低剂量甲泼尼龙琥珀酸钠对重症支原体肺炎患儿T淋巴细胞亚群及炎症因子水平的影响

Effects of low dose methylprednisolone sodium succinate on T lymphocyte subsets and inflammatory factors in children with severe mycoplasma pneumonia

摘要:

目的 研究低剂量甲泼尼龙琥珀酸钠对重症支原体肺炎患儿T淋巴细胞亚群及炎症因子水平的影响。方法 选取2019年1月—2022年1月长江大学附属荆州医院收治的100例重症支原体肺炎患儿为研究对象，按照随机数字表法将其分为观察组和对照组，每组50例。对所有患儿进行平喘、止咳化痰等对症治疗，对照组在该基础上静脉滴注阿奇霉素，第1天剂量为10 mg/kg，第2～5天剂量为5 mg/kg，5 d为1个疗程，共2个疗程；观察组在对照组基础上采用低剂量甲泼尼龙琥珀酸钠静脉滴注，第1～2天剂量为1.5～2.0 mg/kg，1次/d，第3天调整剂量为1 mg/kg，之后1周内逐渐降低剂量至停药为止。比较两组临床疗效、临床症状改善时间、治疗前后T淋巴细胞亚群（CD4⁺、CD8⁺、CD4⁺/CD8⁺）、治疗前后血清炎症因子［C反应蛋白（CRP）、肿瘤坏死因子-α（TNF-α）、白细胞介素-10（IL-10）］水平，观察并记录两组不良反应发生情况。结果 观察组治疗总有效率高于对照组（P <0.05）；观察组肺部啰音消失时间、喘息消失时间、咳嗽减轻时间、肺部阴影消失时间短于对照组（P <0.05）；观察组治疗前后CD4⁺、CD8⁺、CD4⁺/CD8⁺的差值高于对照组（P <0.05）；观察组治疗前后CRP、TNF-α、IL-10的差值高于对照组（P <0.05）；两组不良反应总发生率比较，差异无统计学意义（P >0.05）。结论 低剂量甲泼尼龙琥珀酸钠联合阿奇霉素治疗重症支原体肺炎患儿有利于缩短各项症状改善时间，并可改善患儿免疫功能紊乱、减轻炎症反应，疗效较好、安全性较高。

Abstract:

Objective To study the effects of low dose methylprednisolone sodium succinate on T lymphocyte subsets and inflammatory factors in children with severe mycoplasma pneumonia.Methods A total of 100 children with severe mycoplasma pneumonia admitted to our hospital from January 2019 to January 2022 were selected as the research objects, and divided into observation group and control group by random number table method, with 50 cases in each group. All the children were treated with antiasthmatic, antitussive, and sputum treatment. The control group was given azithromycin intravenically on the basis of antiasthmatic, antitussive, and sputum treatment. The first day dose was 10mg/kg, the second to the fifth day dose was 5 mg/kg, and the fifth day was a course of treatment, two courses in total. Observation group and control group were treated with low-dose methylprednisolone sodium succinate intravenous drip on the basis of 1.5 to 2.0 mg /kg in the 1st to 2nd day, once a day, the adjusted dose was 1mg/kg in the 3rd day, and the dose was gradually reduced within 1 week until the drug was stopped. Clinical efficacy, improvement time of various clinical symptoms, levels of T lymphocyte subsets (CD4⁺, CD8⁺, CD4⁺/CD8⁺) before and after treatment, and levels of serum inflammatory factors [C-reactive protein (CRP), tumor necrosis factor -α (TNF-α), interleukin-10 (IL-10) ] before and after treatment were compared between the two groups. The adverse reactions of the two groups were observed and recorded.Results The total effective rate of the observation group was higher than that of the control group (P < 0.05). The rales disappearance time, wheezing disappearance time, cough reduction time, and X-ray lung shadow disappearance time in the observation group were shorter than those in the control group (P < 0.05). The differences of CD4⁺, CD8⁺, and CD4⁺/CD8⁺ in the observation group were higher than those in the control group (P < 0.05). The differences of CRP, TNF-α and IL-10 in the observation group before and after treatment were higher than those in the control group (P < 0.05). There was no significant difference in the incidence of adverse reactions between observation group and control group (P > 0.05).Conclusion Low-dose methylprednisolone sodium succinate combined with azithromycin in the treatment of children with severe mycoplasma pneumonia is beneficial to shorten the time for the improvement of symptoms, and can improve the immune dysfunction of children, reduce inflammatory response, with good efficacy and high safety.