不同剂量甲强龙治疗早期普通型登革热的临床研究

Clinical study of different doses of methylprednisolone in treatment of early common dengue fever

目的探讨不同剂量甲强龙治疗早期普通型登革热的临床疗效。方法将90例早期普通型登革热患者(病程≤4天)随机分为对照组、低剂量激素组、高剂量激素组,每组各30例。对照组患者给予常规治疗(入院分组后即开始);低剂量激素组和高剂量激素组患者在对照组基础上分别加用甲强龙1 mg·kg-1·d-1和5 mg·kg-1·d-1静脉滴注,均从病程第4天开始,连续4天。比较3组患者退热时间、住院时间及治疗不同时间肝功能[ALT、AST、γ-谷氨酰基转移酶]、心肌酶[肌酸激酶、肌酸激酶同工酶、乳酸脱氢酶]、炎症因子[白细胞介素(IL)-lα、IL-8及肿瘤坏死因子-α]水平。结果高剂量激素组患者退热时间和住院时间均短于对照组及低剂量激素组(P<0.05).3组患者治疗第1天肝功能、心肌酶及炎症因子水平比较,差异均无统计学意义(P>0.05).治疗第9天高剂量激素组患者肝功能、心肌酶及炎症因子水平均低于对照组及低剂量激素组(P <0.05),而治疗第9天对照组和低剂量激素组患者肝功能、心肌酶及炎症因子水平比较,差异均无统计学意义(P>0.05)。3组患者治疗第5天PLT计数均低于同组治疗第1天,治疗第9天PLT计数均高于同组治疗第5天(P<0.05)。结论在常规治疗基础上加用适当剂量的甲强龙能减轻早期普通型登革热患者的炎症反应及肝脏、心肌损害,有利于临床恢复。

Objective To explore the clinical efficacy of different doses of methylprednisolone in treatment of early common dengue fever. Methods Ninety patients with early common dengue fever (course of the disease < 4 days) were randomly divided into control group, low-dose glucocorticoid group and high-dose glucocorticoid group, 30 cases in each group. Pateints in control group were given routine treatment ( starting after being admissed). Pateints in low-dose glucocorticoid group and high dose glucocorticoid group were given methylprednisolone 1 mg·kg-1·d-1 and 5 mg·kg-1·d-1intravenous injection, from the 4th day after onset, 4 consecutive days on the basis of control group respectively. Antipyretic time, hospitalization time and liver function [ ALT, AST, 7-glutamyl transferase ( 7-GT )], myocardial enzymes [ creatine kinase ( CK ), creatine kinase isoenzyme ( CK-MB ), lactate dehydrogenase (LDH )] and inflammatory factors [ interleukin ( IL)-1α, IL-8 and tumor necrosis factor ( TNF )-α] of different time in treatment were compared among 3 groups. Results Antipyretic time and hospitalization time of high-dose glucocorticoid group were shorter than those of control group and low-dose glucocorticoid group (P <0.05). There were no significant differences of liver function, myocardial enzymes and inflammatory factors among 3 groups on the first day of treatment ( P > 0. 05 ). Levels of liver function, myocardial enzymes and inflammatory factors of high-dose glucocorticoid group were all lower than those of control group and low-dose glucocorticoid group on the ninth day of treatment( P <0. 05), while there were no significant differences of liver function, myocardial enzymes and inflammatory factors between control group and low-dose glucocorticoid group on the ninth day of treatment ( P > 0. 05 ). PLT counts of the 3 groups on the fifth day of treatment were lower than those on the first day of treatment in the same group, while PLT counts on the ninth day of treatment were all higher than those on the fifth day of treatment in the same group. Conclusion On the basis of routine treatment, appropriate dose of methylprednisolone can alleviate inflammation reaction and damage of liver, myocardium of patients with early common,and to facil让ate clinical recovery.