不同剂量甲泼尼龙三联疗法对难治性肺炎支原体肺炎患儿免疫功能及炎性因子水平的影响

Effects of Different Doses of Triple Therapy of Methylprednisolone on Immune Function and Inflammatory Factor Levels in Children with Refractory Mycoplasma Pneumoniae Pneumonia

目的:探讨不同剂量甲泼尼龙三联疗法对难治性肺炎支原体肺炎患儿免疫功能及炎性因子水平的影响。方法:选取我院在2017年5月到2018年6月期间收治的120例肺炎支原体肺炎患儿,根据随机数字表法将其分为对照组、低剂量组、中剂量组和高剂量组,每组均为30例。对照组采用阿奇霉素联合头孢他啶进行治疗,低剂量组、中剂量组和高剂量组在对照组的基础上分别给予1 mg/(kg·d)、2 mg/(kg·d)、5 mg/(kg·d)的甲泼尼龙进行治疗。比较各组患儿的临床疗效、临床症状消失时间及不良反应发生情况,并比较各组患儿治疗前后CD3^+、CD4^+、CD8^+、红细胞沉降率(ESR)、C反应蛋白(CRP)、肿瘤坏子因子-α(TNF-α)、白介素-6(IL-6)水平。结果:高剂量组的总有效率高于对照组(P<0.05)。高剂量组患儿临床各项症状消失时间短于中剂量组、低剂量组和对照组(P<0.05),中剂量组和低剂量组患儿临床各项症状消失时间短于对照组(P<0.05)。治疗后高剂量组、中剂量组、低剂量组的CD3^+、CD4^+水平高于对照组(P<0.05)。治疗后高剂量组患儿的ESR、CRP、IL-6水平低于中剂量组、低剂量组和对照组,且中剂量组和低剂量组患儿的ESR、CRP、IL-6水平低于对照组(P<0.05)。各组的不良反应发生率比较无统计学差异(P>0.05)。结论:甲泼尼龙三联疗法治疗难治性肺炎支原体肺炎患儿疗效确切,可提高患儿免疫功能,且高剂量的甲泼尼龙三联疗法可促进患儿的临床症状改善,更明显地降低炎性因子的水平,安全可靠。

Objective: To investigate the effects of different doses of triple therapy of methylprednisolone on immune function and inflammatory factor levels in children with refractory Mycoplasma pneumoniae pneumonia. Methods: 120 cases of refractory Mycoplasma pneumoniae pneumonia who were treated in our hospital from May 2017 to June 2018 were selected. According to the random digital table method, the patients were divided into the control group, the low dose group, the middle dose group and the high dose group, which were 30 cases in each group. The control group were used azithromycin and ceftazidime treatment, low dose group, middle dose group and high dose group were given 1 mg/(kg·d), 2 mg/(kg·d), 5 mg/(kg·d) methylprednisolone. The clinical efficacy, the time of disappearance of clinical symptoms and adverse reactions were compared in all groups, the levels of CD3^+, CD4^+, CD8^+, erythrocyte sedimentation rate(ESR), C reactive protein(CRP), tumor necrosis factor-α(TNF-α) and interleukin-6(IL-6) were compared before and after treatment in all groups. Results: The total effective rate in the high dose group was higher than that in the control group(P<0.05). The disappearance time of the clinical symptoms in the high dose group was shorter than that of the middle dose group, the low dose group and the control group(P<0.05). The disappearance time of clinical symptoms in middle dose group and low dose group was shorter than that in control group(P<0.05). After treatment, the level of CD3^+ and CD4^+cells in high dose group, middle dose group and low dose group were higher than those of control group(P<0.05). After treatment, the levels of ESR, CRP and IL-6 in high dose group were lower than those in middle dose group, low dose group and control group, and the levels of ESR, CRP and IL-6 in the middle dose group and the low dose group were lower than those in the control group(P<0.05). There was no significant difference in the incidence of adverse reactions in each group(P>0.05). Conclusion: Methylprednisolone triple therapy is effective in treating refractory Mycoplasma pneumoniae pneumonia in children. It can improve the immune function of children, and high dose methylprednisolone triple therapy can accelerate the improvement of clinical symptoms in children, and it can significantly reduce the level of inflammatory factors, which is safe and reliable.