阿奇霉素联合甲泼尼龙治疗小儿重症支原体肺炎对免疫功能的影响

Effect of Azithromycin Combined with Methylprednisolone on Immune Function in Children with Severe Mycoplasmal Pneumonia

目的探讨甲泼尼龙治疗小儿重症支原体肺炎的疗效及对患儿肺功能和免疫功能的影响。方法选取2017年8月至2019年8月于北京市延庆区医院收治的重症支原体肺炎患儿126例,根据治疗不同分为对照组和观察组,每组63例。对照组的患儿给予阿奇霉素治疗,观察组的患儿给予阿奇霉素联合甲泼尼龙治疗,对比两组患儿的临床疗效、临床症状及肺功能的改善情况,并观察不良反应发生率;比较患儿治疗前后免疫球蛋白(IgA、IgG、IgM)、免疫细胞(CD3+、CD4+、CD8+)及细胞因子(IL-6、IL-8、IL-10、TNF-α)的水平变化情况。结果观察组患儿治疗的有效率(93.65%)高于对照组(76.19%)(χ^(2)=7.596,P=0.022);观察组患儿发热、咳嗽、啰音、肺部阴影临床症状消失时间短于对照组(P<0.05);治疗后,两组患儿一秒用力呼气容积(FEV1)、一秒率(FEV1/FVC)、呼气峰流速(PEF)的水平较治疗前提高,并且观察组患儿肺功能水平高于对照组(P<0.05);观察组不良反应发生率(7.94%)和对照组(11.11%)差异无统计学意义(χ^(2)=0.368,P=0.544);治疗后观察组患儿的IgA、IgG、IgM、CD3+、CD4+水平高于对照组,而CD8+低于对照组(P均<0.05);观察组患儿IL-6、IL-8、TNF-α低于对照组,而IL-10高于对照组(P<0.05)。结论阿奇霉素联合甲泼尼龙治疗小儿重症支原体肺炎临床疗效显著,能改善患儿肺功能及免疫功能。

Objective To investigate the effect of methylprednisolone on severe mycoplasmal pneumonia in children and its influence on pulmonary function and immune function.Methods Totally 126 children with severe mycoplasmal pneumonia admitted to our hospital from August 2017 to August 2019 were divided into control group and observation group according to random number table.The children in the control group were treated with azithromycin and the children in the observation group were treated with azithromycin and methylprednisolone for 7 days.The clinical efficacy,clinical symptoms and improvement of pulmonary function were compared between the two groups,and the incidence of adverse reactions were observed.Changes of Immunoglobulin(IgA,IgG,IgM),immune cells(CD3+,CD4+,CD8+)and cytokines(IL-6,IL-8,IL-10,TNF-α)in children were compared.Results The effective rate of the treatment group was(93.65%),which was significantly higher than that of the control group(76.19%)(χ^(2)=7.596,P=0.022),the differences were statistically significant(P<0.05).The observation group of children with fever,cough,rales,lung shadow clinical symptoms disappeared significantly shorter than the control group,the differences were statistically significant(P<0.05).After treatment,the 1 second volume(FEV1),1 second rate(FEV1/FVC)and peak flow velocity(PEF)were higher than those before treatment,and the pulmonary function in the observation group was significantly higher than that in the control group,the differences were statistically significant(P<0.05).The incidence of adverse reactions in the observation group was7.94%,which was slightly lower than that of the control group11.11%,and the differences were not statistically significant(χ^(2)=0.368,P=0.544).IgA,IgG,IgM,CD3+,CD4+from the observation group were higher than those in control group,the CD8+was lower than the control group,the differences were statistically significant(P<0.05).The levels of IL-6,IL-8 and TNF-αin the observation group were lower than those in the control group,and the level of IL-10 was higher than that of control group,the differences were statistically significant(P<0.05).Conclusion Azithromycin combined with methylprednisolone in the treatment of severe mycoplasmal pneumonia in children has been shown to improve pulmonary function and immune function.