小剂量长疗程阿奇霉素联合吸入用糖皮质激素对小儿慢性细支气管炎的疗效  

Curative effect of low-dose and long-course Azithromycin combined with inhaled corticosteroid on pediatric chronic bronchiolitis

作　　者：马群英[1] 李雪梅[1] 黎明真 张欢 李红霞 Ma Qunying;Li Xuemei;Li Mingzhen;Zhang Huan;Li Hongxia(Department of Pediatrics,Zigong First People's Hospital,Sichuan,Zigong 643000,China)

机构地区：[1]自贡市第一人民医院儿科,四川自贡643000

出　　处：《发育医学电子杂志》2024年第5期350-355,共6页Journal of Developmental Medicine (Electronic Version)

摘　　要：目的探讨小剂量长疗程阿奇霉素联合吸入用糖皮质激素(inhaled corticosteroid,ICS)对小儿慢性细支气管炎的疗效。方法前瞻性选取2021年1月至2022年10月自贡市第一人民医院收治的120例慢性细支气管炎患儿进行研究,采用随机数字表法将其分为对照组(n=60)和观察组(n=60)。对照组患儿在常规对症治疗基础上使用小剂量长疗程阿奇霉素,观察组患儿在对照组基础上联合ICS治疗。比较2组患儿治疗前后的治疗效果、临床症状改善时间、血清免疫功能指标、血清炎性指标及不良反应发生情况。治疗后随访6个月,比较2组患儿急性发作情况。统计学方法采用独立样本t检验、配对样本t检验和χ^(2)检验。结果观察组患儿总有效率高于对照组,差异有统计学意义[93.3%(56/60)与80.0%(48/60),χ^(2)=4.615,P=0.032]。观察组与对照组患儿的喘息缓解时间、湿啰音缓解时间、咳嗽缓解时间分别为(4.6±1.2)d、(7.3±1.9)d、(6.2±1.5)d与(5.2±1.5)d、(8.7±2.1)d、(6.9±1.6)d,观察组均短于对照组(t值分别为2.419、3.826、2.472,P值均<0.05)。观察组与对照组患儿治疗后CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)分别为(39.6±4.3)%、(22.4±3.5)%、1.7±0.4与(32.3±3.5)%、(27.6±4.5)%、1.2±0.4,观察组CD4^(+)和CD4^(+)/CD8^(+)均高于对照组(t值分别为10.199、6.847,P值均<0.001),观察组CD8^(+)低于对照组(t=7.065,P<0.001)。观察组与对照组患儿治疗后粒细胞-巨噬细胞集落刺激因子(granulocytemacrophage colony stimulating factor,GM-CSF)、可溶性白细胞介素-2受体(soluble interleukin-2 receptor,SIL-2R)、血清白细胞介素-6(interleukin-6,IL-6)分别为(731.6±224.6)mg/L、(239.1±58.5)mg/L、(39.6±4.0)ng/L与(962.5±262.5)mg/L、(287.3±62.4)mg/L、(44.6±4.3)ng/L,观察组均低于对照组(t值分别为5.177、4.365、6.595,P值均<0.001)。观察组患儿恶心呕吐、小腹疼痛、轻微皮疹发生率与对照组比较,差异均无统计学意义(P值均>0.05)�Objective To explore the curative effect of low-dose and long-course Azithromycin combined with inhaled glucocorticoid(ICS)on pediatric chronic bronchiolitis.Method A total of 120 children with chronic bronchiolitis admitted to Zigong First People's Hospital were prospectively selected from January 2021 to October 2022.According to random number table method,they were divided into control group(n=60)and observation group(n=60).Children in control group were given routine symptomatic treatment and low-dose and long-course Azithromycin,while children in observation group were treated with ICS on basis of control group.The curative effect,improvement time of clinical symptoms,serum immune function indicators,serum inflammatory indicators and occurrence of adverse reactions in the two groups were compared before and after treatment.All patients were followed up for 6 months after treatment to compare acute onset.Statistical methods performed by the independent sample t-test,paired sample t-test andχ^(2) test.Result The total effective rate of observation group was higher than that of control group[93.3%(56/60)vs 80.0%(48/60),χ^(2)=4.615,P=0.032].The remission time of wheezing,wet rale and cough in observation group and control group were(4.6±1.2)d,(7.3±1.9)d,(6.2±1.5)d and(5.2±1.5)d,(8.7±2.1)d,(6.9±1.6)d,and remission time of these symptoms in observation group were shorter than those in control group(t=2.419,3.826,2.472,all P<0.05).After treatment,CD4^(+),+CD8^(+) and CD4^(+)/CD8^(+)in observation group and control group were(39.6±4.3)%,(22.4±3.5)%,1.7±0.4 and(32.3±3.5)%,(27.6±4.5)%,1.2±0.4,respectively.CD4^(+) and CD4^(+)/CD8^(+)in observation group were higher than those in control group(t=10.199,+6.847,all P<0.001),while CD8 was lower than that in control group(t=7.065,P<0.001).After treatment,granulocyte-macrophage colony stimulating factor(GM-CSF),soluble interleukin-2 receptor(SIL-2R)and serum interleukin-6(IL-6)in observation group and control group were(731.6±224.6)mg/L,(239.1±58.5)mg/L,(39.6

关 键 词：阿奇霉素 吸入用糖皮质激素 小儿慢性细支气管炎 临床改善 免疫功能 

分 类 号：R725.6[医药卫生—儿科]