早期小剂量糖皮质激素对儿童重症肺炎血清TNF-α、sICAM-1水平的影响

The early application of low-dose glucocorticoid in treating children with severe pneumonia on the serum TNF-α and sICAM-1 level

目的观察早期小剂量糖皮质激素对儿童重症肺炎血清肿瘤坏死因子-α（TNF-α）、可溶性细胞间黏附分子-1（sICAM-1）水平的影响。方法选取2014年4月—2015年3月陕西省人民医院儿科收治的重症肺炎患儿82例,根据抽签法随机分为观察组和对照组,每组41例。对照组采取常规治疗,观察组早期给予小剂量糖皮质激素。记录比较2组患儿的体征与症状好转时间,治疗前和治疗7d后血气和炎性因子指标,并进行临床疗效评价。结果观察组总的临床疗效明显高于对照组[92.68%（38/41）vs.73.17%（30/41）,χ~2=5.513,P〈0.05]。观察组咳嗽消失、体温恢复正常、肺外症状好转及住院时间明显短于对照组[（9.23±1.32）d、（3.04±0.32）d、（5.24±0.63）d、（10.23±1.45）d vs.（14.28±1.38）d、（5.15±1.03）d、（8.31±1.35）d、（15.37±2.34）d,t=16.933、12.527、13.195、11.956,P〈0.01]。治疗后7d,观察组的氧分压（PO_2）、二氧化碳分压（PCO_2）水平明显高于对照组[（9.24±2.42）kPa、（5.43±1.24）kPa vs.（8.21±1.45）kPa、（4.56±0.97）kPa,t=2.338、3.539,P〈0.05,P〈0.01]。治疗后7d,观察组的TNF-α、sICAM-1明显低于对照组[（26.43±2.45）ng/L、（15.32±4.15）ng/L vs.（53.21±5.32）ng/L、（24.19±4.87）ng/L,t=29.277、8.877,P〈0.01],而IL-10高于对照组[（115.32±17.43）pg/ml vs.（87.42±15.32）pg/ml,t=7.698,P〈0.01]。结论重症肺炎患儿早期给予小剂量短疗程糖皮质激素治疗,能明显改善血气指标及血清TNF-α、sICAM-1水平,有效地缓解患儿的临床症状,临床疗效显著。

Objective To study the influence of early application of low-dose glucocorticoid in treating children with severe pneumonia on the serum TNF-α and sICAM-1 level.Methods Eighty-two cases of children with severe pneumonia were selected from April 2014 to March 2015 in Shanxi Peoples Hospital,according to the draw method were divided into the observation group and the control group,41 cases in each group.The control group were treated with conventional treatment,and the observation group were early given small doses of glucocorticoid.Signs and symptoms change for the better time,blood gas and inflammatory factor index before and after the 7 d treatment of children in the two groups were recorded and observed,and the clinical curative effect of the two groups were compared.Results The total clinical efficacy rate of the observation group was 92.68%（38/41）,significantly higher than the control group 73.17%（30/41）（χ~2=5.513,P0.05）.The observation group cough disappeared,body temperature return to normal,extrapulmonary symptoms improved,and hospitalized time significantly shorter than the control group[（9.23±1.32）d,（3.04±0.32）d,（5.24±0.63）d,（10.23±1.45）d vs.（14.28±1.38）d,（5.15±1.03）d,（8.31±1.35）d,（15.37±2.34）d],there was an obvious difference between the two groups（t=16.933,12.527,13.195,11.956,P0.01）.7 d after treatment,oxygen partial pressure（PO_2）,partial pressure of carbon dioxide（PCO_2） level of the observation group were significantly higher than the control group[（9.24 ±2.42） kPa,（5.43±1.24）kPa vs.（8.21 ±1.45） kPa,（4.56±0.97） kPa]（t=2.338,3.539,P0.05,P0.01）.7 d after treatment,TNF-a,sICAM-1 of the observe group was obviously lower than the control group[（26.43±2.45）ng/L,（15.32±4.15） ng/L vs.（53.21±5.32）ng/L（24.19 ±4.87）ng/L],but IL-10 was higher than the control group[（115.32 ±17.4-3） pg/ml vs.（87.42 ± 15.32） pg/ml],differences between the two groups were significantly statistical（t = 29.277,8.877,7.698,P 0.01）.Conclusion Children with severe pneumonia received early low-dose and short course glucocorticoids treatment,can obviously improve the blood gas indexes,serum TNF-α and sICAM-1 level,effectively alleviate their clinical symptoms,whose clinical curative effect is remarkable.