支气管镜肺泡灌洗联合甲泼尼龙对难治性肺炎支原体肺炎患儿的影响

Effect of bronchoscopic alveolar lavage combined with methylprednisolone on children with refractory Mycoplasma pneumoniae pneumonia

目的探究支气管镜肺泡灌洗联合甲泼尼龙对难治性肺炎支原体肺炎(RMPP)患儿的影响。方法本研究为随机对照试验。纳入于2019年6月至2021年8月郑州大学附属儿童医院收治的90例RMPP患儿作为研究对象,采用随机数字表法分为两组,各45例。对照组男26例、女19例,年龄(5.84±0.87)岁,采用阿奇霉素抗感染治疗;研究组男28例、女17例,年龄(5.92±0.85)岁,在对照组基础上采用支气管镜肺泡灌洗联合甲泼尼龙治疗,两组均治疗4周。对比两组临床疗效、症状消失时间、炎症因子[C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、干扰素-γ(IFN-γ)]水平及不良反应。采用t检验、χ^(2)检验、Fisher确切概率法。结果研究组治疗总有效率为95.56%(43/45),高于对照组71.11%(32/45),差异有统计学意义(χ^(2)=9.680,P=0.002)。研究组发热消失时间、肺部啰音消失时间、咳嗽消失时间、胸片恢复正常时间分别为(5.42±0.86)d、(6.85±0.49)d、(10.38±1.26)d、(14.31±3.58)d,均低于对照组[(9.86±0.88)d、(10.80±0.52)d、(14.57±1.37)d、(19.67±3.69)d],差异均有统计学意义(均P<0.05)。治疗后,研究组CRP[(13.21±3.27)mg/L]、TNF-α[(15.82±3.61)ng/L]、IL-6[(14.46±4.83)ng/L]、IFN-γ水平[(7.62±0.48)ng/L]均低于对照组[(28.85±4.15)mg/L、(26.49±3.59)ng/L、(37.49±4.42)ng/L、(15.46±1.39)ng/L],差异均有统计学意义(均P<0.05)。两组不良反应发生率对比,差异无统计学意义(P>0.05)。结论RMPP患儿应用支气管镜肺泡灌洗联合甲泼尼龙治疗能够有效减轻炎症因子水平,并可缩短病程,获得较好的临床效果,无明显不良反应,安全性高,值得推广。

Objective To investigate the effect of bronchoscopic alveolar lavage combined with methylprednisolone on children with refractory Mycoplasma pneumoniae pneumonia(RMPP).Methods It was a randomized controlled trial.A total of 90 children with RMPP who were treated in Children's Hospital Affiliated to Zhengzhou University from June 2019 to August 2021 were enrolled as the research objects.They were divided into two groups by the random number table method,with 45 cases in each group.In the control group,26 males and 19 females,aged(5.84±0.87)years,were treated with azithromycin for anti-infection;in the study group,28 males and 17 females,aged(5.92±0.85)years,were treated with bronchoscopic alveolar lavage combined with methylprednisolone on the basis of the control group.Both groups were treated for 4 weeks.The clinical efficacy,duration of symptom disappearance,levels of inflammatory factors[C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),and interferon-γ(IFN-γ)],and adverse reactions were compared between the two groups.t test,χ^(2) test,and Fisher exact probability method were used.Results The total effective rate of the study group was 95.56%(43/45),which was higher than that of the control group[71.11%(32/45)],with a statistically significant difference(χ^(2)=9.680,P=0.002).The disappearance time of fever,the disappearance time of lung rales,the disappearance time of cough,and the time of chest radiography returning to normal in the study group were(5.42±0.86)d,(6.85±0.49)d,(10.38±1.26)d,and(14.31±3.58)d,respectively,which were shorter than those in the control group[(9.86±0.88)d,(10.80±0.52)d,(14.57±1.37)d,and(19.67±3.69)d],with statistically significant differences(all P<0.05).After treatment,the levels of CRP[(13.21±3.27)mg/L],TNF-α[(15.82±3.61)ng/L],IL-6[(14.46±4.83)ng/L],and IFN-γ[(7.62±0.48)ng/L]in the study group were lower than those in the control group[(28.85±4.15)mg/L,(26.49±3.59)ng/L,(37.49±4.42)ng/L,and(15.46±1.39)ng/L],with statistically significant differences(all P<0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion The application of bronchoscopic alveolar lavage combined with methylprednisolone in the treatment of children with RMPP can effectively reduce the levels of inflammatory factors,shorten the course of disease,and obtain better clinical effects,without obvious adverse reactions,with high safety,which is worth popularizing.