不同剂量甲泼尼龙对小儿重症支原体肺炎的疗效及安全性观察
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摘要
目的分析并比较不同剂量甲泼尼龙对小儿重症支原体肺炎的疗效、症状恢复时间及安全性的影响。方法选取112例重症支原体肺炎患儿,按照随机数字表法随机分为3组:小剂量治疗组(甲泼尼龙静脉滴注,2mg/kg·d)、大剂量治疗组(甲泼尼龙静脉滴注,10 mg/kg·d)及对照组(阿奇霉素常规治疗)。比较三组患儿的临床治疗有效率、症状恢复时间、肺部阴影吸收情况、不良反应发生率及疾病转归情况的差异。结果 (1)小剂量组治疗总有效率为91. 9%,大剂量组为97. 3%,对照组为55. 3%,小剂量组、大剂量组治疗总有效率均高于对照组(χ~2=12. 8617,18. 1595,P=0. 0003,0. 0001)。(2)三组患儿的退热时间、咳嗽缓解时间、住院时间的差异均具有统计学意义(均P <0. 05),其中大剂量组患儿的上述时间均短于其余两组(均P <0. 001)。(3)小剂量组、大剂量组患儿肺部阴影2/3吸收率均高于对照组(χ~2=12. 1191,20. 7264,均P <0. 001)。(4)两组患儿不良反应总发生率的差异无统计学意义(χ~2=0. 2741,P=0. 6006)。结论甲泼尼龙可提高重症支原体肺炎患儿治疗有效率,缩短住院时间,较大剂量甲泼尼龙效果好。
Objective To analyze and compare the effect of different doses of methylprednisolone on the efficacy,recovery time and safety in treatment of children with severe mycoplasmal pneumonia. Methods 112 children with severe mycoplasmal pneumonia were randomly divided into three groups: the small dose treatment group( intravenous infusion of methylprednisolone,2 mg/Kgod),the high-dose treatment group( intravenous infusion of methylprednisolone,10 mg/kgod) and the control group( Azithromycin conventional treatment). The difference of the clinical treatment efficiency,symptom recovery time,lung shadow absorption condition,adverse reaction rate and disease outcome in the three groups were compared. Results( 1) The total effective rate was 91. 9% in the low-dose group,97. 3% in the high-dose group,and 55. 3% in the control group. The total effective rate of the low-dose group and the high-dose group was higher than that of the control group( χ~2= 12. 8617,18. 1595,P = 0. 0003,0. 0001).( 2)There were significant differences in fever time,cough remission time and hospital stay among the three groups( P <0. 05),and the above time in the high dose group was shorter than the other two groups( both P < 0. 001).( 3) The absorption rate of 2/3 lung shadow in the low-dose group and the high-dose group was higher than that in the control group( χ~2= 12. 1191,20. 7264,both P < 0. 001).( 4) There was no significant difference in the total incidence of adverse reactions among the three groups( χ~2= 0. 2741,P = 0. 6006). Conclusion Methylprednisolone can improve the treatment efficiency of children with severe mycoplasmal pneumonia,shorten the duration of hospital stay,and the effect of larger dose of methylprednisolone is better.
Objective To analyze and compare the effect of different doses of methylprednisolone on the efficacy,recovery time and safety in treatment of children with severe mycoplasmal pneumonia. Methods 112 children with severe mycoplasmal pneumonia were randomly divided into three groups: the small dose treatment group( intravenous infusion of methylprednisolone,2 mg/Kgod),the high-dose treatment group( intravenous infusion of methylprednisolone,10 mg/kgod) and the control group( Azithromycin conventional treatment). The difference of the clinical treatment efficiency,symptom recovery time,lung shadow absorption condition,adverse reaction rate and disease outcome in the three groups were compared. Results( 1) The total effective rate was 91. 9% in the low-dose group,97. 3% in the high-dose group,and 55. 3% in the control group. The total effective rate of the low-dose group and the high-dose group was higher than that of the control group( χ~2= 12. 8617,18. 1595,P = 0. 0003,0. 0001).( 2)There were significant differences in fever time,cough remission time and hospital stay among the three groups( P <0. 05),and the above time in the high dose group was shorter than the other two groups( both P < 0. 001).( 3) The absorption rate of 2/3 lung shadow in the low-dose group and the high-dose group was higher than that in the control group( χ~2= 12. 1191,20. 7264,both P < 0. 001).( 4) There was no significant difference in the total incidence of adverse reactions among the three groups( χ~2= 0. 2741,P = 0. 6006). Conclusion Methylprednisolone can improve the treatment efficiency of children with severe mycoplasmal pneumonia,shorten the duration of hospital stay,and the effect of larger dose of methylprednisolone is better.
