甲泼尼龙琥珀酸钠治疗儿童重症支原体肺炎的疗效及对炎症因子的影响

[收稿日期]2019-11-21　[修回日期]2020-06-12
[基金项目]国家卫生计生委医药卫生科技发展研究项目(w2016EWAH15)
[作者单位]安徽医科大学附属六安市人民医院儿科,安徽六安237005
[作者简介]汪　珊(1981-),女,副主任医师.
[文章编号]1000⁃2200(2022)01⁃0044⁃03
㊃临床医学㊃
甲泼尼龙琥珀酸钠治疗儿童
重症支原体肺炎的疗效及对炎症因子的影响
汪　珊,韦　红,李启先
[摘要]目的:探讨甲泼尼龙琥珀酸钠对比常规对症治疗儿童重症支原体肺炎的疗效及对炎性因子的影响㊂方法:选择重症支原体肺炎患儿60例,采用随机数字表法将病人分为研究组与对照组,各30例㊂对照组采用常规对症治疗,研究组在对照组基础上结合甲泼尼龙琥珀酸钠治疗㊂比较2组临床症状改善情况,治疗前后血清中白细胞介素⁃6(IL⁃6)㊁肿瘤坏死因子α(TNF⁃α)㊁干扰素γ(IFN⁃γ)及C 反应蛋白(CRP)水平㊂结果:观察组患儿退热时间㊁咳嗽消失时间㊁肺部啰音消失时间均明显短于对照组(P <0.01)㊂治疗前2组患儿CRP㊁IL⁃6㊁TNF⁃α㊁IFN⁃γ水平差异均无统计学意义(P >0.05);治疗后2组患儿CRP㊁IL⁃
6㊁TNF⁃α㊁IFN⁃γ水平均低于治疗前(P <0.05),且研究组患儿CRP㊁IL⁃6㊁TNF⁃α㊁IFN⁃γ水平均低于对照组(P <0.05~P <0.01)㊂结论:在常规对症治疗基础上给予甲泼尼龙琥珀酸钠辅助治疗,可有效改善重症支原体肺炎患儿的临床症状,促进炎性因子及CRP 水平下降,降低炎症反应,疗效显著㊂
[关键词]重症支原体肺炎;甲泼尼龙琥珀酸钠;炎性因子;儿童
[中图法分类号]R 725.6 [文献标志码]A DOI :10.13898/ki.issn.1000⁃2200.2022.01.011
Effect of methylprednisolone sodium succinate in the treatment
of severe mycoplasma pneumonia in children and its effects on inflammatory factors
WANG Shan,WEI Hong,LI Qi⁃xian
(Department of Pediatrics ,Lu′an People′s Hospital Affiliated to Anhui Medical University ,Lu′an Anhui 237005,China )
[Abstract ]Objective :To investigate the effects of methylprednisolone sodium succinate in the treatment of severe mycoplasma pneumonia,and its influence on inflammatory factors in children.Methods :Sixty children with severe mycoplasma pneumonia were divided into the study group and control group according to the random umber table method(50cases in each group).The control group was treated with conventional symptomatic treatment,while the study group was treated with methylprednisolone sodium succinate on the basis of the control group.The clinical symptoms improvement,and serum levels of interleukin⁃6(IL⁃6),tumor necrosis factor α(TNF⁃
α),interferon γ(IFN⁃γ)and C⁃reactive protein(CRP)before and after treatment were compared between two groups.Results :The time of fever abatement,cough disappearance and lung rales disappearance in study group were significantly shorter than those in control group(P <0.01).Before treatment,there was no statistical significance in the levels of CRP,IL⁃6,TNF⁃αand IFN⁃γbetween two groups(P >0.05).After treatment,the levels of CRP,IL⁃6,TNF⁃αand IFN⁃γin two groups were lower than those before treatment (P <0.05),and the levels of CRP,IL⁃6,TNF⁃αand IFN⁃γin study group were lower than those in control group(P <0.05to P <0.01).Conclusions :On the basis of routine symptomatic treatment,the adjuvant therapy of methylprednisolone sodium succinate can effectively improve the clinical symptoms,promote the decline of inflammatory factors,reduce the inflammatory response,and has significant effects in children with severe mycoplasma pneumonia.
