甲泼尼龙联合阿奇霉素序贯治疗小儿难治性肺炎支原体肺炎的疗效分析  

Efficacy of sequential treatment with methylprednisolone combined with azithromycin on paediatric refractory mycoplasma pneumoniae pneumonia

作　　者：杨向灵 徐午丹 明闪 张利明 Yang Xiangling;Xu Wudan;Ming Shan;Zhang Liming(Department of Pediatrics,Zhengzhou Ninth People's Hospital,Zhengzhou 450000,China)

机构地区：[1]郑州市第九人民医院儿科,郑州450000

出　　处：《国际医药卫生导报》2024年第14期2399-2403,共5页International Medicine and Health Guidance News

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20190971)。

摘　　要：目的探讨甲泼尼龙联合阿奇霉素序贯治疗对小儿难治性肺炎支原体肺炎(RMPP)的疗效及对血清几丁质酶样蛋白(YKL-40)、淀粉样蛋白A(SAA)、肺表面活性物质相关蛋白-A(SP-A)的影响。方法本研究采用病例对照研究。选取2022年6月至2023年6月期间郑州市第九人民医院收治的126例RMPP患儿,使用随机数字表法分为对照组和观察组,每组63例。观察组中男性33例,女性30例,年龄4~11(8.34±3.61)岁,发病至入院时间8~49(34.59±10.13)h;对照组男性36例,女性27例,年龄5~10(8.06±3.34)岁,发病至入院时间11~50(34.26±10.24)h。对照组患儿给予门冬氨酸阿奇霉素静脉滴注,剂量为10 mg/kg,1次/d;治疗3 d后改为阿奇霉素片10 mg/kg口服治疗,1次/d,7 d为1个疗程。观察组在对照组基础上联合甲泼尼龙琥珀酸钠静脉滴注治疗,初始剂量为2 mg/kg,1次/d,连续使用5 d后将剂量调整至1 mg/kg,继续治疗2 d,7 d为1个疗程。两组均连续治疗2个疗程。比较两组治疗效果、治疗前后血清因子水平和肺功能指标差异,分析安全性。采用t检验、χ^(2)检验。结果观察组治疗总有效率高于对照组[95.24%(60/63)比79.37%(50/63)],差异有统计学意义(χ^(2)=7.159,P=0.008)。观察组的咳嗽痰鸣、干湿性啰音、憋喘消失时间及住院时间分别为(3.24±0.78)d、(3.47±0.71)d、(5.06±1.37)d、(3.47±0.83)d,均短于对照组的(6.04±1.31)d、(5.87±1.52)d、(7.58±1.21)d、(6.11±1.12)d,差异均有统计学意义(t=14.577、11.355、10.943、15.032,均P<0.001)。治疗后,观察组的用力肺活量(FVC)、第1秒用力呼气容积(FEV1)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、高敏C反应蛋白(hs-CRP)、SAA、YKL-40、SP-A水平分别为(2.96±0.54)L、(2.56±0.42)L、(63.47±2.11)ng/L、(1.34±0.18)ng/L、(7.02±1.13)mg/L、(26.34±6.61)mg/L、(30.64±5.41)μg/L、(36.07±6.58)μg/L,对照组分别为(2.02±0.51)L、(1.53±0.31)L、(123.36±2.14)ng/L、(2.69±0.22)ng/L、(9.63±1.51)mg/L、Objective To investigate the efficacy of methylprednisolone combined with azithromycin sequential therapy on pediatric refractory mycoplasma pneumoniae pneumonia(RMPP)and the effects on serum chitinase-like protein(YKL-40),amyloid A(SAA),and lung surface-active substance-associated protein-A(SP-A).Methods A total of 126 children with RMPP recruited by Zhengzhou Ninth People's Hospital during June 2022 and June 2023 were included in the study,and were divided into a control group(azithromycin)and an observation group(methylprednisolone+azithromycin)by the random number table method,with 63 cases in each group.In the observation group,there were 33 boys and 30 girls,aged 4 to 11(8.34±3.61)years,and the time from onset to admission was 8 to 49(34.59±10.13)h.In the control group,there were 36 boys and 27 girls,aged 5 to 10(8.06±3.34)years,and the time from onset to admission was 11 to 50(34.26±10.24)h.The control group was given intravenous drip with azithromycin aspartate at a dose of 10 mg/kg once a day;after 3 days of treatment,it was changed to oral azithromycin,at a dose of 10 mg/kg,once a day,with 7 days as a course of treatment.The observation group was given methylprednisolone sodium succinate intravenous drip on the basis of the control group,the initial dose was 2 mg/kg,once a day,and the dose was adjusted to 1 mg/kg after 5 days of continuous treatment,and continued for 2 days,with 7 days as a course of treatment.Both groups were treated for 2 consecutive courses.The two groups were compared in terms of therapeutic effects,differences in serum factor levels and lung function indexes before and after treatment,and the safety was analyzed.t test andχ^(2) test were used.Results The total effective rate of the observation group was higher than that of the control group[95.24%(60/63)vs.79.37%(50/63)],with a statistically significant difference(χ^(2)=7.159,P=0.008).In the observation group,the disappearance time of cough and sputum sound,dry and wet rales,and wheezing and hospital stay were(3.24±0.78)d,(3

关 键 词：甲泼尼龙 阿奇霉素 难治性肺炎支原体肺炎 临床疗效 儿童 

分 类 号：R725.6[医药卫生—儿科]