儿童肺炎支原体感染相关喘息临床治疗研究

Clinical Treatment of Children with Mycoplasma Pneumoniae Infection Related Wheezing

目的:探讨儿童肺炎支原体(MP)感染相关喘息的临床特征及治疗方法,进一步为临床诊治MP感染喘息患儿提供参考。方法:选取2岁以上MP感染及非感染喘息患儿各180例,MP感染组加用阿奇霉素治疗,所有随访病例急性发作时选用支气管扩张剂及布地奈德雾化治疗。两组病例按选用长期控制的药物分为三组(n=60),即孟鲁司特组、孟鲁司特组+ICS组、对照组,比较治疗前和治疗6个月后的临床指标。结果:(1) MP感染患儿:孟鲁司特组与对照组治疗后FeNO和EOS检测阳性病例数比较差异有统计学意义(P<0. 05);孟鲁司特+ICS组与对照组治疗后急性发作、肺部体征阳性例数、FeNO、IgE、EOS、过敏原、肺功能阳性例数比较差异有统计学意义(P<0. 05);孟鲁司特+ICS组与孟鲁司特组治疗后急性发作、肺部体征、FeNO检测阳性病例数比较差异有统计学意义(P<0. 05)。(2)非MP感染患儿:孟鲁司特组与对照组治疗后肺功能检测阳性病例数比较差异有统计学意义(P<0. 05);孟鲁司特+ICS组与对照组治疗后急性发作、肺部体征阳性例数、FeNO、IgE、EOS、肺功能阳性例数比较差异有统计学意义(P<0. 05);孟鲁司特+ICS组与孟鲁司特组治疗后肺部体征阳性例数比较差异有统计学意义(P<0. 05)。结论:目前常用的孟鲁司特或孟鲁司特+ICS的治疗方案对MP感染诱发喘息是有效的,孟鲁司特+ICS的联合治疗对MP感染后诱发喘息患儿治疗效果优于单用孟鲁司特。今后需进一步扩大样本量进行临床长期随访研究,以期进一步明确MP感染导致儿童哮喘的发生机制以及对哮喘患儿的长期影响。

Objective: To probe into the clinical features and treatment of children with Mycoplasma pneumoniae(MP) infection related wheezing,so as to provide reference for the clinical diagnosis and treatment of MP infection related wheezing in children. Methods:Totally 360 children with MP infection(n = 180) and non-infection(n = 180) related wheezing over 2 years old were selected. The MP infection group was additionally treated with azithromycin. All the follow-up cases were given bronchodilator and budesonide inhalation in acute onset. The two group of patients were divided into three groups according to the long-term control of drugs: montelukast group(n= 60),montelukast+ICS group(n = 60) and control group(n = 60). Clinical indicators were compared before treatment and after 6months of treatment. Results:(1) MP infection group: There were statistically significant differences in the number of cases of positive FeNO and EOS samples between the montelukast group and the control group(P < 0. 05). There were significant differences in the number of cases of acute exacerbations,positive pulmonary signs,Fe NO,Ig E,EOS,allergens,and pulmonary function between the montelukast+ICS group and the control group(P<0. 05). The differences of the number of cases of acute exacerbations,pulmonary signs and Fe NO were statistically significant between the montelukast + ICS group and the montelukast group(P < 0. 05).(2) Non-infection group: montelukast group showed statistically significant difference in the number of cases of pulmonary function tests after treatment compared with the control group(P< 0. 05). There were significant differences in the number of cases of acute exacerbations,positive pulmonary signs,Fe NO,Ig E,EOS and pulmonary function between the montelukast+ICS group and the control group(P<0. 05). There was statistically significant difference in the number of cases of positive pulmonary signs between the montelukast + ICS group and the montelukast group after treatment(P<0. 05). Conclusion: The current treatment regimen of montelukast or montelukast+ICS is effective for the treatment of wheezing induced by MP infection. The effectiveness of combination therapy with montelukast + ICS is superior to montelukast in children with MP infection related wheezing. It is still necessary to further expand the sample size for clinical long-term follow-up study in order to further clarify the pathogenesis of childhood asthma caused by MP infection and the long-term effects.