纤维支气管镜肺泡灌洗与甲泼尼龙治疗难治性肺炎支原体肺炎的疗效比较  

Therapeutic effects comparison of bronchoscopic alveolar lavage and methylprednisolone on refractory mycoplaama pneumoniae pneumonia

作　　者：王子威[1] 胡彦宏[1] 何瑜娜 李井峰 Wang Ziwei;Hu Yanhong;He Yuna;Li Jingfeng(Department of Pediatrics,Beijing Friendship Hospital Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院儿科,100050

出　　处：《北京医学》2021年第2期126-129,共4页Beijing Medical Journal

摘　　要：目的比较纤维支气管镜肺泡灌洗与糖皮质激素治疗难治性肺炎支原体肺炎(refractory mycoplaama pneu-moniae pneumonia,RMPP)的效果。方法选取2015年1月至2019年3月首都医科大学附属北京友谊医院儿科收治的RMPP患儿65例,随机分为肺泡灌洗组(n=33)和甲泼尼龙组(n=32),比较两组发热、咳嗽持续时间,观察治疗前后ESR、乳酸脱氢酶(lactate dehydrogenase,LDH)、血清铁蛋白(serum ferritin,SF)、D-二聚体、IL-6、TNF-α变化及治疗后1个月胸部CT肺部恢复情况。结果肺泡灌洗组发热、咳嗽持续时间均较甲泼尼龙组显著缩短(P<0.05),1个月后肺部恢复情况好于甲泼尼龙组,差异有统计学意义(总有效率:97.0%比87.5%,P<0.05);治疗后,肺泡灌洗组ESR、SF水平与甲泼尼龙组比较,差异无统计学意义(P>0.05),LDH、D-二聚体水平较甲泼尼龙组显著降低(P<0.05),甲泼尼龙组IL-6、TNF-α水平较肺泡灌洗组显著降低(P<0.05)。结论纤维支气管镜肺泡灌洗术与糖皮质激素对RMPP患儿临床症状及实验室炎症指标均有改善作用。糖皮质激素对细胞因子降低效果优于纤维支气管镜肺泡灌洗术,但纤维支气管镜肺泡灌洗术对加速肺部病变吸收、改善预后比糖皮质激素效果明显。Objective To compare the efficacy of bronchoscopic alveolar lavage and glucocorticoid in the treatment of refractory mycoplaama pneumoniae pneumonia(RMPP).Methods Sixty-five cases of RMPP were randomly divided into alveolar lavage group and methylprednisolone group.The duration of fever and cough were observed and compared.ESR,lactate dehydrogenase(LDH),serum ferritin(SF),D-dimer,IL-6,TNF-αbefore and after treatment,and pulmonary recovery of chest CT one month after treatment were observed and compared between the two groups.Results The duration of fever and cough in alveolar lavage group were significantly shorter than those in methylprednisolone group.Lung recovery was better than that in methylprednisolone group after one month(P<0.05).The levels of ESR and SF in alveolar lavage group were not significantly different from those in methylprednisolone group(P>0.05).After treatment,the levels of IL-6 and TNF-αin methylprednisolone group were significantly lower than those in alveolar lavage group(P<0.05).The levels of LDH and D-dimer in alveolar lavage group were significantly lower than those in methylprednisolone group(P<0.05).Conclusions Alveolar lavage and glucocorticoid can improve clinical symptoms and laboratory inflammatory indexes in children with RMPP.The effect of glucocorticoid on cytokine reduction is better than that of alveolar lavage,but alveolar lavage can accelerate the absorption of lung lesions and improve prognosis than glucocorticoid.

关 键 词：纤维支气管镜肺泡灌洗 甲泼尼龙 难治性肺炎支原体肺炎 黏液痰栓 

分 类 号：R725.6[医药卫生—儿科]