第三代头孢菌素结合免疫球蛋白治疗小儿化脓性脑膜炎的临床疗效

Clinical efficacy of third-generation cephalosporins combined with immunoglobulins in treating pediatric purulent meningitis

摘要:

目的 探讨第三代头孢菌素结合免疫球蛋白对小儿化脓性脑膜炎的治疗效果。方法 选取2020年1月—2023年1月在山东大学齐鲁医院接受治疗的104例化脓性脑膜炎患儿。采用随机数字表法将患儿分为对照组和观察组，各52例。对照组接受头孢曲松钠治疗，观察组在对照组的基础上联合免疫球蛋白治疗，两组头孢曲松均治疗14 d，观察组免疫球蛋白治疗5 d。记录两组患儿临床疗效、症状消退时间（意识改善时间、退热时间）。比较患儿治疗前后的血清炎症因子水平［肿瘤坏死因子-α（TNF-α）、白细胞介素-1β（IL-1β）、IL-6、超敏C反应蛋白（hs-CRP）］、T细胞亚群水平（CD3⁺、CD4⁺、CD8⁺）、脑脊液生化指标（白细胞计数、糖定量、蛋白定量、神经元特异性烯醇化酶、S-100β蛋白）。结果 观察组总有效率高于对照组（P <0.05）。观察组意识改善时间和退热时间均短于对照组（P <0.05）。观察组治疗后TNF-α、IL-1β、IL-6、hs-CRP均低于对照组（P <0.05）。两组患儿治疗后TNF-α、IL-1β、IL-6、hs-CRP均低于治疗前（P <0.05）。观察组治疗前后TNF-α、IL-1β、IL-6、hs-CRP的差值均大于对照组（P <0.05）。观察组治疗后CD3⁺、CD4⁺均高于对照组（P <0.05），CD8⁺低于对照组（P <0.05）。两组患儿治疗后CD3⁺、CD4⁺均高于治疗前（P <0.05），CD8⁺低于治疗前（P <0.05）。观察组治疗前后CD3⁺、CD4⁺、CD8⁺的差值均大于对照组（P <0.05）。观察组治疗后白细胞计数、蛋白定量、NSE、S-100β均低于对照组（P <0.05），糖定量高于对照组（P <0.05）。两组患儿治疗后白细胞计数、蛋白定量、NSE、S-100β均低于治疗前（P <0.05），糖定量高于治疗前（P <0.05）。观察组治疗前后白细胞计数、糖定量、蛋白定量、NSE、S-100β的差值均大于对照组（P <0.05）。结论 头孢曲松钠结合免疫球蛋白有助于提高小儿化脓性脑膜炎的治疗效果。

Abstract:

Objective To explore the therapeutic effects of third-generation cephalosporins combined with immunoglobulins in pediatric purulent meningitis.Methods A total of 104 children with purulent meningitis treated at our hospital from January 2020 to January 2023 were selected. They were divided into a control group and an observation group using the random number table, with 52 children in each. The control group received ceftriaxone sodium, while the observation group received ceftriaxone sodium and immunoglobulin. Both groups received treatment with ceftriaxone for 14 days, while the observation group received treatment with immunoglobulin for 5 days. The clinical efficacy and symptom resolution time (time to consciousness improvement and defervescence) were recorded for the two groups of pediatric patients. The levels of serum inflammatory factors [tumor necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1β), interleukin-6 (IL-6), high-sensitivity C-reactive protein (hs-CRP) ], T cell subsets (CD3⁺, CD4⁺, CD8⁺), and cerebrospinal fluid (CSF) biochemical markers (white blood cell count, glucose quantification, protein quantification, neuron-specific enolase, S100β protein) were compared before and after treatment.Results The observation group exhibited a higher overall effective rate than the control group (P < 0.05). The observation group showed shorter times to consciousness improvement and defervescence compared with the control group (P < 0.05). After treatment, levels of TNF-α, IL-1β, IL-6, and hs-CRP were lower in the observation group than in the control group (P < 0.05). Both groups exhibited significant decreases in TNF-α, IL-1β, IL-6, and hs-CRP after treatment compared with baseline (P < 0.05). The pre- to post-treatment changes in TNF-α, IL-1β, IL-6, and hs-CRP were greater in the observation group than in the control group (P < 0.05). After treatment, the observation group had higher CD3⁺ and CD4⁺ levels and lower CD8⁺ levels compared with the control group (P < 0.05). Both groups showed increases in CD3⁺ and CD4⁺ and decreases in CD8⁺ after treatment compared with baseline (P < 0.05). The pre- to post-treatment changes in CD3⁺, CD4⁺, and CD8⁺ levels were greater in the observation group than in the control group (P < 0.05). Following treatment, the observation group also exhibited lower white blood cell counts, lower levels of total protein, NSE, and S-100β, and higher glucose levels compared with the control group (P < 0.05). Both groups showed decreases in white blood cell counts and levels of total protein, NSE, and S-100β, and increases in glucose after treatment compared with baseline (P < 0.05). The pre- to post-treatment changes in white blood cell counts and levels of glucose, total protein, NSE, and S-100β were greater in the observation group than in the control group (P < 0.05).Conclusion The combination of ceftriaxone sodium and immunoglobulin enhances the treatment efficacy of pediatric purulent meningitis.