甲泼尼龙冲击疗法治疗儿童难治性肺炎支原体肺炎的疗效及对血清TNF-α、sB7-H3和G-CSF水平的影响

Efficacy of Methylprednisolone Pulse Therapy in Treatment of Refractory Mycoplasma Pneumoniae Pneumonia in Children and Its Effect on Serum TNF-α,sB7-H3 and G-CSF Levels

目的探讨甲泼尼龙冲击疗法治疗儿童难治性肺炎支原体肺炎(RPMM)的疗效及对血清肿瘤坏死因子-α(TNF-α)、可溶性B7同源体3(sB7-H3)和粒细胞集落刺激因子(G-CSF)的影响。方法选取2018年1月至2021年10月昆明市儿童医院收治的100例RPMM患儿作为研究对象,根据甲泼尼龙的不同治疗剂量分为对照组和观察组,各50例。对照组和观察组均在常规治疗的基础上分别给予甲泼尼龙常规剂量[2 mg/(kg·d)]和冲击剂量[20 mg/(kg·d)]静脉注射治疗,持续用药3 d。比较两组的临床疗效、症状/体征改善情况(完全退热时间、肺内啰音消失时间、咳嗽缓解时间、胸部X线片阴影吸收时间)、住院时间、免疫功能指标(CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+))、促炎性细胞因子(TNF-α、sB7-H3和G-CS)水平变化,及不良反应发生情况。结果观察组的总有效率高于对照组[92.0%(46/50)比82.0%(41/50)](P<0.01)。观察组的完全退热时间、胸部X线片阴影吸收时间和住院时间均短于对照组[(3.6±0.8)d比(5.0±0.4)d、(8.1±2.4)d比(11.0±2.1)d、(10.7±1.2)d比(14.1±0.9)d](P<0.05或P<0.01)。治疗后,两组患儿的CD3^(+)、CD4^(+)和CD4^(+)/CD8^(+)均升高,且观察组高于对照组[(45.43±2.03)%比(39.70±1.98)%、(38.12±2.52)%比(31.59±2.24)%、1.98±0.58比1.80±0.35](P<0.05或P<0.01)。与治疗前相比,治疗后两组患儿的血清TNF-α、sB7-H3和G-CSF水平均下降,且观察组低于对照组[(26.38±0.16)μg/L比(36.54±0.13)μg/L、(3.26±1.82)ng/L比(5.15±1.14)ng/L、(6.16±2.01)μg/L比(8.87±1.94)μg/L](P<0.05或P<0.01)。两组的总不良反应发生率比较差异无统计学意义(P>0.05)。结论与常规小剂量相比,冲击剂量甲泼尼龙可显著降低RMPP患儿的血清TNF-α、sB7-H3和G-CSF表达水平,减轻炎症反应,提高疗效,且安全性较好。

Objective To investigate the effect of methylprednisolone pulse therapy on children with refractory mycoplasma pneumoniae pneumonia(RPMM)and the effects on serum levels of tumor necrosis factor-α(TNF-α),soluble B7 homologue 3(sB7-H3)and granulocyte colony-stimulating factor(G-CSF).Methods A total of 100 children with RPMM admitted to Kunming Children′s Hospital from Jan.2018 to Oct.2021 were included,and divided into an observation group and a control group according to different treatment doses of methylprednisolone,with 50 cases in each group.Both groups were given intravenous methylprednisolone at low dose[2 mg/(kg·d)]and impulse dose[20 mg/(kg·d)]on the basis of conventional treatment,with continuous medication for 3 days.The clinical efficacy,symptoms/signs improvement(time of complete fever relief,time of lung rale disappearance,time of cough relief,time of chest X-ray shadow absorption),hospital stay,changes in levels of immune function indicators(CD3^(+),CD4^(+),CD4^(+)/CD8^(+)),inflammatory cytokines(TNF-α,sB7-H3 and G-CS),and occurrence of adverse reactions of the two groups were compared.Results The total curative effect of the observation group was higher than that of the control group[92.0%(46/50)vs 82.0%(41/50)](P<0.01).The observation group had shorter complete fever relief time,chest X-ray shadow absorption time,and hospitalization time than the control group[(3.6±0.8)d vs(5.0±0.4)d,(8.1±2.4)d vs(11.0±2.1)d,(10.7±1.2)d vs(14.1±0.9)d](P<0.05 or P<0.01).After treatment,the levels of CD3^(+),CD4^(+),and CD4^(+)/CD8^(+)in both groups increased,and the observation group was higher than the control group[(45.43±2.03)%vs(39.70±1.98)%,(38.12±2.52)%vs(31.59±2.24)%,1.98±0.58 vs 1.80±0.35](P<0.05 or P<0.01).Compared with before treatment,the levels of serum TNF-α,sB7-H3 and G-CSF of both groups after treatment decreased,and the observation group was lower than the control group[(26.38±0.16)μg/L vs(36.54±0.13)μg/L,(3.26±1.82)ng/L vs(5.15±1.14)ng/L,(6.16±2.01)μg/L vs(8.87±1.94)μg/L](P<0.05).There was no statistically significant difference in the total incidence of adverse reactions between the two groups(P>0.05).Conclusion Compared with the conventional low dose,the impulse dose of methylprednisolone can significantly reduce the expression levels of serum TNF-α,sB7-H3 and G-CSF in children with RMPP,reduce the inflammatory response,improve the efficacy,and have a good safety.