多西环素在儿童重症耐大环内酯类肺炎支原体肺炎应用分析  

Application of doxycycline in severe macrolide-resistant mycoplasma pneumoniae pneumonia in children

作　　者：朱德胜 贺杰 肖政辉 周雄 黄娇甜 张新萍 Zhu Desheng;He Jie;Xiao Zhenghui;Zhou Xiong;Huang Jiaotian;Zhang Xinping(Pediatric Intensive Care Unit,the Affiliated Children's Hospital of Xiangya School of Medicine,Central South University,Hunan Children's Hospital,Changsha 410007,China)

机构地区：[1]中南大学湘雅医学院附属儿童医院(湖南省儿童医院)重症医学科,长沙410007

出　　处：《中国小儿急救医学》2025年第2期122-127,共6页Chinese Pediatric Emergency Medicine

基　　金：湖南省科技创新计划项目(2021SK50506)。

摘　　要：目的探讨多西环素治疗儿童重症耐大环内酯类肺炎支原体肺炎(MRMPP)的有效性和安全性。方法回顾性分析2020年1月至2023年11月湖南省儿童医院重症医学科收治的92例重症MRMPP患儿资料。根据抗肺炎支原体治疗策略分组, 全程使用多西环素者为多西环素组(12例), 全程使用阿奇霉素者为阿奇霉素组(53例), 由阿奇霉素更换为多西环素者为换药组(27例)。比较3组治疗转归和不良反应。结果 3组患儿的月龄(F=49.365, P<0.001)、体重(H=40.595, P<0.001)差异有统计学意义, 多西环素组平均月龄最大、中位体重最重, 换药组次之, 阿奇霉素组最低。抗MP治疗后, 多西环素组与换药组和阿奇霉素组相比, 患儿退热时长更短[3.0(2.0, 3.8)d比5.0(4.0, 5.0)d比6.0(5.0, 7.0)d, H=25.243, P<0.001], 48 h和72 h退热比例更高(48 h:41.7%比0比0, 72 h:75.0%比0比5.7%, 均P<0.001), 机械通气时长更短[83.0(70.0, 93.0)h比135.0(129.0, 172.0)h比152.0(139.0, 164.5)h, H=9.980, P=0.007], ICU住院时长更短[7.0(6.0, 8.0)d比10.0(8.0, 13.0)d比11.0(9.0, 13.0)d, H=21.887, P<0.001], 甲泼尼龙使用比例更低[8.3%比57.1%比54.7%, P=0.008]。使用多西环素、阿奇霉素的患儿均出现了胃肠道反应, 发生率分别为10.3%(4/39)、13.8%(11/80), 差异无统计学意义(P=0.771)。共67例(72.8%)患儿随访到有效资料, 其中多西环素组闭塞性细支气管炎发生率为8.3%(1/12), 换药组为13.6%(3/22), 阿奇霉素组为15.2%(5/33), 差异无统计学意义(P>0.05)。随访到的在病程中使用过多西环素治疗的34例患儿中, 无一例发生药物相关牙齿黄染、牙釉质发育不良。结论多西环素治疗儿童重症MRMPP可快速改善临床症状, 缩短病程, 降低甲泼尼龙使用几率, 短期使用较为安全。Objective To investigate the efficacy and safety of doxycycline in children with macrolide-resistant mycoplasma pneumoniae pneumonia(MRMPP).Methods A retrospective analysis was conducted on the data from 92 children with severe MRMPP admitted to the Intensive Care Unit of Hunan Children's Hospital from January 2020 to November 2023.Depending on antibiotic treatment strategies for mycoplasma pneumoniae,patients were divided into three groups:Doxycycline group(those treated with doxycycline,12 cases);Azithromycin group(those treated with azithromycin,53 cases);and Switch group(those switched from azithromycin to doxycycline,27 cases).Clinical outcomes and adverse reactions were compared among the three groups.Results Significant statistical differences were found among the three groups in terms of age(F=49.365,P<0.001)and weight(H=40.595,P<0.001),with the Doxycycline group presenting the highest average age and median weight,followed by the Switch group,and then the Azithromycin group.After antibiotic treatment,children in the Doxycycline group,when compared to the Switch group and the Azithromycin group,showed a shorter fever resolution time[3.0(2.0,3.8)days vs.5.0(4.0,5.0)days vs.6.0(5.0,7.0)days,H=25.243,P<0.001],a higher defervescence rate at 48 hours and 72 hours(41.7%vs.0 vs.0 at 48 hours,and 75.0%vs.0%vs.5.7%at 72 hours,both P<0.001),a shorter mechanical ventilation duration[83.0(70.0,93.0)hours vs.135.0(129.0,172.0)hours vs.152.0(139.0,164.5)hours,H=9.980,P=0.007],a shorter ICU stay[7.0(6.0,8.0)days vs.10.0(8.0,13.0)days vs.11.0(9.0,13.0)days,H=21.887,P<0.001],and a lower proportion of Methylprednisolone usage[8.3%vs.57.1%vs.54.7%,P=0.008].There was no significant statistical difference in extrapulmonary complications and co-pathogens(both P>0.05).Gastrointestinal reactions occurred in all children treated with doxycycline and azithromycin,with rates of 10.3%(4/39)and 13.8%(11/80),respectively,showing no statistical significance(P=0.771).Among the 67(72.8%)cases with available follow-up data,the incidence o

关 键 词：多西环素 儿童 重症耐药肺炎支原体肺炎 阿奇霉素 

分 类 号：R72[医药卫生—儿科]