小剂量糖皮质激素+阿奇霉素治疗小儿大叶性肺炎的疗效分析

Curative effect of small-dose glucocorticoids+ azithromycin treatment on lobar pneumonia

目的:研究小剂量糖皮质激素+阿奇霉素治疗对大叶性肺炎患儿炎症反应及应激反应的影响。方法:选择资阳市第一人民医院2015年1月-2018年1月期间收治的肺炎支原体大叶性肺炎患儿作为研究对象并随机分为两组,GCs组接受小剂量糖皮质激素+阿奇霉素治疗、对照组接受阿奇霉素治疗。治疗前及治疗后3d、治疗后5d时,测定血清及外周血中的炎症反应指标及应激反应指标。结果:与组内治疗前比较,两组治疗后外周血中TLR4、NF-κB、NOX2、p38MAPK、iNOS、GRP78、PERK、ATF4、CHOP、Caspase-12的表达强度以及血清中TNF-α、HMGB-1、ICAM-1、NO、MDA、8-OhdG的含量均显著降低且GCs组治疗后外周血中TLR4、NF-κB、NOX2、p38MAPK、iNOS、GRP78、PERK、ATF4、CHOP、Caspase-12的表达强度以及血清中TNF-α、HMGB-1、ICAM-1、NO、MDA、8-OhdG的含量均显著低于对照组。结论:小剂量糖皮质激素+阿奇霉素治疗小儿大叶性肺炎能够较单纯阿奇霉素治疗更为有效地抑制炎症及应激反应。

Objective：To study the effect of small-dose glucocorticoids ＋ azithromycin therapy on inflammatory response and stress response in children with lobar pneumonia.Methods：Children with mycoplasma pneumoniae lobar pneumonia who were treated in the First People＇s Hospital of Ziyang between January 2015 and January 2018 were chosen as the research subjects and randomly divided into two groups：GCs group were treated with low-dose glucocorticoids ＋ azithromycin,and control group were treated with azithromycin.The inflammatory response indicators and stress response indicators in serum and peripheral blood were measured before treatment as well as 3 dand 5 dafter treatment.Results：Compared with those of same group before treatment,peripheral blood TLR4,NF-κB,NOX2,p38 MAPK,iNOS,GRP78,PERK,ATF4,CHOP and Caspase-12 expression intensity as well as serum TNF-α,HMGB-1,ICAM-1,NO,MDA and 8-OhdG levels of both groups significantly decreased after treatment（P〈0.05）,and peripheral blood TLR4,NF-κB,NOX2,p38 MAPK,iNOS,GRP78,PERK,ATF4,CHOP and Caspase-12 expression intensity as well as serum TNF-α,HMGB-1,ICAM-1,NO,MDA and 8-OhdG levels of GCs group after treatment were significantly lower than those of control group（P〈0.05）.Conclusion：Smalldose glucocorticoid＋azithromycin therapy is more effective than azithromycin therapy to suppress the inflammatory and stress response in children with lobar pneumonia.