丙种球蛋白联合阿奇霉素对重症支原体肺炎患儿血气指标及凝血状态和氧化应激的影响

Effects of gamma globulin combined with azithromycin on blood gas indexes,coagulation status and oxidative stress in children with severe mycoplasma pneumonia

目的 探讨丙种球蛋白联合阿奇霉素对重症支原体肺炎(severe mycoplasma pneumonia, SMPP)患儿血气指标、凝血状态和氧化应激水平的影响。方法 将2020年9月-2023年2月焦作市第二人民医院儿科收治的116例SMPP患儿随机分为常规组(58例)和球蛋白组(58例),常规组患儿静脉滴注阿奇霉素,球蛋白组患儿在常规组基础上联合静脉滴注丙种球蛋白;对比两组患儿临床疗效(有效率和症状改善时间)、免疫功能(CD4^(+)、CD8^(+)和CD4^(+)/CD8^(+)水平)、血气指标[动脉血氧饱和度(SaO_(2))、动脉二氧化碳分压(PaCO_(2))、动脉血氧分压(PaO_(2))]、血清炎症介质[肿瘤坏死因子-α(TNF-α)、半乳糖凝集素-3(Gal-3)]、凝血指标[D-二聚体(D-D)、纤维蛋白原(Fbg)]、血清氧化应激指标[超氧化物歧化酶(SOD)、丙二醛(MDA)]和肺部感染评分(CPIS)、儿童生存质量普适性核心量表(PedsQL)评分。结果 球蛋白组患儿治疗总有效率(87.93%)明显高于常规组(72.41%),且症状(体温恢复、咳嗽缓解和啰音消失)改善时间较常规组明显缩短(P<0.05)。与治疗前比较,治疗后两组中CD4^(+)、CD4^(+)/CD8^(+)、SaO_(2)、PaO_(2)、SOD水平和PedsQL评分显著升高,而CD8^(+)、PaCO_(2)、TNF-α、Gal-3、D-D、Fbg、MDA水平和CPIS评分显著降低(P<0.05),且球蛋白组变化幅度大于常规组(P<0.05)。结论 丙种球蛋白联合阿奇霉素治疗SMPP患儿疗效良好,可有效提高患儿的免疫功能,改善血气指标和凝血状态,减轻肺部感染和氧化应激损伤。

Objective To investigate the effects of gamma globulin combined with azithromycin on blood gas indexes,coagulation status and oxidative stress in children with severe mycoplasma pneumonia(SMPP).Methods Totally 116 children with severe mycoplasma pneumonia admitted to the Second Peoples Hospital of Jiaozuo from September 2020 to February 2023 were randomly divided into conventional group(58 cases)and globulin group(58 cases).The conven-tional group was given intravenous azithromycin,and the globulin group was given intravenous gamma globulin on the ba-sis of the conventional group.The clinical efficacy(effective rate and symptom improvement time),immune function(CD4^(+),CD8^(+)and CD4^(+)/CD8^(+)levels),blood gas indices[arterial oxygen saturation(SaO_(2)),arterial carbon dioxide partial pressure(PaCO_(2)),arterial oxygen partial pressure(PaO_(2))]and serum inflammatory mediators[tumor necrosis faction-α(TNF-α),galactosin-3(Gal-3)],coagulation index[D-dimer(D-D),fibrinogen(Fbg)],serum oxidative stress index[superoxide dismutase(SOD),malondialdehyde(MDA)],and pulmonary infection score(CPIS),child quality of Life Universal Core Scale(PedsQL)score were compared between the two groups.Results The total effective rate of globulin group was 87.93%,which was significantly higher than that of conventional group(72.41%),and the improvement time of symptoms(body temperature recovery,cough relief and rales disap-pearance)was significantly shorter than that of conventional group(P<0.05).Compared with before treatment,after treatment,the levels of CD4^(+),CD4^(+)/CD8^(+),SaO_(2),PaO_(2) SOD and PedsQL score were significantly increased,while the levels of CD8^(+),PaCO_(2),TNF-α,Gal-3,D-D,Fbg,MDA and CPIS score were significantly decreased(P<0.05),and the change range of globulin group was greater than that of conventional group(P<0.05).Conclusion The combination of gamma globulin and azithromycin is effective in the treatment of severe mycoplasma pneumonia in children,which can effectively improve the immune function of children,improve blood gas indexes and coagulation status,reduce lung infection and oxidative stress damage.