不同剂量甲基强的松龙治疗儿童难治性肺炎支原体肺炎临床疗效及安全性分析

Clinical efficacy and safety analysis of different doses of methylprednisolone in the treatment of refractory Mycoplasma pneumoniae pneumonia in children

目的比较不同剂量甲基强的松龙治疗儿童难治性肺炎支原体肺炎(RMPP)的临床疗效及安全性。方法 60例儿童难治性肺炎支原体肺炎患儿,按随机数字表法分为大剂量组和小剂量组,各30例。小剂量组患儿给予1~2 mg/(kg·d)甲基强的松龙治疗,连续静脉滴注5 d,再改为口服甲泼尼松龙,1周停药;大剂量组患儿给予10~20 mg/(kg·d)甲基强的松龙冲击治疗,连续静脉滴注3 d,再改为口服甲泼尼松龙,1周停药。比较两组患儿主要症状体征消失时间,治疗前及治疗后1周血清C反应蛋白(CRP)及D-二聚体(D-D)水平,治疗后3周临床治疗效果以及治疗过程中不良反应发生情况。结果两组患儿体温、咳嗽、肺部啰音消失时间及总有效率比较差异无统计学意义(P>0.05);大剂量组治疗过程中不良反应发生率为56.67%,明显高于小剂量组的23.33%,差异具有统计学意义(P<0.05)。两组患儿治疗后CRP和D-D水平均较治疗前明显下降,差异具有统计学意义(P<0.05);两组患儿治疗前后CRP和D-D水平比较差异均无统计学意义(P>0.05)。结论小剂量甲基强的松龙[1~2 mg/(kg·d),连用5 d]治疗儿童难治性肺炎支原体肺炎的临床疗效与大剂量相当,均能快速改善症状体征及促进生化指标恢复,但小剂量安全性显著提高。

Objective To compare the clinical efficacy and safety analysis of different doses of methylprednisolone in the treatment of refractory Mycoplasma pneumoniae pneumonia（RMPP） in children. Methods A total of 60 children with refractory Mycoplasma pneumoniae pneumonia were divided by random number table method into high-dose group and low-dose group, with 30 cases in each group. Low-dose group received methylprednisolone by 1~2 mg/（kg·d） for 5 d of continuous intravenous infusion then changed to oral prednisolone and withdrawal in 1 week. High-dose group received methylprednisolone pulse therapy by 10~20 mg/（kg·d） for 3 d of continuous intravenous infusion then changed to oral prednisolone and withdrawal in 1 week. Comparison were made on disappearance time of main symptoms and signs, serum C reactive protein（CRP） and D-dimer（D-D） levels before treatment and 1 week after treatment, clinical treatment effect after 3 weeks of treatment and occurrence of adverse reactions during treatment between two groups. Results Both groups had no statistically significant difference in body temperature, cough, pulmonary rale disappearance time and total effective rate（P0.05）. High-dose group had obviously higher incidence of adverse reactions during treatment as 56.67% than 23.33% in low-dose group, and the difference was statistically significant（P0.05）. Both groups had obviously lower CRP and D-D level after treatment than before treatment, and the difference was statistically significant（P0.05）. Both groups had no statistically significant difference in CRP and D-D level before and after treatment（P0.05）. Conclusion Low-dose methylprednisolone [1~2 mg/（kg·d） for 5 d] shows equal clinical efficacy with high doses for the treatment of refractory Mycoplasma pneumoniae pneumonia in children, and both can rapidly improve symptoms and signs and promote the recovery of biochemical indicators, but the safety of low-doses is significantly improved.