地塞米松与甲泼尼龙治疗儿童难治性支原体肺炎的疗效及安全性比较

Comparison of Efficacy and Safety of Dexamethasone Versus Methylprednisolone in the Treatment of Children with Refractory Mycoplasma Pneumoniae Pneumonia

目的:探讨地塞米松与甲泼尼龙治疗儿童难治性肺炎支原体肺炎(RMPP)的临床疗效及安全性差异。方法:128例RMPP患儿按随机数表法分为A组(63例)和B组(65例)。在常规治疗基础上,A组给予地塞米松0.35 mg/(kg·d),每日1次静脉滴注,B组给予甲泼尼龙2 mg/(kg·d),每日2次静脉滴注,疗程均为5 d,比较两组患儿治疗总有效率、临床症状改善情况、血浆心肌酶谱[肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)]、血清炎性因子[肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、干扰素-γ(IFN-γ)]及药物不良反应发生情况。结果:B组总有效率为86.15%,高于A组的71.43%(P<0.05)。B组患儿体温恢复正常时间、咳嗽消失时间、肺部啰音消失时间和X线胸片肺部阴影消失时间分别为(4.55±1.05)d、(6.67±1.12)d、(10.76±1.47)d和(7.97±1.03)d,短于A组的(5.24±1.42)d、(7.23±1.57)d、(11.63±2.52)d和(8.43±1.26)d,差异均有统计学意义(P均<0.05)。治疗后,两组患儿CK、CK-MB、LDH、TNF-α、IL-6和IFN-γ水平均低于治疗前(P<0.05),且B组降低幅度更大(P<0.05)。A组不良反应发生率为22.22%,高于B组的9.23%(P<0.05)。结论:甲泼尼龙治疗儿童RMMP的临床疗效和安全性均优于地塞米松。

Objective:To observe the difference of clinical efficacy and safety of dexamethasone vs.methylprednisolone in the treatment of children with refractory Mycoplasma pneumoniae pneumonia(RMPP).Methods:A total of 128 children with RMPP were randomly divided into group A(n=63)and group B(n=65).On the basis of conventional treatment,group A was given dexamethasone 0.35 mg/(kg·d),intravenously once a day,and group B was given methylprednisolone 2 mg/(kg·d),2 times a day for intravenous drip.Two groups were both treated for 5 days.The clinical efficacy,improvement of clinical symptoms,plasma myocardial enzyme profile such as creatine kinase(CK),creatine kinase isoenzyme(CK-MB),lactate dehydrogenase(LDH),serum inflammatory factors such as tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),and gamma-interferon(IFN-γ)and adverse drug reactions between the two groups were compared.Results:The total effective rate in group B was 86.15%,which was higher than that in group A(71.43%)(P<0.05).Time that symptoms disappeared of group B was much shorter than that in group A,such as fever(4.55±1.05)d vs.(5.24±1.12)d,cough(6.67±1.12)d vs.(7.23±1.57)d,lung rales(10.76±1.47)d vs.(11.63±2.52)d and X-ray lung shadow(7.97±1.03)d vs.(8.43±1.26)d,and the differences were all statistically significant(all P<0.05).After treatment,the levels of CK,CK-MB,LDH,TNF-α,IL-6 and IFN-γof the two groups were all decreased compared with before treatment(P<0.05),and the decrease in group B was more significant than that in group A(P<0.05).The incidence of adverse drug reactions in group A was 22.22%,which was higher than 9.23%in group B(P<0.05).Conclusion:The results of this study show that methylprednisolone is better than dexamethasone in clinical efficacy and safety in children with RMPP.