[Key words ]severe mycoplasma pneumonian;methylprednisolone sodium succinate;inflammatory factor;child
支原体肺炎是临床上常见的儿童呼吸道疾病,是由肺炎支原体引起的急性肺部炎症,临床症状表现为咳嗽㊁发热,部分患儿经过常规对症治疗后其临床症状仍持续性加重,逐渐发展为重症肺炎,病情严重时会导致全身并发症,严重危及患儿的生命安
全[1-2]㊂研究[3]发现,甲泼尼龙琥珀酸钠在治疗肺
炎中的效果良好㊂本研究旨在探讨常规对症治疗基础上给予甲泼尼龙琥珀酸钠对儿童重症支原体肺炎的疗效及对炎性因子的影响㊂现作报道㊂1　资料与方法
1.1　一般资料　选择2017年3月至2019年8月我科收治的重症支原体肺炎患儿60例,采用随机数字表法分为观察组与对照组,各30例㊂儿童重症支原体肺炎缺乏统一的诊断标准,所选病例均参照小
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4J Bengbu Med Coll ,January 2022,Vol.47,No.1
儿重症肺炎诊断标准[4],且经颗粒凝集法检测血MP∶IgM≥1∶160,确诊近期有支原体感染㊂排除标准:(1)合并严重器质性病变者;(2)合并恶性肿瘤者;(3)中枢神经严重受损者;(4)药物过敏者;(5)中途退出研究者㊂观察组:男17例,女13例,年龄<14岁;对照组:男16例,女14例,年龄<14岁㊂2组基础资料具有可比性㊂本研究经我院伦理委员会批准,患儿家长知情同意并签订知情同意书㊂1.2　治疗方法　对照组患儿采用阿奇霉素静滴(10mg㊃kg-1㊃d-1)抗感染㊁合并细菌感染者加用β內酰胺类抗生素,止咳平喘及吸氧等常规对症治疗㊂观察组患儿在此基础上结合甲泼尼龙琥珀酸钠治疗,注射用甲泼尼龙琥珀酸钠(Pfizer Manufacturing Belgium NV;注册证号H20080284;规格40mg)静脉滴注,每日2次,每次1mg/kg,疗程5~7d㊂
1.3　观察指标　(1)记录2组患儿的退热时间及咳嗽㊁肺部啰音消失时间㊂(2)采集2组患儿治疗前后的早晨空腹静脉血5mL,3000r/min离心10min,取血清保存于-20℃冰箱中待用㊂采用ELISA法测定血清白细胞介素(IL)6㊁肿瘤坏死因子α(TNF⁃α)㊁干扰素γ(IFN⁃γ)及C反应蛋白(CRP)水平㊂
1.4　统计学方法　采用χ2检验和t检验㊂
2　结果
2.1　2组患儿临床症状改善情况比较　观察组患儿退热时间㊁咳嗽消失时间㊁肺部啰音消失时间均明显短于对照组(P<0.01)(见表1)㊂
表1　2组患儿临床症状改善情况比较(x±s)
分组n
退热
时间/d
咳嗽消失
时间/d
肺部啰音
消失时间/d
观察组30 1.40±0.75 3.31±1.28 2.27±0.69
对照组30 3.11±1.24 4.35±1.30 4.52±1.39
t 7.26 3.787.94
P <0.01<0.01<0.01 2.2　2组患儿炎性因子水平比较　治疗前2组患儿CRP㊁IL-6㊁TNF⁃α㊁IFN⁃γ水平差异均无统计学意义(P>0.05);治疗后2组患儿CRP㊁IL⁃6㊁TNF⁃α㊁IFN⁃γ水平均低于治疗前(P<0.05),且研究组患儿CRP㊁IL⁃6㊁TNF⁃α㊁IFN⁃γ水平均低于对照组(P<0.05~P<0.01)(见表2)㊂
