-CRP were decreased as compared with those before treatment in the three groups (P < 0.05). The levels of serum IL-17 and hs-CRP in the high-dose VC group were lower than those in the low-dose VC and control group, but there was no difference between low-dose VC group and control group (P>0.05). After treatment, levels of serum VC were increased as compared with that before treatment in high-dose VC group and low-dose VC group, and it was higher in the high-dose VC group than low-dose VC group (P < 0.05). There were no differences in IL-17 and hs-CRP between low-dose VC group and control group (P>0.05). After treatment, mRNA levels of Nrf2 protein in peripheral blood mononuclear cells and P1 protein in throat swabs were decreased compared with those before treatment in the three groups (P < 0.05). The expression level of Nrf2 mRNA in the high-dose VC group was higher than that in the low-dose VC group and control group (P < 0.05), but there was no significant difference in mRNA expression of PI protein among the three groups (P>0.05). There were no obvious adverse reactions in any group during treatment.
Conclusion
Azithromycin combined with high-dose VC can effectively improve clinical symptoms, enhance immunity, reduce IL-17 and hs-CRP levels, maintain Nrf2 mRNA level and improve clinical curative effect in MPP children, and has higher safety.

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References (26)

References

[1]	TSAI T A, TSAI C K, KUO K C, et al. Rational stepwise approach for Mycoplasma pneumoniae pneumonia in children[J]. Wei Mian Yu Gan Ran Za Zhi, 2021, 54(4): 557-565. doi: 10.1016/j.jmii.2020.10.002
[2]	KRAFFT C, CHRISTY C. Mycoplasma pneumonia in children and adolescents[J]. Pediatr Rev, 2020, 41(1): 12-19. doi: 10.1542/pir.2018-0016
[3]	AHN J G, CHO H K, LI D H, et al. Efficacy of tetracyclines and fluoroquinolones for the treatment of macrolide-refractory Mycoplasma pneumoniae pneumonia in children: a systematic review and meta-analysis[J]. BMC Infect Dis, 2021, 21(1): 1003. doi: 10.1186/s12879-021-06508-7
[4]	卓佳佳, 苏晓霁, 张晨宇, 等. 两种儿童肺炎早期部分免疫指标的变化及临床价值[J]. 贵州医科大学学报, 2021, 46(9): 1101-1106. https://www.cnki.com.cn/Article/CJFDTOTAL-GYYB202109020.htm
[5]	石娟, 马春骥, 郝秀静, 等. Dickkopf相关蛋白1抑制肺炎支原体P1-C诱导小鼠肺上皮细胞过度分泌MUC5AC[J]. 生物工程学报, 2023, 39(1): 248-261. https://www.cnki.com.cn/Article/CJFDTOTAL-SHWU202301019.htm
[6]	LI Y R, ZHU H. Vitamin C for sepsis intervention: from redox biochemistry to clinical medicine[J]. Mol Cell Biochem, 2021, 476(12): 4449-4460. doi: 10.1007/s11010-021-04240-z
[7]	AMMAR M A, AMMAR A A, CONDENI M S, et al. Vitamin C for sepsis and septic shock[J]. Am J Ther, 2021, 28(6): e649-e679. doi: 10.1097/MJT.0000000000001423
[8]	陈意, 马骥, 陈丽娟, 等. 大剂量维生素C在支气管哮喘大鼠肺部感染中的疗效及对肺功能的影响研究[J]. 中华医院感染学杂志, 2019, 29(19): 2905-2909. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHYY201919008.htm
[9]	张间霞, 庄健海, 吕微风, 等. 成年病毒性肺炎患者T淋巴细胞亚群的水平变化及临床意义[J]. 检验医学与临床, 2020, 17(24): 3601-3603. doi: 10.3969/j.issn.1672-9455.2020.24.013
