复可托辅助阿奇霉素对支原体肺炎患儿疗效和预后研究  

Study on therapeutic effect and prognosis of spleen aminopeptide combined with azithromycin in children with mycoplasma pneumoniae infection

作　　者：魏海燕 鲍士莉 王香敏 WEI Hai-yan;BAO Shi-li;WANG Xiang-min(Department of Pediatrics,the First Affiliated Hospital of Anhui University of Science and Technology,Huainan First People’s Hospital,Huainan 232000,China)

机构地区：[1]安徽理工大学第一附属医院淮南市第一人民医院儿科,安徽淮南232000

出　　处：《中国药物应用与监测》2023年第5期339-343,共5页Chinese Journal of Drug Application and Monitoring

基　　金：合肥市卫生健康应用医学研究(Hwk2021zd016)。

摘　　要：目的:研究复可托辅助阿奇霉素用药对肺炎支原体(MP)感染患儿疗效和预后不良的危险因素。方法:以2020年2月至2023年1月我院收治MP感染患儿119例为对象,按照随机数字法分成对照组(59例,予以阿奇霉素治疗)和观察组(60例,加用复可托治疗),治疗7 d后,对比两组疗效、临床症状指标、炎性指标、Th17/Treg水平,并分析预后不良的危险因素。结果:对照组患儿总有效率[66.10%(39/59)]较观察组[85.00%(49/60)]低,差异有统计学意义(P=0.016);观察组患儿的发热消失、咳嗽消失、肺部啰音消失以及住院的具体时长[分别为(4.62±0.77)d,(6.83±1.44)d,(4.25±0.77)d和(7.63±1.34)d]较对照组[分别为(5.42±1.62)d,(10.71±2.11)d,(5.44±0.98)d和(12.30±1.72)d]短,均差异有统计学意义(均P<0.01);两组患儿经过治疗后的TNF-α、IL^(-1)β和IL-6下降明显,观察组TNF-α、IL^(-1)β和IL-6水平[分别为(18.27±3.72)ng·L^(-1),(42.27±3.31)ng·L^(-1),(39.89±5.37)ng·L^(-1)]低于对照组[分别为(20.75±3.73)ng·L^(-1),(52.17±3.27)ng·L^(-1),(42.39±5.79)ng·L^(-1)],均差异有统计学意义(均P<0.01);两组Th17/Treg浓度水平明显下降,观察组Th17/Treg水平(0.22±0.03)较对照组(0.52±0.05)更低;不良预后患儿与预后良好预后患儿在严重程度、年龄、病程、免疫抑制剂、哮喘史以及幽门螺旋抗体等指标存在差异(均P<0.05);多因素分析发现严重程度较高、年龄较小、病程较长、免疫抑制剂使用史、哮喘史以及幽门螺旋抗体是不良预后的危险因素。结论:复可托辅助阿奇霉素治疗MP感染疗效更好,患儿的Th17/Treg水平显著下调,针对存在不良预后风险的患儿,及时对治疗方案进行调整。Objective:To study the effect of spleen aminopeptide combined with azithromycin on the efficacy and risk factors of poor prognosis in children with MP infection.Methods:In this study,119 patients with MP pneumonia treated in our hospital from February 2020 to January 2023 were taken as the research objects.According to random number table method,the above children were randomly divided into observation group(n=60,treated with azithromycin combined with spleen aminopeptide)and control groupp(n=59,treated with azithromycin).Both groups were treated for 7 days.The differences of treatment effect,clinical symptom index,inflammatory index and Th17/Treg level between the two groups were compared,and the risk factors of poor prognosis was nanlyzed.Results:The total effective rate of the control group(66.10%(39/59))was lower than that of observation group(85.00%(49/60)),(P=0.016).The disappearance time of fever,cough,lung rale and hospital stay in the observation group((5.42±1.62)d,(10.71±2.11)d,(5.44±0.98)d and(12.30±1.72)d,respectively)were lower than those of control group((5.42±1.62)d,(10.71±2.11)d,(5.44±0.98)d and(12.30±1.72)d,respectively),and the difference were statistically significant(all P<0.01).After treatment,TNF-α,IL-β and IL-6 decreased significantly in both groups.IL^(-1),TNF-αand IL-6 in the observation group((18.27±3.72)ng·L^(-1),(42.27±3.31)ng·L^(-1),(39.89±5.37)ng·L^(-1))were lower than those of control group((20.75±3.73)ng·L^(-1),(52.17±3.27)ng·L^(-1),(42.39±5.79)ng·L^(-1)),and the difference were statistically significant(all P<0.01).The level of Th17/Treg in the two groups decreased obviously,and the level of Th17/Treg in the observation group(0.22±0.03)was obviously lower than that of the control group(0.52±0.05).There were significant differences in severity,age,course of disease,immunosuppressive agents,history of asthma and Helicobacter pylori(HP)antibody between children with poor prognosis and those with good prognosis(all P<0.05).Through multivariate analysis,higher

关 键 词：支原体肺炎 预后 复可托 阿奇霉素 TH17/TREG 

分 类 号：R725.6[医药卫生—儿科]