不同剂量甲泼尼龙联合肺泡灌洗对小儿重症支原体肺炎的疗效观察

Observation on the efficacy of different doses of methylprednisolone combined with bronchoalveolar lavage on severe mycoplasma pneumonia in children

摘要:

目的 探讨不同剂量甲泼尼龙联合肺泡灌洗对小儿重症支原体肺炎的疗效。方法 本研究为前瞻性随机对照试验。选取2022年6月—2024年8月陕西省人民医院收治的重症支原体肺炎患儿154例，均接受甲泼尼龙联合肺泡灌洗治疗。将患儿分为低剂量组49例［1 mg/（kg·d）］、中剂量组54例［2 mg/（kg·d）］、高剂量组51例［4 mg/（kg·d）］。观察各组患儿的疗效、肺功能指标［第1秒用力呼气量（FEV₁）、用力肺活量（FVC）、呼吸峰流速（PEF）］、血清炎症因子［肿瘤坏死因子α（TNF-α）、C反应蛋白（CRP）、白细胞介素-6（IL-6）］及不良反应发生情况。结果 高剂量组的治疗总有效率高于低剂量组（P <0.05）。高剂量组治疗后FEV₁、FVC、PEF均高于低剂量组（P <0.05）。高剂量组治疗前后FEV₁、FVC、PEF的差值均大于低剂量组（P <0.05），中剂量组大于低剂量组（P <0.05）。高剂量组治疗后TNF-α、CRP、IL-6水平均低于中剂量组（P <0.05），中剂量组低于低剂量组（P <0.05）。高剂量组治疗前后TNF-α、CRP、IL-6的差值均大于低剂量组（P <0.05），中剂量组大于低剂量组（P <0.05）。低、中、高剂量组的不良反应总发生率比较，差异无统计学意义（P >0.05）。结论 在重症支原体肺炎患儿中，与1 mg/（kg·d）剂量相比，4 mg/（kg·d）剂量的甲泼尼龙联合肺泡灌洗在提高总有效率、改善肺功能（FEV₁、FVC、PEF）和降低炎症因子（TNF-α、CRP、IL-6）水平的短期疗效更好，且在本研究观察期内未显著增加不良反应发生率。

Abstract:

Objective To explore the efficacy of different doses of methylprednisolone combined with bronchoalveolar lavage on severe mycoplasma pneumonia in children.Methods Prospective randomized controlled trial. A total of 154 children with severe mycoplasma pneumonia admitted to Shaanxi Provincial People's Hospital from June 2022 to August 2024 were selected, all of whom received treatment with methylprednisolone combined with bronchoalveolar lavage. The children were divided into a low-dose group of 49 cases [1 mg/(kg·d) ], a medium-dose group of 54 cases [2 mg/(kg·d) ], and a high-dose group of 51 cases [4 mg/(kg·d) ]. The efficacy, pulmonary function indicators (FEV₁, FVC, PEF), serum inflammatory factors (TNF-α, CRP, IL-6) and the occurrence of adverse reactions were observed in each group.Results The total effective rate in the high-dose group was higher than that in the low-dose group (P < 0.05). After treatment, FEV₁, FVC, and PEF in the high-dose group were higher than those in the low-dose group (P < 0.05). The differences in FEV₁, FVC, and PEF before and after treatment were greater in the high-dose group than in the low-dose group, and greater in the medium-dose group than in the low-dose group (P < 0.05). After treatment, TNF-α, CRP, and IL-6 levels in the high-dose group were lower than those in the medium-dose group, and lower in the medium-dose group than in the low-dose group (P < 0.05). The differences in TNF-α, CRP, and IL-6 before and after treatment were greater in the high-dose group than in the low-dose group, and greater in the medium-dose group than in the low-dose group (P < 0.05). There was no statistically significant difference in the incidence of adverse reactions among the low-, medium-, and high-dose groups (P > 0.05).Conclusion In children with severe mycoplasma pneumonia, compared to a dose of 1 mg/(kg·d), a dose of 4 mg/(kg·d) of methylprednisolone combined with bronchoalveolar lavage demonstrated more significant short-term efficacy in improving the overall response rate, enhancing pulmonary function (FEV₁, FVC, PEF), and reducing levels of inflammatory factors (TNF-α, CRP, IL-6), without significantly increasing the incidence of adverse reactions during the observation period of this study.