地塞米松对支原体肺炎肺外并发症患儿免疫指标的影响

Influence of Dexamethasone on Immune Indexes of Mycoplasma Pneumonia Children with Extrapulmonary Complications

目的:探讨支原体肺炎肺外并发症患儿早期应用地塞米松治疗前后部分体液及细胞免疫指标的变化及临床恢复情况,并分析相关作用机理。方法:将40例支原体肺炎并肺外并发症患儿随机分为地塞米松组和非地塞米松组,两组均用包括阿奇霉素等基础治疗方案,其中地塞米松组早期应用小剂量地塞米松(0.2～0.3mg.kg-1.d-1),逐渐减量治疗5 d,设立对照组20例。测定相关血清免疫学指标并进行比较,评价疗效。结果:治疗前两组患儿外周血IgG、IgM、IgA、CD8+T细胞均高于对照组(P<0.05),CD4+T细胞、CD4+T细胞/CD8+T细胞值低于对照组(P<0.05);治疗后地塞米松组IgG、IgM、IgA与治疗前差异无统计学意义(P>0.05),CD4+T细胞、CD4+T细胞/CD8+T细胞值较治疗前升高(P<0.05),CD8+T细胞较治疗前降低(P<0.05);非地塞米松组IgG、IgM、IgA、CD8+T细胞均较治疗前升高(P<0.05),CD4+T细胞、CD4+T细胞/CD8+T细胞值较治疗前降低(P<0.05);地塞米松组的发热时间、肺部罗音消失时间及肺外症状消失时间均较非地塞米松组短(P<0.05)。结论:支原体肺炎并肺外并发症患儿的体液及细胞免疫均存在紊乱,小剂量地塞米松早期干预可对患儿的免疫功能起到调节作用,并加快病情的恢复。

Objective： To explore the changes of humoral and cellular immune indexes in mycoplasma pneumonia children with extrapulmonary complications after treatment of dexamethasone at early stage,and to observe clinical recovery condition and to analyze relevant mechanism.Methods： Based on clinical features and related laboratory examination,forty mycoplasma pneumonia children with extrapulmonary complications were selected and divided into two groups： dexamethasone group（group D） and non-dexamethasone group（group N）,and twenty children were chosen as healthy control.All of the forty children accepted fundamental treatment including azithromycin.Besides,group D was given small dose of dexamethasone（0.2~0.3 mg·kg-1·d-1） and gradually reducing dose in 5 days.The changes of serum levels of immunoglobulin G（IgG）,IgM,IgA and T lymphocyte subsets CD4＋T cell,CD8＋ T cell and ratio of CD4＋ T cell to CD8＋ T cell were compared between group D and group E before and after treatment.Clinical recovery conditions of the two groups were also compared.Results： Before therapy,IgG,IgM,IgA and CD8＋ T cell levels in the two groups were higher than those in control group（P0.05）.CD4＋ T cell,ratio of CD4＋ T cell to CD8＋ T cell were lower than those in control group（P0.05）.No statistical difference was found in IgG,IgM and IgA levels in group D before and after therapy（P0.05）,however,after treatment,CD4＋ T cell,ratio of CD4＋ T cell to CD8＋ T cell increased significantly（P0.05）,CD8＋ T cell decreased significantly（P0.05）.In group N,IgG,IgM,IgA and CD8＋ T cell levels increased（P0.05）after therapy,CD4＋T cell,ratio of CD4＋ T cell to CD8＋ T cell decreased（P0.05）.Fever time,disappearing time of lung rale and recovery time of extra-pulmonary complications of group D obviously shortened compared with those of group N（P0.05）.Conclusions： Humoral and cellular immunity disorders occur in mycoplasma pneumonia children with extra-pulmonary complications,using small dose of dexamethasone at early stage can regulate immune function and promote the recovery from illness obviously.