甲泼尼龙辅助治疗儿童肺炎支原体感染性大叶性肺炎疗效与安全性分析  

Efficacy and safety of methylprednisolone in adjuvant treatment of lobar pneumonia caused by Mycoplasma pneumoniae in children

作　　者：张贺[1] 刘晓萌 宋义琴[1] 于海明 Zhang He;Liu Xiaomeng;Song Yiqin;Yu Haiming(Department of Respiratory,Baoding Children’s Hospital,Baoding 071000,China)

机构地区：[1]河北保定市儿童医院呼吸科/保定市儿童呼吸消化疾病临床研究重点实验室呼吸科,保定071000

出　　处：《新医学》2020年第8期624-627,共4页Journal of New Medicine

基　　金：保定市科技计划项目(17ZF037)。

摘　　要：目的探讨甲泼尼龙辅助治疗儿童肺炎支原体感染性大叶性肺炎的疗效与安全性。方法收集168例肺炎支原体感染性大叶性肺炎患儿临床资料,根据治疗方法将其分为对照组(大环内酯类抗菌药物常规治疗,46例)与早期干预组(大环内酯类抗菌药物疗程未满7 d应用甲泼尼龙,64例),晚期干预组(大环内酯类抗菌药物疗程满7 d或以上应用甲泼尼龙,58例),比较3组患儿的治疗效果及不良反应。结果3组患儿的退热时间、咳嗽缓解时间及总住院时间比较差异有统计学意义(P均<0.05),其中早期干预组及晚期干预组均短于对照组(P均<0.05),早期干预组均短于晚期干预组(P均<0.05)。治疗2周后,3组患儿肺部影像学好转率比较差异有统计学意义(P<0.05),其中早期干预组患儿肺部阴影好转率高于对照组(P<0.017)。3组不良反应总发生率比较差异无统计学意义(P>0.05)。早期干预组患儿的甲泼尼龙平均用量为(16.98±3.41)mg,低于晚期干预组患儿的甲泼尼龙平均用量[(27.58±4.12)mg](P<0.05)。结论在大环内酯类药物的基础上应用甲泼尼龙能缩短肺炎支原体感染性大叶性肺炎患儿临床症状改善时间,有利于肺部病变阴影吸收,而在大环内酯类药物应用早期加用甲泼尼龙效果优于晚期,且可减少甲泼尼龙用量,更为安全。Objective To evaluate the clinical efficacy and safety of methylprednisolone in the treatment of lobar pneumonia caused by Mycoplasma pneumoniae(MP) in children.Methods Clinical data of 168 children with lobar pneumonia caused by MP were respectively analyzed.All children were divided into three groups according to different treatment regimes.In the control group(n = 46),children received routine macrolide antibiotics treatment.In the early-intervention group(n = 64),methylprednisolone was supplemented within 7-d macrolide antibiotics treatment.In the late-intervention group(n = 58),methylprednisolone was administered after 7-d macrolide antibiotics treatment.Clinical efficacy and safety were statistically compared among three groups.Results The remission time of fever and cough,and the total length of hospital stay significantly differed among three groups(all P < 0.05).The remission time of fever and cough,and the total length of hospital stay in the early-and late-intervention groups were significantly shorter compared with those in the control group(all P < 0.05),and those in early-intervention group were shorter than those in late-intervention group(all P < 0.05).After 2 weeks of corresponding treatment,the improvement rate of pulmonary shadow significantly differed among all three groups(all P < 0.05).The improvement rate of pulmonary shadow in the early-intervention group was remarkably higher than that in the control group(P < 0.017).The total incidence of adverse reactions did not considerably differ among three groups(all P > 0.05).In the early-intervention group,the total dose of methylprednisolone was(16.98±3.41) mg,significantly lower than(27.58±4.12) mg in the late-intervention group(P < 0.05).Conclusions The supplement of methylprednisolone based on macrolide antibiotics treatment can effectively shorten the remission time of clinical symptoms and promote the absorption of pulmonary shadow.Moreover,the clinical efficacy in earlyintervention group is better than that in late-intervention group.And

关 键 词：甲泼尼龙 辅助治疗 儿童 大叶性肺炎 肺炎支原体 发热 肺部影像学 不良反应 

分 类 号：R725.6[医药卫生—儿科]