摘要
目的探讨甲泼尼松龙联合免疫球蛋白治疗难治性小儿肺炎支原体肺炎(refractory mycoplasma pneumoniae pneumonia,RMPP)疗效及对炎症因子及免疫功能的影响。方法选取徐州医科大学附属徐州儿童医院2019年12月至2021年12月收治的180例RMPP患儿,按照随机数字表法分成对照组和研究组,每组90例,所有患儿均给予阿奇霉素和免疫球蛋白治疗,基础上对照组给予1~2 mg/(kg·d)甲泼尼松龙治疗,研究组给予10~12 mg/(kg·d)甲泼尼松龙治疗,对比对照组和研究组患儿治疗前后临床疗效、临床症状变化、炎症因子、T淋巴细胞表面分子表达及不良反应发生情况。结果研究组患儿咳嗽消失时间、肺啰音消失时间及发热消失时间少于对照组[d:(7.20±2.20)比(11.41±3.30)、(5.21±1.50)比(8.12±1.63)、(2.20±0.61)比(3.80±0.90),t值分别为8.41、10.49、11.74,P值均<0.05]。研究组治疗总有效率高于对照组[n(%):88(88.89)比65(72.22),χ2=8.01,P<0.05)]。治疗后,对照组和研究组红细胞沉降率(erythrocyte sedimentation rate,ESR)、C反应蛋白(C-reactive protein,CRP)、白细胞介素(interleukin-4,IL)-4、干扰素-γ(interferon-γ,IFN-γ)、IL-17和IL-18与治疗前比较均明显降低,差异均具有统计学意义[mm/h:(13.42±3.20)比(15.81±4.70)、mg/L:(12.91±2.92)比(16.62±4.02)、pg/mL:(23.54±3.63)比(29.32±4.53)、(26.21±3.50)比(33.40±3.70)、(13.40±2.21)比(20.22±2.83)、(25.42±3.71)比(30.30±4.50),t值分别为5.63、6.43、6.96、6.57、6.68、6.63,P值均<0.05]。与治疗前对比,治疗后对照组和研究组患儿血清可溶性CD4明显升高、CD8明显降低,但研究组比对照组变化更显著[%:(35.54±2.73)比(31.43±2.32)、(3.20±0.80)比(4.40±0.90),t值分别为7.35、7.91,P值均<0.05]。对照组和研究组不良反应率差异无统计学意义(P>0.05)。结论大剂量甲泼尼松龙联合免疫球蛋白治疗RMPP患儿的疗效更佳,可改善患儿病情,降低炎症因子水平、提高患儿机体免疫功能。
Objective To explore the therapeutic effect of methylprednisolone combined with immunoglobulin in the treatment of refractory mycoplasma pneumonia(RMPP)and the impact on inflammatory factors and immune function.Methods A total of 180 children with RMPP admitted to Xuzhou Children's Hospital affiliated with Xuzhou Medical University from December 2019 to December 2021 were selected.According to the random number table method,the patients were divided into a control group and a study group,with 90 cases in each group.All patients were treated with azithromycin and immunoglobulin.On this basis,the control group was treated with 1~2 mg/(kg·d)methylprednisolone,while the study group was treated with 10~12 mg/(kg·d).The clinical efficacy,clinical symptom changes,inflammatory factors,T lymphocyte surface molecules,and adverse reactions before and after treatment were compared.Results The disappearance time of cough,lung rales,and fever in the study group was shorter than that in the control group[d:(7.20±2.20)vs(11.41±3.30),(5.21±1.50)vs(8.12±1.63),(2.20±0.61)vs(3.80±0.90),t values were 8.41,10.49,11.74,all P values<0.05].The total effective rate of treatment in the research group was higher than that in the control group[n(%):88(88.89)vs 65(72.22),χ2=8.01,P<0.05)].After treatment,the erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),interleukin(IL)-4,interferon-γ(IFN-γ),IL-17 and IL-18 of two groups were significantly reduced compared to before treatment.After treatment,all indicators in the study group were lower than those in the control group[mm/h:(13.42±3.20)vs(15.81±4.70),mg/L:(12.91±2.92)vs(16.62±4.02),pg/mL:(23.54±3.63)vs(29.32±4.53),(26.21±3.50)vs(33.40±3.70),(13.40±2.21)vs(20.22±2.83),(25.42±3.71)vs(30.30±4.50),t values were 5.63,6.43,6.96,6.57,6.68,6.63,all P values<0.05].Compared with before treatment,after treatment,the serum soluble CD4 in both groups of children were significantly increased,while CD8 were significantly decreased.The study group was more significant than the control group[%:(35.54±2.73)vs(31.43±2.32),(3.20±0.80)vs(4.40±0.90),t values were 7.35,7.91,both P values<0.05].There was no statistically significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion The combination of high-dose methylprednisolone and immunoglobulin has a better therapeutic effect on children with RMPP,which can significantly improve their condition,reduce the levels of inflammatory factors and inhance immune function.
作者
闵婕
郭斐
刘怀彬
MIN Jie;GUO Fei;LIU Huaibin(Xuzhou Children's Hospital Affiliated to Xuzhou Medical University,Xuzhou 221006,China)
出处
《国际免疫学杂志》
CAS
2024年第2期155-161,共7页
International Journal of Immunology
基金
徐州市科研计划项目(KC19170)。
关键词
甲泼尼松龙
免疫球蛋白
肺炎支原体肺炎
炎症因子
Methylprednisolone
Immunoglobulin
Mycoplasma pneumoniae pneumonia
Inflammatory factor
作者简介
通信作者:刘怀彬,Email:82902176@qq.com,电话:13921796837。
