静脉注射人免疫球蛋白联合雾化吸入布地奈德对小儿感染性肺炎的临床应用

Clinical application of intravenous immunoglobulin combined with budesonide nebulization in pediatric infectious pneumonia

摘要:

目的 探讨静脉注射人免疫球蛋白联合雾化吸入布地奈德治疗小儿感染性肺炎的临床疗效。方法 选取2021年2月—2024年2月在秦皇岛市妇幼保健院治疗的小儿感染性肺炎患儿82例，采用随机数字表法分为对照组41例（布地奈德雾化吸入治疗）和联合组41例（在对照组基础上静脉注射人免疫球蛋白）。对比两组患儿治疗前后的临床特征（啰音消失时间、咳嗽消失时间、住院时间）、炎症指标［白细胞介素-8（IL-8）、高敏C反应蛋白（hs-CRP）、降钙素原（PCT）］、免疫球蛋白［免疫球蛋白A（IgA）、免疫球蛋白G（IgG）、免疫球蛋白M（IgM）］水平、预后评分［急性生理与慢性健康状况评分Ⅱ（APACHE Ⅱ）、肺炎严重指数（PSI）评分］及不良反应的发生情况。结果 联合组患儿啰音消失时间、咳嗽消失时间、住院时间均短于对照组（P <0.05）。联合组治疗后PCT、hs-CRP和IL-8均低于对照组，联合组治疗前后PCT、hs-CRP和IL-8的差值均大于对照组（P <0.05）。联合组治疗后IgA、IgG和IgM均高于对照组，联合组治疗前后IgA、IgG和IgM的差值均大于对照组（P <0.05）。联合组治疗后APACHE Ⅱ评分、PSI评分均低于对照组，联合组治疗前后APACHE Ⅱ评分、PSI评分的差值均大于对照组（P <0.05）。联合组与对照组患儿不良反应总发生率比较，差异无统计学意义（P >0.05）。结论 静脉注射人免疫球蛋白联合雾化吸入布地奈德治疗能显著提高小儿感染性肺炎的治疗效果，加快症状改善，治疗安全，适合临床广泛应用。

Abstract:

Objective To investigate the clinical efficacy of intravenous immunoglobulin (IVIG) combined with budesonide nebulization in the treatment of pediatric infectious pneumonia.Methods A total of 82 pediatric patients with infectious pneumonia treated at Qinhuangdao Maternal and Child Health Hospital from February 2021 to February 2024 were randomly divided into a control group (n = 41, treated with budesonide nebulization) and a combination group (n = 41, treated with IVIG in addition to budesonide nebulization). Clinical features, inflammatory markers, immunoglobulin levels, prognostic scores, and adverse reactions were compared between the two groups before and after treatment.Results The combination group showed significantly shorter time to rale disappearance, cough resolution, and hospitalization compared to the control group (P < 0.05). Post-treatment levels of procalcitonin (PCT), high-sensitivity C-reactive protein (hs-CRP), and interleukin-8 (IL-8) were lower in the combination group, with greater reductions compared to the control group (P < 0.05). Immunoglobulin A (IgA), immunoglobulin G (IgG), and immunoglobulin M (IgM) levels were higher in the combination group after treatment, with greater increases compared to the control group (P < 0.05). Acute Physiology and Chronic Health Evaluation II (APACHE II) and Pneumonia Severity Index (PSI) scores were lower in the combination group post-treatment, with more significant reductions than the control group (P < 0.05). No statistically significant difference was found in the total incidence of adverse reactions between the two groups (P > 0.05).Conclusion Intravenous immunoglobulin combined with budesonide nebulization significantly improves the treatment efficacy of pediatric infectious pneumonia, accelerates symptom resolution, is safe, and is suitable for widespread clinical application.