表2　2组患儿炎性因子水平比较(x±s)分组n CRP/(mg/L)IL⁃6/(ng/L)TNF⁃α/(mg/L)IFN⁃γ/(ng/L)治疗前
　研究组3045.49±10.1517.04±2.28 2.20±0.14102.58±16.35　对照组3045.73±9.9417.23±2.09 2.21±0.17100.94±15.84 t 0.090.340.250.39 P >0.05>0.05>0.05>0.05治疗后
　研究组3012.7±3.5*7.21±0.66* 1.31±0.10*82.89±11.06*　对照组3017.4±5.7*11.32±1.07* 1.75±0.13*90.12±13.87* t 3.8517.9114.69 2.23 P <0.01<0.01<0.01<0.05 组内配对t检验:*P<0.05
3　讨论
儿童由于年龄较小,免疫力低下,导致其很容易感染肺炎支原体而发病,此时患儿的血清炎性因子表现异常[5],炎症介质学说认为支原体感染者IL⁃6㊁TNF⁃α㊁IFN⁃γ等多种炎症介质水平升高,可导致肺及肺外系统免疫损伤㊂支原体肺炎是由多种细胞特别是肥大细胞㊁嗜酸性粒细胞和T淋巴细胞参与的慢性气道炎症,在易感者中此种炎症可引起反复发作的气促,胸闷和/或咳嗽等症状,多在夜间和/或凌晨发生,气道对多种刺激因子反应性增高,但症状可自行或经治疗缓解[6]㊂支原体肺炎的形成和发作与反复呼吸道感染有关,在支原体肺炎患儿中,可存在有细菌㊁病毒㊁支原体等的特异性IgE,如果吸入相应的抗原则可激发支原体肺炎,在病毒感染后,可直接损害呼吸道上皮,致使呼吸道反应性增高,有学者[7]认为病毒感染所产生的干扰素,IL⁃1使嗜碱性粒细胞释放的组胺增多㊂
甲泼尼龙琥珀酸是一种糖皮质激素,具有受体亲和力高,抗炎作用强等优点,能够抑制机体炎性介质释放,维持溶酶体膜稳定,降低气道高反应性,改善临床症状[8]㊂本研究中,研究组临床症状退热时间㊁咳嗽消失时间㊁肺部啰音消失时间均明显短于对照组㊂这与甲泼尼龙琥珀酸具有较强的抗炎及免疫抑制作用相关,甲泼尼龙琥珀酸不仅能拮抗和抑制炎症介质的释放及实验性炎症及关节炎的反应程度,而且能抑制T细胞功能㊁延迟型变态反应㊁IL⁃1的分泌㊁裂原及抗原刺激的T细胞分裂与增殖[9]㊂本研究结果显示,研究组患儿的临床症状改善情况明显优于对照组,提示甲泼尼龙琥珀酸钠辅助治疗
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蚌埠医学院学报2022年1月第47卷第1期
能够有效改善患儿的临床症状,促进患儿退热,促进咳嗽㊁肺部啰音消失[10]㊂同时,研究组患儿治疗后的IL⁃6㊁TNF⁃α㊁IFN⁃γ及CRP水平均低于对照组,表明甲泼尼龙琥珀酸钠辅助治疗能够有效发挥抗炎作用,诱导机体抗炎因子合成,促进肺部炎症反应吸收速度加快,抑制细胞免疫,降低炎性因子水平,减轻炎症反应[11-12]㊂
综上所述,在常规对症治疗基础上予以甲泼尼龙琥珀酸钠辅助治疗,可有效改善重症支原体肺炎患儿的临床症状,促进炎性因子水平下降,降低炎症反应,疗效显著,值得推荐㊂
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