摘要
目的:探讨丙种球蛋白联合加倍剂量甲泼尼龙治疗常规剂量甲泼尼龙无效的难治性重症支原体肺炎(SMP)的临床效果。方法:采用完全随机分组法将随机列表中符合纳入标准的118例难治性SMP患者均分为两组。对照组采用阿奇霉素干混悬剂联合加倍剂量的甲泼尼龙进行治疗;观察组在对照组基础上静脉滴注400mg/(kg·d)丙种球蛋白进行治疗。对比两组临床治疗效果。测定两组患者治疗前和治疗5d后(治疗后)血清炎症因子、T淋巴细胞亚群、免疫球蛋白指标的变化情况。结果:观察组治疗后的显效率和总有效率均明显高于对照组(P<0.05)。用药治疗5d后,两组患者血清白细胞介素-6(IL-6)、IL-10、干扰素-γ(IFN-γ)、肿瘤坏死因子-α(TNF-α)、神经生长因子(NGF)均明显下降(P<0.05),外周血中CD3+和IgG、IgA、IgM水平均明显增加,CD4+/CD8+明显升高(P<0.05);组间对比,观察组IL-6、IL-10、IFN-γ、TNF-α、NGF明显低于对照组,CD3+和IgG、IgA、IgM水平高于对照组,CD4+/CD8+大于对照组(P<0.05)。结论:丙种球蛋白联合加倍剂量甲泼尼龙在常规剂量甲泼尼龙治疗无效的难治性SMP患者治疗中疗效显著,这可能与其可更好的抑制机体炎症反应,调节机体免疫平衡有关。
Objective:To investigate the clinical effect of gamma globulin combined with double-dose methylprednisolone in the treatment of refractory severe mycoplasmal pneumonia(SMP)with conventional dose of methylprednisolone.Methods:118 cases with refractory SMP who met the inclusion criteria in the randomized list were divided into 2 groups by completely randomized grouping method.The control group was treated with a dry suspension of spectinomycin combined with a double dose of methylprednisolone.The observation group was treated by intravenous infusion of 400 mg/(kg·d)gamma globulin on the basis of the control group.The clinical effects of the two groups were compared.The changes of serum inflammatory factors,T lymphocyte subsets and immunoglobulin indexes before and after treatment were measured.Results:The effective rate and total effective rate of the observation group were significantly higher than those of the control group(P<0.05).After treatment with drugs for 5 days,the levers of serum IL-6,IL-10,IFN-γ,TNF-αand NGF were significantly decreased in the two groups(P<0.05),the levels of CD 3+,IgG,IgA and IgM in peripheral blood of the two groups increased significantly,and the value of CD 4+/CD 8+increased significantly(P<0.05).Compared with the control group,the levels of IL-6,IL-10,IFN-γ,TNF-αand NGF were significantly lower than those of the control group,the levels of CD 3+and IgG,IgA and IgM were higher than those of the control group,and CD 4+/CD 8+was greater than the control group(P<0.05).Conclusion:The combination of gamma globulin and double-dose methylprednisolone was effective in the treatment of cases with refractory SMP(who received routine doses of methylprednisolone quality did not respond),which may be related to better inhibition of the body’s inflammatory response and regulation of immune balance in children.
作者
马明铭
李芳
杨慧
阿选德
MA Mingming;LI Fang;YANG Hui(Respiratory Medicine,Xining First People's Hospital(Xining 810000))
出处
《陕西医学杂志》
CAS
2019年第10期1374-1377,共4页
Shaanxi Medical Journal
关键词
支气管肺炎
药物疗法
甲泼尼龙
剂量
丙种球蛋白
疗效
机制
Bronchial pneumonia
Drug therapy
Methylprednisolone
Dose
Gamma globulin
Efficacy
Mechanism
