回顾性评价阿奇霉素联合糖皮质激素治疗小儿难治性支原体肺炎的疗效及安全性  

Observation on the safety and effect of azithromycin combined with methylprednisolone for children with refractory mycoplasma pneumonia

作　　者：周升铭 毕婷婷[1] 陈文思[1] 何柳瑜[2] Zhou Shengming;Bi Tingling;Chen Wensi;He Liuyu(Department of Pharmacy,Guangdong Women and Children Hospital,Guangzhou 510010,China;Internal Medicine,Guangdong Women and Children Hospital,Guangzhou 510010,China)

机构地区：[1]广东省妇幼保健院药学部,广州510010 [2]广东省妇幼保健院内科,广州510010

出　　处：《国际医药卫生导报》2018年第15期2314-2317,共4页International Medicine and Health Guidance News

摘　　要：目的通过评价阿奇霉素联合糖皮质激素治疗小儿难治性支原体怖炎的疗效和安全性，并且比较联合用药对免疫学相关因子的改变，探讨两者联合应用的临床价值。方法选取2015年1月至2017年1月期间某三甲妇幼保健院收治诊断为d,JL难治性支原体怖炎患儿120例，将纳入研究的病例随机分为对照组60例、研究组60例。对两组患儿进行常规治疗，包括退烧、止咳平喘等。在此基础上，对照组静脉滴注阿奇霉素10rag／（kg·d），用4d停3d，治疗两个疗程。研究组再加甲泼尼龙2mg／（kg·d）静脉滴注，当患者临床症状改善、体温降至正常值后改为口服泼尼松片1mg／（kg·d）。比较两组患者临床症状缓解时间、血清免疫因子水平及疗效。结果研究组体温降低、咳嗽缓解、哕音消失以及入院治疗的时间比对照组明显减少（P〈0．05）；超敏C反应蛋白（hs—CRP）和血沉（ESR）水平研究组均显著低于对照组患儿（P〈0．05）；比较免疫因子的变化，CD4^＋比例和CD4^＋／CD8^＋研究组明显高于对照组，而CD8^＋明显低于对照组（P〈0．05）。比较药物不良反应，两组都有轻度的不良发应，但不良发应的数量和严重程度比较差异无统计学意义（P〉0．05）。结论阿奇霉素联合糖皮质激素治疗的疗效明显，不良反应少，安全性高；同时能改善免疫功能，这一联合治疗方案值得临床广泛推广。Objective To investigate the safety and effect of azithromycin combined with methylprednisolone for children with refractory mycoplasma pneumonia, and explore the clinical value of the combined application. Methods 120 children with refractory mycoplasma pneumonia admitted to our hospital from January 2015 to January 2017 were selected, and were randomly divided into the control group and the research group, 60 cases in each group. Conventional treatment was implemented in both two groups, including abatement of fever, relieving cough. The control group was treated with intravenous drip of azithromycin 10 mg/（kg.d）, after every 4 days, stopping 3 days, 7 days as a treatment course, lasting for 2 courses. On the basis, the research group was treated with intJcavenous drip of methylprednisolone 2 mg/（kg.d）, and then oral prednison tablets 1 mg/（kg.d） after clinical symptoms improving and temperature returning to normal. Results The time of temperature recovery, cough disappearmace, pulmonary rales disappearance, and hospitalization of the research group were significantly shorter than those of the control group （P〈0.05）. After treatment, the levels of hs-CRP and ESR in the research group were significantly lower than those in the control group （P〈0.05）; the proportion of CD4^＋ and CD4^＋/CD8^＋ in the peripheral blood of the research group were significantly higher than those of the control group, mad the proportion of CD8^＋ was significantly lower than that of the control group （P〈0.05）. There was no statistically significant difference in the adverse reactions of the drug between the two groups （P〉0.05）. Conclusion Azithromycin combined with methylprednisolone in the treatment of children with refractory mycoplasma pneumonia can improve the curative effect, improve the immune function, mad has high safety, which is worthy of clinical promotion.

关 键 词：阿奇霉素 糖皮质激素 儿童 难治性支原体肺炎 

分 类 号：R725.6[医药卫生—儿科]