引文
[1]姜燕,唐红强.小剂量甲泼尼龙冲击疗法治疗小儿支原体肺炎的临床疗效及其对肿瘤坏死因子α的影响研究[J].实用心脑肺血管病杂志,2016,24(12):156-158.
[2] GARCIA-MORANTE B,SEGALES J,LOPEZ-SORIA S,et al. Induction of mycoplasmal pneumonia in experimentally infected pigs by means of different inoculation routes[J]. Vet Res,2016,47(1):54.
[3]张潮,姚宝珍.阿奇霉素联合甲泼尼龙对重症支原体肺炎患儿免疫功能及心肌酶谱的影响[J].实用医院临床杂志,2018,15(1):188-190.
[4] MIYASHITA N,NARITA M,TANAKA T,et al. Histological findings in severe Mycoplasma pneumoniae pneumonia[J]. J Med Microbiol,2017,66(5):690-692.
[5]赵淑清,赵艳荣.小剂量注射用甲泼尼龙琥珀酸钠冲击治疗对儿童难治性支原体肺炎的效果[J].医学综述,2017,23(4):798-801.
[6]张月玲.不同剂量甲泼尼龙琥珀酸钠治疗小儿重症支原体肺炎的临床效果观察[J].临床合理用药杂志,2016,9(29):60-61.
[7] SCHOTT C,CAI H,PARKER L,et al. Hydrogen peroxide production and free radical-mediated cell stress in Mycoplasma bovis pneumonia[J]. J Comp Pathol,2014,150(2/3):127-137.
[8]高春燕,贺金娥,屈晖,等.甲泼尼龙辅助治疗儿童难治性支原体肺炎60例疗效分析[J].陕西医学杂志,2014,43(1):94-95.
[9] YANG D H,REN L L,LU B B,et al. First report of severe Mycoplasma Hyorhinis Pneumonia in adult:a case report[J]. Chest,2016,149(4):A71.
[10]马晓鹏,郝婷婷,郝莉霞,等.两种剂量甲泼尼龙辅助二联抗生素治疗小儿RMPP合并肺外并发症临床研究[J].河北医药,2017,39(17):2607-2609.
[11] GUO L,LIU F,LU M P,et al. Increased T cell activation in BALF from children with Mycoplasma pneumoniae pneumonia[J]. Pediatr Pulmonol,2015,50(8):814-819.
[12]陈莉莉,刘金荣,赵顺英,等.常规剂量甲泼尼龙治疗无效的儿童难治性肺炎支原体肺炎的临床特征和治疗探讨[J].中华儿科杂志,2014,52(3):172-176.
[13] ORTIZ DE LA TABLA V,BERRUEZO M,GARCA PAYE,et al. Evaluation of the Virclia automated chemiluminescent immunoassay system for diagnosing pneumonia caused by Mycoplasma pneumoniae[J]. J Clin Lab Anal,2018,32(6):e22431.
[14] VARIPAPA R,ZEMORE Z,MILLER K. Rapid improvement of severe Mycoplasma Pneumoniae Pneumonia After Initiation of Corticosteroids[J]. Chest,2017,152(4):A105.
[15]荣杰鑫,王亚亭,李远波,等.甲泼尼龙对儿童难治性肺炎支原体肺炎疗效和安全性评价的Meta分析[J].安徽医药,2017,21(9):1688-1693.
[16] MESSACAR K,SCHREINER T L,MALONEY J A,et al. A cluster of acute flaccid paralysis and cranial nerve dysfunction temporally associated with an outbreak of enterovirus D68 in children in Colorado,USA[J]. Lancet,2015,385(9978):1662-1671.
[17] TASHIRO M,FUSHIMI K,KAWANO K,et al. Comparison of efficacy of antimicrobial agents among hospitalized patients with Mycoplasma pneumoniae pneumonia in Japan during large epidemics of macrolide-resistant M. pneumoniae infections:a nationwide observational study[J]. Clin Infect Dis,2017,65(11):1837-1842.
[18]任明星,薛国昌,沈琳娜,等.甲泼尼龙联合阿奇霉素治疗小儿难治性支原体肺炎的疗效与安全性分析[J].中国全科医学,2015,18(5):588-591.
[19] OLSON D,WATKINS L K F,DEMIRJIAN A,et al. Outbreak of Mycoplasma pneumoniae-Associated Stevens-Johnson Syndrome[J]. Pediatrics,2015,136(2):e386-e394.
[20]杨挺.小剂量激素辅助治疗小儿难治性肺炎支原体肺炎的疗效观察[J].中国医刊,2014,49(1):85-87.
