纤维支气管镜联合甲泼尼龙应用于儿童RMPP中的疗效及安全性分析

Efficacy and safety analysis of fiberoptic bronchoscopy combined with methylprednisolone in children with RMPP

目的:探讨纤维支气管镜联合甲泼尼龙对难治性肺炎支原体肺炎(refractory mycoplasma pneumoniae pneumonia,RMPP)患儿的疗效和安全性以及可溶性B7-H3(sB7-H3)在RMPP中的作用。方法:选取我院从2015年7月至2017年10月收治的70例难治性支原体肺炎患儿,按照随机数字表法均分为两组:支气管镜组35例,常规治疗3 d后,给予纤维支气管镜下肺泡灌洗治疗;联合治疗组35例,甲泼尼龙和常规治疗3 d后,给予纤维支气管镜下肺泡灌洗治疗。正常对照组:选取同期因异物行支气管镜的患儿35例。两组治疗4周后,观察两组的总有效率、咳嗽消失时间、发热消失时间、啰音消失时间、胸片恢复正常时间、并发症及不良反应,两组患儿和正常对照组sB7-H3和支气管肺泡灌洗液炎症因子水平,分析两组患者sB7-H3与炎症因子的相关关系。结果:治疗4周后,联合治疗组总有效率(97. 1%)明显高于支气管镜组(82. 9%),差异具有统计学意义(P <0. 05);联合治疗组的咳嗽消失时间、发热消失时间、啰音消失时间及胸片恢复正常时间等均明显短于支气管镜组(P <0. 05);两组患者的s B7-H3及白介素1β(IL-1β)、白介素2(IL-2)、白介素6(IL-6)、干扰素γ(INF-γ)等炎症因子水平明显高于正常对照组(P <0. 05);联合治疗组sB7-H3及IL-1β、IL-2明显低于支气管镜组(P <0. 05);两组患者s B7-H3与IL-1β(r=0.815,P <0. 001)和IL-2(r=0. 629,P <0. 001)呈正相关关系; s B7-H3与IL-6(r=0. 295,P=0. 165)和INF-γ(r=0. 189,P=0. 148)无明显相关关系。两组患儿均未出现严重并发症和药物不良反应。结论:纤维支气管镜联合甲泼尼龙治疗RMPP患儿疗效显著,可明显提高临床疗效、缩短病程;同时,sB7-H3、IL-1β、IL-2、IL-6及INF-γ等因子在RMPP患儿中明显升高,联合治疗可降低s B7-H3、IL-1β及IL-2水平;此外,sB7-H3可能参与IL-1β和IL-2的释放,从而促进RMPP的发生。

AIM safety of fiberoptic ： To explore the efficacy and bronchoscopy combined with methylprednisolone in children with refractory myco plasma pneumoniae pneumonia （RMPP） and the role of sB7-H3 in RMPP. METHODS： Seventy ca- ses of RMPP （from July 2015 to October 2017） in our hospital were divided into bronchoscope group （ n = 35 ） and combined treatment group （ n = 35 ） according to random number table method. The bronchoscope group accepted the conventional treat- ment for three days, and then accepted the treatment of fiberoptic bronchoscopy for alveolar lavage. The combined treatment group accepted the conventional treatment and methylprednisolone for three days, and then accepted the fiberoptic bronchoscopy for alveolar lavage. And 35 patients with bronchoscopy due to foreign bodies in the same period were chosen as normal control group. After the treatment for 4 weeks, the total effective rates, disappearance time of cough, disappearance of fever, disappearance of rales, normal time of chest radiograph, complica- tions and adverse reactions were observed. And the levels of sBT-H3 and other inflammatory factors in bronchoalveolar lavage fluid of two groups and nor- mal control were observed. The relationship between sB7-H3 and inflammatory factors in RMPP patients were analyzed. RESULTS：After the treatment for four weeks, the total effective rate of combined treat- ment group （97.1% ） was much higher than that of bronchoscope group （ 82.9% ） , which was signifi- cantly different （ P 〈 0.05 ）. The disappearancetime of cough, fever, rales, normal time of chest ra- diograph in combined treatment group were much shorter than these in bronchoscope group （P 〈 0.05）. The levels of sB7-H3, IL-1β, IL-2, IL-6 and INF-γin RMPP patients were much higher than those of normal control group （ P 〈 0. 05 ）. And the levels of sB7-H3, IL-113 and IL-2 in combined treat- ment group were much lower than those in bronchoscope group （P 〈 0.05）. Among the RMPP pa- tients, there were positive correlations between sBT- H3 with IL-1β （r=0. 815, P〈0.001） and IL-2 （r =0. 629, P 〈0. 001 ）, while there were no correla- tions between sB7-H3 with IL-6 （ r = 0. 295, P = 0. 165） and INF-γ（r =0. 189, P =0. 148）. There were no serious complications and adverse drug reactions in both groups. CONCLUSION： The effect of fiberoptic bronchoscopy combined with methylprednisolone in RMPP children is significant; it can sig- nificantly shorten the course of the disease. Further- more, the levels of sB7-H3, IL-1β, IL-2, IL-6 and INF-γ in RMPP children were significantly in- creased, and the combined treatment may reduce the levels of sB7-H3, IL-1β and IL-2. In addition, sB7-H3 may be involved in the release of IL-1β and IL-2, thereby promoting the occurrence of RMPP.