低剂量甲泼尼龙对急性化脓性骨髓炎伴脓毒血症患儿免疫功能及预后的影响  

Effect of low dose methylprednisolone on immune function and prognosis in children with acute suppurative osteomyelitis and sepsis

作　　者：甘先民[1] 侯悦媚[1] 黄乙勇 黎行宙 符凯[1] 

机构地区：[1]海南省妇幼保健院小儿骨科,海南海口570203

出　　处：《中华医院感染学杂志》2017年第14期3327-3330,共4页Chinese Journal of Nosocomiology

基　　金：海南省自然科学基金资助项目(20168326)

摘　　要：目的探究低剂量甲泼尼龙对急性化脓性骨髓炎伴脓毒血症患儿免疫功能及预后的影响,为临床治疗提供参考依据。方法将医院在2015年6月-2016年11月收治的79例急性化脓性骨髓炎伴脓毒血症的患儿,根据治疗方式的不同,分为激素组39例和常规组40例;观察两组患儿免疫功能改善及预后情况。结果 79例患儿中血培养出86株病原菌,以革兰阳性菌为主,共80株占93.02%;治疗前,两组患儿的CD_4^+与CD_8^+水平差异无统计学意义,但治疗后,激素组的CD_4^+与CD_8^+显著高于常规组,差异有统计学意义(P<0.05);治疗后,激素组患儿向慢性骨髓炎发展的共占5.13%,死亡可完全避免,显著优于常规组,差异有统计学意义(P<0.05)。结论低剂量甲泼尼龙辅助治疗急性化脓性骨髓炎伴脓毒血症的患儿,可明显调节免疫功能,显著改善预后,且常规行细菌培养及药敏分析,利于对接下来的诊治。OBJECTIVE To explore effect of low dose methylprednisolone on immune function and prognosis in children with acute suppurative osteomyelitis and sepsis,so as to provide references for clinical treatment.METHODS A total of 79 children with acute suppurative osteomyelitis with sepsis treated in our hospital from Jun.2015 to Nove.2016 were selected.According to the different treatment methods,the patients were divided into hormone group（39cases）and routine group（40cases）.The improvement of immune function and the prognosis of the two groups were observed.RESULTS There were 86 strains of pathogens in blood cultures of 79 patients,among which 80 strains were gram-positive bacteria,accounting for 93.02%.Before treatment,the difference of CD4^＋ and CD8^＋ levels between the two groups was not significant.But after treatment,the levels of CD4^＋ and CD8^＋ in hormone group were significantly higher than those in control group（P〈0.05）.After treatment,the incidence of the development of chronic osteomyelitis in hormone group accounted for 5.13%,and death could be completely avoided,which was significantly better than that of routine group（P〈0.05）.CONCLUSIONLow doses of methylprednisolone in adjuvant treatment of acute suppurative osteomyelitis with sepsis in children,can significantly adjust the immune function,significantly improve the prognosis,combining with routine bacterial culture and drug susceptibility analysis,which is helpful for the diagnosis and treatment of the disease.

关 键 词：甲泼尼龙 急性化脓性骨髓炎 脓毒血症 免疫功能 预后 

分 类 号：R631[医药卫生—外科学]