丙酸倍氯米松混悬液雾化吸入治疗支原体肺炎患儿的临床研究

Clinical trial of beclometasone dipropionate suspension for inhalation in the treatment of children with Mycoplasma pneumoniae pneumonia

目的 观察丙酸倍氯米松混悬液雾化吸入治疗肺炎支原体肺炎(Mpp)患儿的临床疗效及其对血清免疫球蛋白的影响。方法 将Mpp患儿按随机数字表法分为对照组和试验组。对照组给予乳糖酸红霉素20~30 mg·kg^(-1),每天1次,静脉滴注;试验组在对照组治疗的基础上,给予丙酸倍氯米松混悬液雾化吸入治疗,按患儿年龄酌减,每次最大剂量不超过0.8 mg, 2组均持续用药2周。比较2组的临床疗效,观察治疗前后2组血清免疫球蛋白[免疫球蛋白G(IgG)、免疫球蛋白A(IgA)、免疫球蛋白M(IgM)]、白细胞(WBC)计数、血红蛋白(Hb)、嗜酸性粒细胞(EOS)计数、血清腺苷脱氧酶(ADA)及肺功能[用力肺活量(FVC)、第1秒用力呼气量(FEV1)、最大自主通气量(MVV)]水平变化,比较2组临床症状消失时间及药物不良反应发生率。结果 对照组和试验组,各75例。试验组和对照组总有效率分别为90.67%和77.33%,差异有统计学意义(P<0.05)。治疗后,试验组和对照组IgG分别为(11.55±1.73)和(9.53±1.29)g·L^(-1),IgA分别为(2.86±0.36)和(2.21±0.33)g·L^(-1),IgM分别为(1.93±0.18)和(1.24±0.16)g·L^(-1),Hb分别为(14.32±1.49)和(11.85±1.50)g·dL^(-1),FVC分别为(1.97±0.32)和(1.65±0.25)L,FEV1分别为(1.40±0.30)和(1.27±0.24)L,MVV分别为(77.13±10.28)和(72.67±11.94)L,WBC分别为(7.31±0.94)×10^(9)·L^(-1)和(8.91±1.43)×10^(9)·L^(-1),EOS分别为(0.21±0.03)×10^(9)·L^(-1)和(0.38±0.04)×10^(9)·L^(-1),ADA分别为(15.67±1.57)和(19.47±1.96)U·L^(-1),咳喘消失时间分别为(6.32±1.08)和(9.91±1.03)d,发热消失时间分别为(2.33±0.47)和(3.88±0.37)d,肺部湿啰音消失时间分别为(5.73±0.72)和(8.33±0.86)d,住院时间分别为(7.69±1.23)和(10.29±1.15)d。试验组的上述指标与对照组比较,差异均有统计学意义(均P<0.05)。试验组和对照组的药物不良反应发生率分别为20.00%和14.67%,差异无统计学意义(P>0.05)。结论 红霉素联合丙酸倍氯米松混悬液雾化吸入治疗可明显提高Mpp患儿临床疗效,有效改善患儿临床症状和肺功能,机制或与联合用药可有效提高患儿血清免疫球蛋白、调节WBC、EOS、ADA表达有关。

Objective To observe the effect of beclometasone dipropionate suspension for Inhalation in the treatment of children with Mycoplasma pneumoniae pneumonia(Mpp)and the influence on serum immunoglobulins.Methods Children with Mpp were divided into control group and treatment group by random number table method.The control group was treated with intravenous drip of erythromycin lactobionate(intravenous drip at 20-30 mg·kg^(-1),qd).On this basis,the treatment group was treated with beclometasone dipropionate suspension for inhalation(the dose was reduced according to children's age and the maximum daily dose was no more than O.8 mg).Both groups underwent 2 weeks of continuous medication.Curative effect was compared between groups.Changes of serum immunoglobulins[immunoglobulin G(IgG),immunoglobulin A(IgA)and immunoglobulin M(IgM)],white blood cell(WBC),hemoglobin(Hb),eosinophil(EOS)count,serum adenosine deaminase(ADA)and pulmonary function[forced vital capacity(FVC),forced expiratory volume in first second(FEV1)and maximum ventilatory volume(MVV)] in the two groups after treatment were observed.The disappearance time of clinical symptoms and the incidence of adverse drug reactions were compared between groups.Results There were 75 cases in control group and 75 cases in treatment group.The total effective rates in treatment group and control group were 90.67%and 77.33%,with significant difference(P<0.05).After treatment,IgG levels in treatment group and control group were(11.55±1.73)and(9.53±1.29)g·L^(-1);IgA levels were(2.86±0.36)and(2.21±0.33)g·L^(-1);IgM levels were(1.93±0.18)and(1.24±0.16)g·L^(-1);Hb levels were(14.32±1.49)g and(11.85±1.50)g·dL^(-1);FVC were(1.97±0.32)and(1.65±0.25)L;FEV1 were(1.40±0.30)and(1.27±0.24)L;MVV were(77.13±10.28)and(72.67±11.94)L;WBC were(7.31±0.94)×10^(9)·L^(-1)and(8.91±1.43)×10^(9)·L^(-1);E0S were(0.21±0.03)×10^(9)·L^(-1)and(0.38±0.04)×10^(9)·L^(-1);ADA levels were(15.67±1.57)and(19.47±1.96)U·L^(-1);the disappearance time of cough and asthma were(6.32±1.08)and(9.91±1.03)d;the disappearance time of fever were(2.33±0.47)and(3.88±0.37)d;the disappearance time of pulmonary moist rales were(5.73±0.72)and(8.33±0.86)d;the length of hospital stay were(7.69±1.23)and(10.29±1.15)d.There were significantly different of above indexes between control group and treatment group(all P<0.05).The incidence of adverse drug reactions in treatment group and control group were 20.00%and 14.67%,with no statistical significance(P>0.05).Conclusion Erythromycin combined with beclometasone dipropionate suspension for inhalation can significantly improve the clinical effect in the treatment of children with Mpp,and effectively improve their clinical symptoms and pulmonary function.The mechanism may be that combined medication can effectively increase serum immunoglobulins and regulate the expression of WBC,EOS and ADA.