阿奇霉素联合甲泼尼龙治疗小儿难治性支原体肺炎45例疗效观察

Clinical Observation of Azithromycin Combined with Methylprednisolone for Treating Children with Refractory Mycoplasma Pneumonia in 45 Cases

目的探讨阿奇霉素联合甲泼尼龙治疗小儿难治性支原体肺炎的临床疗效及对血清炎性因子和T淋巴细胞亚群的影响。方法选取医院2014年1月至2016年1月收治的小儿难治性支原体肺炎患儿90例,随机分为观察组和对照组,各45例。对照组患儿给予退热、止咳、平喘等常规治疗,并口服阿奇霉素颗粒10 mg/(kg·d),连用4 d后停药3 d,7 d为1个疗程,共2个疗程。观察组在对照组治疗基础上给予甲泼尼龙2 mg/(kg·d)静脉滴注,连用14 d。结果观察组患儿体温恢复时间、咳嗽消失时间、肺部罗音消失时间、肺部影像学恢复时间和住院时间均短于对照组患儿(P<0.05);观察组患儿血清肿瘤坏死因子-α(TNF-α)、白细胞介素6(IL-6)和超敏C反应蛋白(hs-CRP)水平均低于对照组患儿(P<0.05);观察组患儿外周血CD_3^+,CD_4^+比例和CD_4^+/CD_8^+高于对照组患儿,CD_8^+比例低于对照组患儿(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论阿奇霉素联合甲泼尼龙治疗小儿难治性支原体肺炎,可提高疗效,改善患儿免疫功能,安全性高,值得临床推广。

Objective To investigate the clinical effect of azithromycin combined with methylprednisolone in the treatment of children with refractory mycoplasma pneumonia and its effect on serum inflammatory factors and T lymphocyte subsets. Methods Totally 90 children with refractory mycoplasma pneumonia admitted to our hospital from January 2014 to January 2016 were selected and randomly divided into the observation group and the control group,45 cases in each group. The control group was given conventional treatment of abatement of fever,relieving cough,relieving asthma and 10 mg/（ kg·d） Azithromycin Granules,after continuous use of 4 d,withdrawal of3 d,7 d for 1 course,the control group was treated for 2 courses. On this basis,the observation group was given intravenous infusion of2 mg/（ kg·d） methylprednisolone for 14 d. Results The recovery time of body temperature,cough disappearance time,pulmonary rales disappearance time, recovery time of pulmonary imaging and hospitalization time in the observation group were significantly less than those in the control group（ P〈0. 05）. After treatment,the levels of TNF-α,IL-6 and hs-CRP in the observation group were significantly lower than those in the control group（ P〈0. 05）. After treatment,the proportion of CD3^＋,CD4^＋and CD4^＋/CD8^＋in the peripheral blood of the observation group was significantly higher than that of the control group,and the proportion of CD8^＋was significantly lower than that of the control group（ P〈0. 05）. There was no significant difference in the incidence of adverse reactions between the two groups（ P〉0. 05）. Conclusion Azithromycin combined with methylprednisolone in the treatment of children with refractory mycoplasma pneumonia can improve the curative effect, improve the immune function and has high safety, which is worthy of clinical promotion.