[10]	卢红霞, 黄晗, 郭燕军, 等. 儿童难治性支原体肺炎白细胞介素-8、白细胞介素-17、CD4-CD8比值与病情及预后的相关性研究[J]. 安徽医药, 2021, 25(12): 2411-2415. doi: 10.3969/j.issn.1009-6469.2021.12.019
[11]	中华医学会儿科学分会呼吸学组. 儿童肺炎支原体肺炎诊治专家共识(2015年版)[J]. 中华实用儿科临床杂志, 2015, 30(17): 1304-1308. doi: 10.3760/cma.j.issn.2095-428X.2015.17.006
[12]	盛江吟, 李昌崇. 婴幼儿肺炎支原体肺炎临床特征及预后分析[J]. 儿科药学杂志, 2020, 26(8): 16-19. https://www.cnki.com.cn/Article/CJFDTOTAL-EKYX202008007.htm
[13]	李真. 阿奇霉素序贯疗法对儿童肺炎支原体肺炎的疗效及对相关炎症因子的影响[J]. 儿科药学杂志, 2019, 25(2): 29-31. https://www.cnki.com.cn/Article/CJFDTOTAL-EKYX201902009.htm
[14]	朱雷. 观察阿奇霉素序贯疗法用于小儿肺炎支原体肺炎(MPP)临床治疗的效果: 评《小儿呼吸系统疾病诊疗与护理》[J]. 中国辐射卫生, 2022, 31(2): 259-259. https://www.cnki.com.cn/Article/CJFDTOTAL-REDI202202024.htm
[15]	喻法明. 小儿病毒性心肌炎应用磷酸肌酸钠配合大剂量维生素C的治疗价值[J]. 中国妇幼保健, 2020, 35(24): 4785-4787. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFYB202024046.htm
[16]	麻丽平. 喜炎平注射液联合维生素C注射液治疗儿童上呼吸道感染的效果及可行性分析[J]. 中国药物与临床, 2021, 21(8): 1361-1363. https://www.cnki.com.cn/Article/CJFDTOTAL-YWLC202108044.htm
[17]	黄晓静, 葛蔚华. 大剂量维生素C辅助治疗儿童支原体肺炎的临床疗效观察[J]. 中国全科医学, 2019, 22(S1): 45-47. https://www.cnki.com.cn/Article/CJFDTOTAL-QKYX2019S1017.htm
[18]	CHEN H Y, ALMONTE-LOYA A, LAY F Y, et al. Epigenetic remodeling by vitamin C potentiates plasma cell differentiation[J]. Elife, 2022, 11: e73754. doi: 10.7554/eLife.73754
[19]	RITZMANN F, LUNDING L P, BALS R, et al. IL-17 cytokines and chronic lung diseases[J]. Cells, 2022, 11(14): 2132. doi: 10.3390/cells11142132
[20]	FAN H F, LU B T, YANG D Y, et al. Distribution and expression of IL-17 and related cytokines in children with Mycoplasma pneumoniae pneumonia[J]. Jpn J Infect Dis, 2019, 72(6): 387-393. doi: 10.7883/yoken.JJID.2019.113
[21]	袁婷, 曾俊, 江华. 静脉高剂量维生素C用于脓毒症治疗: 从分子机制到临床应用[J]. 实用医院临床杂志, 2023, 20(5): 201-204. https://www.cnki.com.cn/Article/CJFDTOTAL-YYLC202305049.htm
[22]	熊学敏, 邵荣昌, 彭瑞, 等. 大剂量维生素C联合罗红霉素对小儿肺炎支原体肺炎的疗效[J]. 西北药学杂志, 2020, 35(1): 121-125. https://www.cnki.com.cn/Article/CJFDTOTAL-XBYZ202001029.htm
[23]	余丽霞, 郑佳佳. 维生素C辅助阿奇霉素治疗小儿支原体肺炎的疗效与对C-反应蛋白肿瘤坏死因子-α及降钙素原水平的影响[J]. 中国妇幼保健, 2022, 37(15): 2815-2818. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFYB202215028.htm
[24]	BAIRD L, YAMAMOTO M. The molecular mechanisms regulating the KEAP1-NRF2 pathway[J]. Mol Cell Biol, 2020, 40(13): e00099-e00020.
[25]	HE F, ANTONUCCI L, KARIN M. NRF2 as a regulator of cell metabolism and inflammation in cancer[J]. Carcinogenesis, 2020, 41(4): 405-416.
[26]	展磊, 王晓红. 肺炎支原体表面黏附蛋白的研究进展[J]. 微生物学免疫学进展, 2023, 51(4): 76-81. https://www.cnki.com.cn/Article/CJFDTOTAL-WSMY202304014.htm

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Effects of azithromycin combined with high-dose vitamin C in children with Mycoplasma pneumoniae pneumonia and its influences on peripheral blood T lymphocyte subsets, inflammatory factors and related proteins

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Effects of azithromycin combined with high-dose vitamin C in children with Mycoplasma pneumoniae pneumonia and its influences on peripheral blood T lymphocyte subsets, inflammatory factors and related proteins

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