阿奇霉素联合甲泼尼龙治疗儿童重症肺炎支原体肺炎疗效观察  

Effect of azithromycin combined with methylprednisolone in the treatment of severe Mycoplasma pneumoniae pneumonia in children

作　　者：李天超[1] 展效文 徐亚利 王志远 LI Tianchao;ZHAN Xiaowen;XU Yali;WANG Zhiyuan(Department of Pediatrics,the Third Affiliated Hospital of Xinxiang Medical University,Xinxiang 453003,Henan Province,China;Department of Pediatrics,the First Affiliated Hospital of Xinxiang Medical University,Weihui 453100,Henan Province,China)

机构地区：[1]新乡医学院第三附属医院儿科,河南新乡453003 [2]新乡医学院第一附属医院儿科,河南卫辉453100

出　　处：《新乡医学院学报》2023年第6期543-547,共5页Journal of Xinxiang Medical University

摘　　要：目的 探讨阿奇霉素联合甲泼尼龙对重症肺炎支原体肺炎患儿的治疗效果及机制。方法 选择2020年9月至2021年10月新乡医学院第三附属医院儿科收治的148例重症肺炎支原体肺炎患儿为研究对象,按治疗方法分为观察组(n=88)和对照组(n=60)。对照组患儿静脉滴注阿奇霉素10 mg·kg^(-1)·d^(-1),连用7 d为1个疗程,停药4 d后重复第2个疗程,共治疗2个疗程;观察组患儿在对照组治疗基础上静脉滴注甲泼尼龙1~2 mg·kg^(-1)·d^(-1),共治疗5 d。比较2组患儿咳嗽消失时间、退热时间、住院时间;于治疗2周后,2组患儿复查胸部CT片,计算CT影像学好转率;分别于治疗前及治疗7、14 d时,应用流式细胞术检测2组患儿外周血中CD3^(+)、CD3^(+) CD4^(+)、CD3^(+) CD8^(+)T淋巴细胞亚群百分比,应用酶联免疫吸附试验检测2组患儿血清中白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、干扰素-γ(IFN-γ)水平。结果 观察组患儿咳嗽消失时间、退热时间均显著早于对照组,住院时间显著短于对照组,CT影像学好转率显著高于对照组(P<0.05)。治疗7、14 d时,2组患儿CD3^(+)、CD3^(+) CD4^(+)T淋巴细胞百分比显著高于治疗前,CD3^(+) CD8^(+)T淋巴细胞百分比显著低于治疗前(P<0.05);治疗14 d时,2组患儿CD3^(+)、CD3^(+) CD4^(+)T淋巴细胞百分比显著高于治疗7 d时,CD3^(+) CD8^(+)T淋巴细胞水平百分比显著低于治疗7 d时(P<0.05)。治疗前,对照组与观察组患儿CD3^(+)、CD3^(+) CD4^(+)、CD3^(+) CD8^(+)T淋巴细胞百分比比较差异均无统计学意义(P>0.05);治疗7、14 d时,观察组患儿CD3^(+)、CD3^(+) CD4^(+)、CD3^(+) CD8^(+)的T淋巴细胞百分比显著高于对照组(P<0.05)。治疗7、14 d时,2组患儿血清IL-6、TNF-α、IFN-γ水平显著低于治疗前(P<0.05);治疗14 d时,2组患儿血清IL-6、TNF-α、IFN-γ水平显著低于治疗7 d(P<0.05)。治疗前,对照组与观察组患儿血清IL-6、TNF-α、IFN-γ水平比较差异均无统计学�Objective To investigate the effect and mechanism of azithromycin combined with methylprednisolone in the treatment of severe Mycoplasma pneumoniae pneumonia in children.Methods A total of 148 children with severe Mycoplasma pneumoniae pneumonia admitted to Department of Pediatrics,the Third Affiliated Hospital of Xinxiang Medical University from September 2020 to October 2021 were selected as the research subjects.According to treatment methods,the patients were divided into observation group(n=88)and control group(n=60).The children in the control group were given azithromycin 10 mg·kg^(-1)·d^(-1) intravenously,7 days as a course of treatment,and the second course of treatment was repeated after 4 days,a total of 2 courses of treatment;on the basis of the treatment in the control group,the children in the observation group were treated with methylprednisolone 1-2 mg·kg^(-1)·d^(-1) intravenously for 5 days.The time of cough disappearance,time of fever being brought down and hospitalization stay of children were compared between the two groups;after 2 weeks of treatment,chest CT of children in the two groups was reexamined,and the improvement rate of CT image was calculated;the percentages of CD3^(+),CD3^(+)CD4^(+),CD3^(+)CD8^(+)T lymphocyte subsets in peripheral blood of children in the two groups were detected by flow cytometry before treatment and at 7,14 days of treatment,respectively;the levels of serum interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)and interferon-γ(IFN-γ)of children in the two groups were detected by enzyme-linked immunosorbent assay.Results The time of cough disappearance and the time of fever being brought down of children in the observation group were significantly earlier than those in the control group,the hospitalization stay was significantly shorter than that in the control group,and the improvement rate of CT image was significantly higher than that in the control group(P<0.05).At 7,14 days of treatment,the percentages of CD3^(+)and CD3^(+)CD4^(+)T lymphocytes in the two

关 键 词：肺炎支原体肺炎 阿奇霉素 甲泼尼龙 炎症因子 

分 类 号：R725.6[医药卫生—儿科]