泼尼松联合阿奇霉素序贯疗法治疗儿童重症肺炎支原体肺炎的疗效及对血清TLR4/MyD88/NF-κB信号通路相关蛋白和下游炎性因子水平的影响  

Efficacy of prednisone combined with azithromycin sequential therapy in treatment of severe Mycoplasma pneumoniae pneumonia in children and its effects on serum TLR4/MyD88/NF-κB signaling pathway related proteins and downstream inflammatory factors

作　　者：严慧[1] 王兰英[1] 吴小磊[1] 洪源[1] 彭建霞[1] YAN Hui;WANG Lan-ying;WU Xiao-lei(Department of Pediatric Internal Medicine Emergency,Tangshan Maternal and Child Health Hospital,Hebei 063003,China)

机构地区：[1]唐山市妇幼保健院儿内急诊科,河北063003

出　　处：《中国临床新医学》2023年第5期474-478,共5页CHINESE JOURNAL OF NEW CLINICAL MEDICINE

基　　金：河北省科技计划项目(编号:182777155)。

摘　　要：目的探讨泼尼松联合阿奇霉素序贯疗法治疗儿童重症肺炎支原体肺炎的疗效及对血清Toll样受体4(TLR4)/髓样分化因子88(MyD88)/核因子κB(NF-κB)信号通路相关蛋白和下游炎性因子水平的影响。方法招募2019年1月至2022年6月唐山市妇幼保健院收治的儿童重症肺炎支原体肺炎患者120例,采用随机数字表法将其分为对照组(采用阿奇霉素治疗,60例)和观察组(采用泼尼松联合阿奇霉素治疗,60例)。治疗4周后,比较两组治疗效果、临床肺部感染量表(CIPS)评分、TLR4/MyD88/NF-κB信号通路相关蛋白以及下游炎性因子的水平。结果观察组患者的体温恢复时间、咳嗽缓解时间、咳痰缓解时间、喘息缓解时间、肺部啰音消失时间较对照组更快,住院时间更短,差异有统计学意义(P<0.05)。治疗后,两组的体温、白细胞计数、气道分泌物、氧合情况、胸部X射线、痰培养等CIPS项目评分以及总分均较治疗前降低,且观察组评分较对照组更低,差异有统计学意义(P<0.05)。治疗后,两组TLR4、MyD88、NF-κB、C-反应蛋白(CRP)、白细胞介素-6(IL-6)、降钙素原(PCT)水平均降低,且观察组水平较对照组更低,差异有统计学意义(P<0.05)。结论泼尼松联合阿奇霉素序贯疗法对人体血清TLR4/MyD88/NF-κB信号通路相关蛋白及下游炎性因子水平有显著下调作用,可提高儿童重症肺炎支原体肺炎患者的临床疗效。Objective To investigate the efficacy of prednisone combined with azithromycin sequential therapy in treatment of severe Mycoplasma pneumoniae pneumonia in children and its effects on serum Toll-like receptor 4(TLR4)/myeloid differentiation factor 88(MyD88)/nuclear factor kappa-B(NF-κB)signaling pathway related proteins and downstream inflammatory factors.Methods One hundred and twenty children with severe Mycoplasma pneumoniae pneumonia who were admitted to Tangshan Maternal and Child Health Hospital from January 2019 to June 2022 were recruited and divided into the control group(treated with azithromycin,60 cases)and the observation group(treated with prednisone combined with azithromycin,60 cases)by random number table method.After 4 weeks of treatment,the therapeutic effects,Clinical Pulmonary Infection Scale(CIPS)scores,levels of TLR4/MyD88/NF-κB signaling pathway related proteins and downstream inflammatory factors were compared between the two groups.Results The temperature recovery time,cough relief time,sputum relief time,wheezing relief time and lung rales disappearance time of the patients in the observation group was faster than that in the control group,and the length of hospital stay in the observation group was shorter,with statistically significant differences between the two groups(P<0.05).After treatment,the scores of CIPS items such as body temperature,white blood cell count,airway secretions,oxygenation,chest X-ray and sputum culture,and total scores in both groups were decreased compared with those before treatment,and the scores in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).After treatment,the levels of TLR4,MyD88,NF-κB,C-reactive protein(CRP),interleukin-6(IL-6)and procalcitonin(PCT)in the two groups were decreased compared with those before treatment,and the above levels in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).Conclusion

关 键 词：儿童重症肺炎支原体肺炎 泼尼松 阿奇霉素 Toll样受体4/髓样分化因子88/核因子κB信号通路 炎性因子 

分 类 号：R725.6[医药卫生—儿科]