小剂量甲泼尼龙对肺炎支原体肺炎患儿血清肿瘤坏死因子α水平的影响

Effect of low-dose methylprednisolone on serum TNF-α level in children with Mycoplasma pneumoniae pneumonia

目的观察小剂量甲泼尼龙对肺炎支原体肺炎(MPP)患儿血清肿瘤坏死因子α(TNF-α)水平的影响。方法选取2012年1月至2012年12月患MPP且住院前均未使用糖皮质激素的38例患儿作为研究对象。采用病例对照研究法随机选取20例为甲泼尼龙干预组(在常规治疗基础上每日静脉滴注甲泼尼龙1 mg/kg,共3 d),余18例为常规治疗组,分别于治疗前,以及治疗后第4天和第7天留取血清样本;随机选取25例同期于保健门诊行健康体检儿童作为正常对照组,体检当天采集血清样本。采用ELISA法检测3组儿童血清TNF-α水平。结果甲泼尼龙干预组和常规治疗组患儿入院时血清TNF-α水平均明显高于正常对照组(均P<0.01),但两组之间差异无统计学意义;治疗后第4天和第7天时,甲泼尼龙干预组TNF-α水平均明显低于常规治疗组(分别P<0.05,P<0.01);第7天时,甲泼尼龙干预组TNF-α水平与正常对照组差异无统计学意义,而常规治疗组仍明显高于正常对照组(P<0.01)。结论小剂量甲泼尼龙可以显著降低MPP患儿血清TNF-α水平,抑制炎症反应,可能减轻炎症反应对机体的损害。

Objective To investigate the effect of low-dose methylprednisolone on serum tumor necrosis factor alpha （TNF-α） level in children with Mycoplasma pneumoniae pneumonia （MPP）. Methods A case-control study was conducted among 38 children with MPP who received treatment in the Affiliated Hospital of Yan＇an University between January and December 2012, and who had not received glucocorticoids before hospitalization. They were randomly divided into methylprednisolone treatment （n=20） and conventional treatment groups （n=18）. The methylprednisolone treatment group was administered with methylprednisolone （1 mg/kg·d） by intravenous drip for three days in addition to conventional treatment. Serum samples were collected from both groups before treatment and on days 4 and 7 of treatment. Twenty-five children who underwent physical examination in the healthcare clinic during the same period were randomly selected as a normal control group, and serum samples were collected on the same day that the physical examination was performed. Serum TNF-α levels in the three groups were measured using enzyme-linked immunosorbent assay. Results On admission, the methylprednisolone treatment and conventional treatment groups had significantly higher serum TNF-α levels than the normal control group （P〈0.01）, but there was no significant difference between the methylprednisolone treatment and conventional treatment groups. On days 4 and 7 of treatment, the methylprednisolone treatment group had significantly lower serum TNF-ct levels than the conventional treatment group （P〈0.05; P〈0.01）. On day 7 of treatment, there was no significant difference in serum TNF-α level between the methylprednisolone treatment and normal control groups, but the conventional treatment group still had a significantly higher serum TNF-α level than the normal control group （P〈0.01）. Conclusions Low-dose methylprednisolone can significantly decrease serum TNF-α level and inhibit inflammatory response in children with MPP, and may reduce damage caused by inflammatory response.