糖皮质激素辅助治疗儿童肺炎支原体大叶性肺炎的疗效

Clinical efficacy of adjuvant therapy with glucocorticoids in children with lobar pneumonia caused by Mycoplasma pneumoniae

摘要:

目的 探讨糖皮质激素辅助治疗儿童肺炎支原体大叶性肺炎的疗效。方法 108例肺炎支原体大叶性肺炎患儿随机分成常规治疗组和激素治疗组，均给予阿奇霉素及其他常规治疗，激素治疗组在此基础上给予地塞米松0.25~0.3 mg/（kg·d）静脉滴注，待体温正常后改泼尼松口服序贯治疗，剂量为0.5~1 mg/（kg·d），逐渐减量，用药总时间7~10 d。两组患儿治疗前后进行肺功能检查以及CRP、ESR、IL-2、IL-6等炎性指标的测定。结果 激素治疗组发热持续时间、咳嗽缓解时间、肺部阴影吸收时间均明显短于常规治疗组（P<0.05）。治疗后，两组患儿血清CRP、ESR、IL-2及IL-6等炎性指标均有明显改善（P<0.05），但激素治疗组较常规治疗组改善更显著（P<0.05）。两组患儿治疗前均存在不同程度的混合性通气功能障碍，激素治疗能明显改善肺功能，特别是促进小气道功能恢复。结论 糖皮质激素辅助治疗儿童肺炎支原体大叶性肺炎可有效缓解临床症状，促进肺部炎症吸收，改善肺功能。

Abstract:

Objective To study the clinical efficacy of adjuvant therapy with glucocorticoids in children with lobar pneumonia caused by Mycoplasma pneumoniae. Methods One hundred and eight children with lobar pneumonia caused by Mycoplasma pneumoniae were randomly divided into routine treatment and hormone treatment groups. Both groups were treated with azithromycin and other symptomatic therapies. In addition to the basic treatment, the hormone treatment group was given dexamethasone 0.25-0.3 mg/(kg·d) by intravenous drip until the body temperature was normal. Then given oral prednisone tablets 0.5-1 mg/(kg·d) (gradually reduced) for a total treatment course of 7-10 days. Before and after treatment pulmonary functions were examined, and serum C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), interleukin-2 (IL-2) and interleukin-6 (IL-6) were measured. Results The duration of fever, cough relief time and pulmonary shadow absorption time on chest X-ray were significantly shorter in the hormone treatment group than in the routine treatment group (P<0.05). After treatment, the two groups showed improvements in serum CRP, ESR, IL-2, and IL-6 (P<0.05), but the hormone treatment group showed significantly more improvement (P<0.05). Varying degrees of mixed ventilation dysfunction were seen in the two groups before treatment, and hormone therapy significantly improved pulmonary function, especially promoting the recovery of small airway function. Conclusions Adjuvant therapy with glucocorticoids can effectively alleviate clinical symptoms, promote the absorption of pulmonary inflammation, and improve pulmonary function in children with lobar pneumonia caused by Mycoplasma pneumoniae.