目的 探讨小儿肺大叶实变性重症肺炎支原体肺炎(MPP)采用阿奇霉素联合不同剂量甲强龙治疗的临床效果。方法 采用随机数字表法将128例肺大叶实变性重症MPP患儿分为低剂量组(n=64)与高剂量组(n=64),在使用阿奇霉素治疗的同时,低剂量组患儿以常规剂量应用甲强龙,高剂量组患儿实施大剂量甲强龙治疗,对其临床治疗效果、免疫功能、炎性指标及不良反应分别进行比较。结果 与低剂量组比较,高剂量组患儿包括咳嗽、发热、喘息、咳痰等各类症状消失时间明显缩短,治疗有效率明显提高,呼吸系统后遗症发生率明显降低,高剂量组患儿的IL-2、IL-6、IL-13、TNF-α与IFN-γ等指标均明显好转(P<0.05);但两组患儿的IgA、IgM、IgG、C3与C4水平比较差异均无统计学意义(P>0.05)。结论 针对肺大叶实变性重症MPP患儿采用大剂量甲强龙联合阿奇霉素治疗不仅能够加快临床症状缓解与病情好转,并且可以有效抑制患儿炎症反应及远期后遗症,具有确切应用价值。
Abstract
OBJECTIVE To discuss the effect of different doses of methylprednisolone combined with azithromycin in the treatment of severe pulmonary lobar degeneration in children with MPP. METHODS One hundred and twenty-eight children with severe MPP of pulmonary lobar degeneration were randomly divided into the low dose group and the high dose group with 64 cases in each group. The children of two groups were given azithromycin. On this basis, the children of low dose group were given conventional doses of methylprednisolone, the children of high dose group were given high-dose methylprednisolone. The clinical efficacy, immune function, inflammatory indexes and adverse reaction were compared. METHODS Compared with the low dose group, the disappearance time of cough, expectoration, wheezing and fever in the observation group was significantly shorter, the effective rate of the high dose group was significantly higher,the incidence of respiratory sequelae was significantly higher, the IL-2, IL-6, IL-13, TNF-α, IFN-γ in the observation group were significantly better (P<0.05). But the IgA, IgM, IgG, C3 and C4 levels in the two groups were not statistically significant (P>0.05). CONCLUSION Large dose of methylprednisolone combined with azithromycin can relieve the clinical symptoms of severe MPP in children with lobar degeneration. It also can promote the rehabilitation of the disease, effectively inhibit the inflammatory response of children and long-term sequelae, has the exact application value.
关键词
小儿肺大叶实变性重症肺炎支原体肺炎 /
阿奇霉素 /
甲强龙 /
用药剂量
{{custom_keyword}} /
Key words
severe MPP of pulmonary lobar degeneration /
azithromycin /
methylprednisolone /
dosage
{{custom_keyword}} /
中图分类号：
R969.3
{{custom_clc.code}}
({{custom_clc.text}})
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] ZHAO L Y. Changes of immune function and inflammation factors of mycoplasma pneumoniae pneumonia infants in acute and recovery stage. Mater Child Health Care China(中国妇幼保健), 2014, 29(1):86-88.
[2] HE J E, GAO C Y, LI H R. Effect of low-dose methylprednisolone on serum TNF-α level in children with Mycoplasma pneumoniae pneumonia. Chin J Contemp Pediatr(中国当代儿科杂志), 2013, 15(10):850-853.
[3] WU A M, CHEN Q, LIU J M, et al. Application of glucocorticoid in children with refractory Mycoplasma pneumoniae pneumonia. J Appli Clini Pediatr(中华实用儿科临床杂志), 2014, 29(10):797-799.
[4] CHEN L L, LIU J R, ZHAO S Y, et al. Clinical features and treatment of refractory Mycoplasma pneumoniae pneumonia unresponded to conventional dose methylprednisolone in children. Chin J Pediatr(中华儿科杂志), 2014, 28(3):172-176.
[5] CHEN J H, YIN G Q, YU J L, et al. Clinical effect of erythromycin and azithromycin in the treatment of pediatric Mycoplasma pneumonia. Chin J Clin Pharmacol(中国临床药理学杂志), 2015,31(8):587-589.
[6] YANG X Q, YI Z W. Pediatrics(儿科学). 6th ED. Beijing:People's Health Publishing House,2003:41-51.
[7] SARAYA T, WATANABE T, TSUKAHARA Y, et al. The correlation between chest X-ray scores and the clinical findings in children and adults with Mycoplasma pneumoniae pneumonia. Int Med, 2017, 37(25):141-146.
[8] ZHANG L J, AN S H, LI J Y, et al. Risk factors of airway mucous plug caused by Mycoplasma pneumoniae pneumonia in children. J Clini Pediatr(临床儿科杂志), 2015, 33(5):432-436.
[9] LI W M, LU Y L, CHEN M Y, et al. Meta analysis of antibiotic utilization rate in children with upper respiratory tract infection before and after the new health care reform. Chin Pharm J(中国药学杂志), 2017, 52(10):880-885.
[10] HE L, WANG S, FU Z M, et al. Multiple risk factor analysis of recurrent respiratory tract infection after Mycoplasma pneumoniae pneumonia in children. J Clin Pediatr(临床儿科杂志), 2015, 33(2):117-120.
[11] GAO H, LUO Z X, LUO J, et al. Clincal risk factors for children with mycoplasma pneumoniae pneumonia sequelae. J Chongqing Med Univ(重庆医科大学学报), 2013, 38(2):165-167.
[12] HE J E, GAO C Y, LI H R. Effect of low-dose methylprednisolone on serum TNF-α level in children with Mycoplasma pneumoniae pneumonia. Chin J Contemp Pediatr(中国当代儿科杂志), 2013, 15(10):850-853.
[13] YANG A J, XI K, YAO Y Q, et al. Effect of qingfei mixture on pediatric mycoplasma pneumoniae pneumonia with phlegm heat obstructing Fei (Lung) syndrome. Chin J Integr Med(中国结核医学杂志), 2017, 23(9):681-688.
[14] ZHU W W. Analysis of effect of small-dose methylprednisolone on the curative effect and immune function of children with Mycoplasma pneumonia. Chin Forei Med Treat(临床肺科杂志), 2015, 36(11):2037-2040.
[15] XU H. Clinical study of methylprednisolone pulse therapy in treatment of refractory Mycoplasma pneumonia in children. Chin J Contr Endem Dis(中国地方病防治杂志), 2014, 29(s2):242.
{{custom_fnGroup.title_cn}}
脚注
{{custom_fn.content}}
PDF(1143 KB)
