不同剂量糖皮质激素联合阿奇霉素治疗小儿难治性支原体肺炎的疗效及安全性研究  

Different dosages of glucocorticoid combined with azithromycin in treatment of children with refractory mycoplasma pneumoniae pneumonia

作　　者：施林燕 钱俊[2] 蔡惠东[2] Shi Linyan;Qian Jun;Cai Huidong(Department of Pediatrics,Zhangjiagong Third People's Hospital,Zhangjiagang 215600,China;Department of Pediatric Respiratory Medicine,Wuxi Children's Hospital,Wuxi 214023,China)

机构地区：[1]张家港市第三人民医院儿科,江苏215600 [2]无锡市儿童医院儿呼吸科,江苏214023

出　　处：《国际医药卫生导报》2021年第9期1274-1277,共4页International Medicine and Health Guidance News

基　　金：江苏省自然科学基金面上研究项目(BK20151112);江苏省医学创新团队项目(CXTDB2017016)。

摘　　要：目的探究不同剂量糖皮质激素联合阿奇霉素治疗小儿难治性支原体肺炎(refractory mycoplasma pneumoniae pneumonia,RMPP)的疗效及安全性。方法选取2015年6月至2019年9月张家港市第三人民医院儿科收治的88例RMPP患儿作为研究对象,采用随机数字表法将所选患儿分为A组和B组,各44例。A组患儿采用常规剂量(2 mg·kg-1·d-1)甲泼尼龙联合阿奇霉素治疗,B组患儿采用小剂量(1 mg·kg-1·d-1)甲泼尼龙联合阿奇霉素治疗。记录并比较两组患儿体温恢复时间、住院时间、不良反应的发生情况及治疗前后血清C反应蛋白(C-reactive protein,CRP)水平,并评价临床疗效。结果A组患儿中男24例,女20例,年龄(8.2±2.8)岁;B组患儿中男25例,女19例,年龄(8.5±2.9)岁;两组患儿的一般资料比较,差异均无统计学意义(均P>0.05)。A组患儿临床治疗总有效率为88.6%(39/44),B组为84.1%(37/44),两组临床治疗总有效率比较,差异无统计学意义(P>0.05)。A组体温恢复时间为(7.2±2.0)d,住院时间为(9.8±2.5)d,B组分别为(7.3±2.2)d、(10.1±2.7)d,两组体温恢复时间及住院时间比较,差异均无统计学意义(均P>0.05)。治疗前,A组血清CRP水平为(68.2±18.7)mg/L,B组为(67.9±17.9)mg/L;治疗后A组血清CRP水平为(14.2±6.4)mg/L,B组为(15.1±7.2)mg/L;两组患儿治疗前血清CRP水平比较,差异无统计学意义(P>0.05),治疗后均较治疗前显著降低,差异均有统计学意义(均P<0.05),两组治疗后血清CRP水平比较差异无统计学意义(P>0.05)。两组患儿治疗期间出现的药物不良反应主要有胃肠道反应、欣快感、面部潮红及大便隐血阳性等,B组不良反应的发生率(6.8%,3/44)明显低于A组(25.0%,11/44),差异有统计学意义(P<0.05)。结论小剂量糖皮质激素联合阿奇霉素具有与常规剂量糖皮质激素联合阿奇霉素治疗小儿RMPP相当的效果,但安全性更高。Objective To investigate the clinical effects and safety of different dosages of glucocorticoids combined with azithromycin in the treatment of children with refractory mycoplasma pneumoniae pneumonia(RMPP).Methods Eighty-eight children with RMPP admitted to the department of pediatrics of our hospital from June,2015 to September,2019 were selected as the research objects,and were divided into group A and group B by the random number table method,with 44 cases in each group.Group A were treated with 2 mg∙kg-1∙d-1 methylprednisolone and azithromycin,and group B with 1 mg∙kg-1∙d-1 methylprednisolone and azithromycin.The temperature recovery times,lengths of hospital stay,occurrences of adverse reactions,and serum c-reactive protein(CRP)levels before and after the treatment were recorded and compared between the two groups.The clinical efficacies were evaluated.Results There were 24 boys and 20 girls in group A;they were(8.2±2.8)years old.There were 25 boys and 19 girls in group B;they were(8.5±2.9)years old.There were no statistical differences in the gender and age between these two groups(both P>0.05).The total effective rate was 88.6%(39/44),and was 84.1%(37/44)in group B,with no statistical difference(P>0.05).The temperature recovery time and the length of hospital stay were(7.2±2.0)d and(9.8±2.5)d in group A,and were(7.3±2.2)d and(10.1±2.7)d in group B,with no statistical differences(both P>0.05).The CRP levels in group A and group B were(68.2±18.7)mg/L and(67.9±17.9)mg/L before the treatment and were(14.2±6.4)mg/L and(15.1±7.2)mg/L after the treatment,with statistical differences between before and after the treatment in both groups(all P<0.05)but no between these two groups before and after the treatment(all P>0.05).During the treatment,the main adverse reactions that occurred in both groups were gastrointestinal reactions,euphoric feeling,facial flushing,positive fecal occult blood,etc.The incidence of adverse reactions in group B was significantly lower than that in group A[6.8%(3/44)vs.2

关 键 词：糖皮质激素 甲泼尼龙 阿奇霉素 难治性支原体肺炎 小儿 安全性 

分 类 号：R725.6[医药卫生—儿科]