[21]史晓玲,李昭,王雪君.甲泼尼龙联合丙种球蛋白对病毒性脑炎重症患儿康复进程及不良反应发生率的影响[J].中国地方病防治杂志,2017,32(7):804,806.
[2] GARCIA-MORANTE B,SEGALES J,LOPEZ-SORIA S,et al. Induction of mycoplasmal pneumonia in experimentally infected pigs by means of different inoculation routes[J]. Vet Res,2016,47(1):54.
[3]张潮,姚宝珍.阿奇霉素联合甲泼尼龙对重症支原体肺炎患儿免疫功能及心肌酶谱的影响[J].实用医院临床杂志,2018,15(1):188-190.
[4] MIYASHITA N,NARITA M,TANAKA T,et al. Histological findings in severe Mycoplasma pneumoniae pneumonia[J]. J Med Microbiol,2017,66(5):690-692.
[5]赵淑清,赵艳荣.小剂量注射用甲泼尼龙琥珀酸钠冲击治疗对儿童难治性支原体肺炎的效果[J].医学综述,2017,23(4):798-801.
[6]张月玲.不同剂量甲泼尼龙琥珀酸钠治疗小儿重症支原体肺炎的临床效果观察[J].临床合理用药杂志,2016,9(29):60-61.
[7] SCHOTT C,CAI H,PARKER L,et al. Hydrogen peroxide production and free radical-mediated cell stress in Mycoplasma bovis pneumonia[J]. J Comp Pathol,2014,150(2/3):127-137.
[8]高春燕,贺金娥,屈晖,等.甲泼尼龙辅助治疗儿童难治性支原体肺炎60例疗效分析[J].陕西医学杂志,2014,43(1):94-95.
[9] YANG D H,REN L L,LU B B,et al. First report of severe Mycoplasma Hyorhinis Pneumonia in adult:a case report[J]. Chest,2016,149(4):A71.
[10]马晓鹏,郝婷婷,郝莉霞,等.两种剂量甲泼尼龙辅助二联抗生素治疗小儿RMPP合并肺外并发症临床研究[J].河北医药,2017,39(17):2607-2609.
[11] GUO L,LIU F,LU M P,et al. Increased T cell activation in BALF from children with Mycoplasma pneumoniae pneumonia[J]. Pediatr Pulmonol,2015,50(8):814-819.
[12]陈莉莉,刘金荣,赵顺英,等.常规剂量甲泼尼龙治疗无效的儿童难治性肺炎支原体肺炎的临床特征和治疗探讨[J].中华儿科杂志,2014,52(3):172-176.
[13] ORTIZ DE LA TABLA V,BERRUEZO M,GARCA PAYE,et al. Evaluation of the Virclia automated chemiluminescent immunoassay system for diagnosing pneumonia caused by Mycoplasma pneumoniae[J]. J Clin Lab Anal,2018,32(6):e22431.
[14] VARIPAPA R,ZEMORE Z,MILLER K. Rapid improvement of severe Mycoplasma Pneumoniae Pneumonia After Initiation of Corticosteroids[J]. Chest,2017,152(4):A105.
[15]荣杰鑫,王亚亭,李远波,等.甲泼尼龙对儿童难治性肺炎支原体肺炎疗效和安全性评价的Meta分析[J].安徽医药,2017,21(9):1688-1693.
[16] MESSACAR K,SCHREINER T L,MALONEY J A,et al. A cluster of acute flaccid paralysis and cranial nerve dysfunction temporally associated with an outbreak of enterovirus D68 in children in Colorado,USA[J]. Lancet,2015,385(9978):1662-1671.
[17] TASHIRO M,FUSHIMI K,KAWANO K,et al. Comparison of efficacy of antimicrobial agents among hospitalized patients with Mycoplasma pneumoniae pneumonia in Japan during large epidemics of macrolide-resistant M. pneumoniae infections:a nationwide observational study[J]. Clin Infect Dis,2017,65(11):1837-1842.
[18]任明星,薛国昌,沈琳娜,等.甲泼尼龙联合阿奇霉素治疗小儿难治性支原体肺炎的疗效与安全性分析[J].中国全科医学,2015,18(5):588-591.
[19] OLSON D,WATKINS L K F,DEMIRJIAN A,et al. Outbreak of Mycoplasma pneumoniae-Associated Stevens-Johnson Syndrome[J]. Pediatrics,2015,136(2):e386-e394.
[20]杨挺.小剂量激素辅助治疗小儿难治性肺炎支原体肺炎的疗效观察[J].中国医刊,2014,49(1):85-87.
[21]史晓玲,李昭,王雪君.甲泼尼龙联合丙种球蛋白对病毒性脑炎重症患儿康复进程及不良反应发生率的影响[J].中国地方病防治杂志,2017,32(7):804,806.