阿奇霉素不同应用时机对肺炎支原体肺炎患儿血清免疫功能、心肌酶的影响

Effect of the timing of azithromycin treatment on serum immune function and myocardial enzymes in children with mycoplasma pneumoniae pneumonia

目的探讨阿奇霉素不同应用时机对肺炎支原体肺炎(Mycoplasma pneumoniae pneumonia,MPP)患儿血清免疫功能、心肌酶的影响。方法选取2019年12月至2020年10月间,我院儿科住院治疗的150例MPP患儿,按照阿奇霉素开始应用时间分为早期应用组(病程≤3天)及非早期应用组(病程>3天),各75例。均给予10 mg/kg阿奇霉素静脉滴注,1次/d,连续5 d,停2天后予阿奇霉素干混悬剂10 mg/(kg.d),1次/d,口服,连续5 d,停用2 d,疗程为14 d。比较两组临床疗效、血清免疫功能及心肌酶谱。结果两组临床疗效比较,差异无统计学意义(P>0.05)。治疗前后两组患儿血清CD^(+)_(3)、CD^(+)_(4)、CD^(+)_(4)/CD^(+)_(8)及CD^(+)_(8)无差异,治疗2个疗程后,非早期应用组患儿血清CD^(+)_(3)、CD^(+)_(4)、CD^(+)_(4)/CD^(+)_(8)高于早期应用组,CD^(+)_(8)水平低于早期应用组,差异无统计学意义(均P>0.05)。两组IgM、IgG、IgA水平,CK-MB、CK、AST及LDH水平与治疗前比较,差异有统计学意义(均P<0.05),但治疗2个疗程后,早期应用组IgM、IgG、IgA水平均低于非早期应用组,差异无统计学意义(均P>0.05),CK-MB、CK、AST及LDH水平均低于非早期应用组,差异有统计学意义(均P<0.05)。结论阿奇霉素早期使用并不能进一步提高MPP患儿的临床疗效及免疫功能,但可以显著改善心肌损害。

Objective To investigate the effect of the timing of azithromycin treatment on serum immune function and myocardial enzymes in children with mycoplasma pneumoniae pneumonia(MPP).Methods A total of 150 children with MPP from December 2019 to October 2020 in our hospital were divided into the early application group(course of disease≤3 days)and the advanced application group(course of disease>3 days),75 cases in each group.All patients were given 10 mg/kg azithromycin intravenously,once a day,for 5 consecutive days.After stopping for 2 days,azithromycin dry suspension was given 10 mg/(kg·d),once a day,orally,for 5 consecutive days,and stopped for 2 consecutive days.The course of treatment was 14 days.The clinical efficacy,serum immune function and myocardial enzyme spectrum were compared between the two groups.Results There was no significant difference in clinical efficacy between the two groups(P>0.05).There was no significant difference in CD^(+)_(3),CD^(+)_(4),CD^(+)_(8) and CD^(+)_(4)/CD^(+)_(8) between the two groups before treatment.The levels of CD^(+)_(3),CD^(+)_(4),CD^(+)_(4)/CD^(+)_(8) in the advanced application group were higher than those in the early application group,and CD^(+)_(8) was lower than that in the early application group(P>0.05).After two courses of treatment,the levels of IgM,IgG,IgA,CK-MB,CK,AST and LDH in the two groups were significantly lower than those before treatment(all P<0.05).After two courses of treatment,the levels of IgM,IgG and IgA in the early application group were lower than those in the advanced application group(all P>0.05),and the levels of CK-MB,CK,AST and LDH in the early application group were lower than those in the advanced application group(all P<0.05).Conclusion The early application of azithromycin can not further improve the clinical efficacy and immune function of MPP children,but can significantly improve myocardial damage.