奥司他韦与帕拉米韦治疗儿童流感病毒性肺炎的临床效果比较

Clinical comparison of oseltamivir with peramivir in treatment of infantile influenza virus pneumonia

目的 探讨奥司他韦和帕拉米韦治疗儿童流感病毒性肺炎的临床效果及不良反应发生情况。方法 选取2022年12月至2023年12月张家港市第五人民医院收治的120例流感病毒性肺炎患儿,抽签随机分为观察组(n=60)和对照组(n=60)。两组患儿均进行常规治疗,同时,观察组加用帕拉米韦,对照组加用奥司他韦,治疗5 d后,比较两组患儿的临床疗效、临床相关指标(体温恢复时间、咳嗽消失时间、肺部啰音消失时间、住院时间及用药成本)、免疫功能指标(CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+))、炎症因子[白细胞介素-6(IL-6)、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)]水平及不良反应发生情况。结果 观察组总有效率91.67%(55/60)高于对照组85.00%(51/60),差异无统计学意义(χ^(2)=1.294,P>0.05);观察组治疗后用药成本、CD4^(+)、CD4^(+)/CD8^(+)分别为(685.55±125.76)元、(38.01±2.76)%、(1.54±0.52),高于对照组[(157.85±24.86)元、(34.88±2.62)%、(1.32±0.36)],差异具有统计学意义(t=31.886,P<0.01;t=6.371,P<0.01;t=2.694,P<0.01);观察组体温恢复时间、咳嗽消失时间、肺部啰音消失时间、住院时间、CD8^(+)、TNF-α、CRP、IL-6分别为(2.68±0.87) d、(9.01±1.25) d、(6.57±0.75) d、(7.75±1.55) d、(24.76±1.54)%、(6.34±1.57) ng·L^(-1)、(5.18±1.24) mg·L^(-1)、(11.58±2.04) ng·L^(-1),均短于或少于对照组[分别为:(4.78±1.06) d、(11.46±1.57) d、(10.75±1.74) d、(12.76±1.88) d、(26.88±1.65)%、(9.48±2.35) ng·L^(-1)、(6.62±1.64) mg·L^(-1)、(14.03±3.16) ng·L^(-1)],差异具有统计学意义(t=11.862,P<0.01;t=9.456,P<0.01;t=17.088,P<0.01;t=15.927,P<0.01;t=7.276,P<0.01;t=8.606,P<0.01;t=5.425,P<0.01;t=5.046,P<0.01);观察组和对照组的不良反应发生率分别为15.00%(9/60)和13.33%(8/60),差异无统计学意义(χ^(2)=0.069,P>0.05)。结论 奥司他韦和帕拉米韦治疗儿童流感病毒性肺炎均可获得良好效果,安全性好,但帕拉米韦可快速缓解患儿症状,有效改善免疫炎症反应,用药成本偏高。

Objective To compare oseltamivir with peramivir in treatment of infantile influenza virus pneumonia.Methods A total of 120 children with influenza virus pneumonia admitted to Zhangjiagang Fifth People's Hospital from December 2022 to December 2023 were randomly divided into the observation and control group,with 60 in each group.In addition to routine treatment,the patients in the observation group were given peramivir and those in the control were given oseltamivir.The therapeutic effect,clinical indexes and changes in the immune function indexes(CD4^(+),CD8^(+),CD4^(+)/CD8^(+))and inflammatory factors(interleukin-6(IL-6),CRP,tumor necrosis factor-α(TNF-α))were compared between the two groups.The occurrence of adverse reactions was also compared.Results The total response rate in the observation group was 91.67%(55/60)and that in the control was 85.00%(51/60),demonstrating no significant difference(χ^(2)=1.294,P>0.05).The drug cost and levels of CD4^(+)and CD4^(+)/CD8^(+)in the observation group were(685.55±125.76)yuan,(38.01±2.76)%and(1.54±0.52),respectively,which were significantly higher than those of(157.85±24.86)yuan,(34.88±2.62)%and(1.32±0.36)in the control.The difference was statistically significant(t=31.886,P<0.01,t=6.371,P<0.01,t=2.694,P<0.01).Body temperature recovery time,cough disappearance time,lung rales disappearance time,hospital stay and the levles of CD8^(+),TNF-α,CRP,IL-6 were(2.68±0.87)d,(9.01±1.25)d,(6.57±0.75)d,(7.75±1.55)d,(24.76±1.54)%,(6.34±1.57)ng·L^(-1),(5.18±1.24)mg·L^(-1) and(11.58±2.04)ng·L^(-1),respectivley in the observation group.They were significantly shorter than or less than those of(4.78±1.06)d,(11.46±1.57)d,(10.75±1.74)d,(12.76±1.88)d,(26.88±1.65)%,(9.48±2.35)ng·L^(-1),(6.62±1.64)mg·L^(-1),(14.03±3.16)ng·L^(-1) in the control(t=11.862,P<0.01,t=9.456,P<0.01,t=17.088,P<0.01,t=15.927,P<0.01,t=7.276,P<0.01,t=8.606,P<0.01,t=5.425,P<0.01,t=5.046,P<0.01).The incidence of adverse reactions was 15.00% (9/60) in the observation group, which was slightly higher than that of 13.33% (8/60) in the control (χ^(2)=0.069, P>0.05). Conclusion Oseltamivir is comparable to peramivir in the treatment of pediatric influenza virus pneumonia. However, peramivir can shorten the time to symptom improvement and better improve immune function and inflammation levels besides the high cost.