肾上腺皮质激素与大环内酯类抗生素联合治疗难治性支原体肺炎临床疗效和安全性观察

Refractory mycoplasma pneumonia clinical efficacy and safety of adrenocorticotropic hormone combination therapy with macrolide antibiotics

目的探讨肾上腺皮质激素与大环内酯类抗生素对难治性肺炎支原体肺炎（mycoplasma pneumoniae pneumonia,MPP）治疗疗效。方法回顾分析2013年2月～2015年12月在我院治疗的36例重症患者临床特征、实验室检查指标、X线胸片特征及诊治过程,并根据其是否应用肾上腺皮质激素分为激素治疗组和未用激素治疗组,比较两组的热退时间、住院时间及治愈率。结果 36例均有咳嗽及发热,且均为高热,均存在血清MP-Ig M阳性（Ig M〉1∶80）,激素治疗组18例痊愈14例,显效2例,有效1例,无效1例,总有效率达94.4%。非激素治疗组18例显效10例,有效5例,无效3例,总有效率83.3%。治愈有效率显著高于非激素组,统计学上有显著差异。激素组发热时间（4.58±1.34）d显著短于非激素组（8.36±1.53）d;平均住院日两组分别为（10.5±1.8）与（15.1±1.9）d,差异有统计学意义。结论确诊重症肺炎支原体肺炎诊断的患者,除应用大环内酯类抗生素外,及时应用肾上腺皮质激素可显著改善患儿症状,有效地减少或避免肺内、肺外并发症的发生,提高治愈率,避免发生严重并发症。

Objective： Discussion about the treatment efficacy between macrolide antibiotics and adrenal cortical hormone of refractory mycoplasma pneumoniae pneumonia（ MMP）. Methods： Retrospective analysis about 36 patients＇ severe clinical features,laboratory parameters,x- ray characteristics and treatment process from February 2013 to February2015 in our hospital. They were divided into two groups according to whether they use adrenal cortical hormone therapy（ Hormone treatment group） or not（ Non- hormone treatment group）. They were compared with fever relieving time,hospitalization time and cure rate. Results ： Samples were 36 cases had cough and fever,which were ardent fever and positive for the presence of serum MP- ig M（ ig M 〉1∶ 80）. Hormone treatment group included 18 cases： 14 cases were cured,2cases got markedly better,1 case got better,1 case were invalid. The total effective rate is 94. 4%. Non- hormonal treatment group included 18 cases： 10 cases got markedly better,5 cases got better,3 cases were invalid. The total efficient rate is 83. 3%. As for efficiency,the hormone treatment group is significantly higher than non- hormone group. The difference are statistically significant. The mean time of fever for hormone treatment group（ 4. 58 ± 1. 34） d,was significantly shorter than the non- hormone treatment group（ 8. 36 ± 1. 53） d; the mean time of hospital stay between two groups was（ 10. 5 ± 1. 8） d and（ 15. 1 ± 1. 9） d. The difference was statistically significant. Conclusion： In patients with the diagnosis of severe mycoplasma pneumoniae pneumonia,in addition to application of macrolide antibiotics,timely application of adrenal cortical hormone can significantly improve symptoms in children,effectively reduce or avoid intrapulmonary and extrapulmonary complications occurred,and improve the cure rate,avoid serious complications.