摘要
目的探讨丙种球蛋白联合甲泼尼龙治疗小儿重症支原体肺炎的疗效及对免疫功能和肺功能的影响。方法选取2016年4月至2017年10月海南省第三人民医院儿科收治的126例重症支原体肺炎患儿为研究对象,依据治疗方法不同分为对照组(甲泼尼龙治疗)和观察组(甲泼尼龙联合丙种球蛋白治疗),每组63例。比较两组的治疗效果,症状、体征消失时间和住院时间,治疗前后免疫功能指标、炎症细胞因子[肿瘤坏死因子-α(TNF-α)、白细胞介素(IL)-6、IL-17、IL-33]和肺功能指标[用力肺活量(FVC)、第一秒用力呼气量(FEV_(1))、FEV_(1)/FVC]的变化及不良反应发生情况。结果观察组治疗总有效率显著高于对照组[93.65%(59/63)比76.19%(48/63)](P<0.05)。观察组退热时间、咳嗽消失时间、肺部湿啰音消失时间、哮鸣音消失时间、肺实变吸收时间和住院时间均明显短于对照组[(2.95±0.35) d比(4.45±0.73) d,(3.56±0.52) d比(6.65±0.85) d,(3.34±0.65) d比(6.28±0.86) d,(3.15±0.47) d比(6.55±0.88) d,(10.25±1.64) d比(13.95±2.45) d,(6.15±2.25) d比(10.05±3.21) d](P<0.01)。治疗前后血清CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)、IgA、IgG、IgM、TNF-α、IL-6、IL-17、IL-33以及FVC、FEV_(1)、FEV_(1)/FVC的主效应差异有统计学意义(P<0.05);不考虑测量时间,两组间上述指标的主效应差异有统计学意义(P<0.01);上述指标的时点间与组间均存在交互作用(P<0.01),且两组治疗前后上述指标的变化幅度不同。治疗后观察组胃肠道反应发生率为3.17%(2/63),对照组为6.35%(4/63),两组比较差异无统计学意义(P>0.05)。结论丙种球蛋白联合甲泼尼龙治疗小儿重症支原体肺炎的疗效显著,能够明显提高机体的细胞和体液免疫功能,减轻机体炎症反应,改善肺功能,缩短病程,改善预后。
Objective To explore the effects of gamma globulin combined with methylprednisolone on the treatment of severe mycoplasma pneumonia in children and the effects on immune function and pulmonary function.Methods A total of 126 children with severe mycoplasma pneumonia in Department of Pediatrics, Hainan Third People′s Hospital from Apr.2016 to Oct.2017 were included, and were randomly divided into a observation group and a control group, with 63 cases in each group.The control group was given methylprednisolone tablets on the basis of the basic treatment, and the observation group was given gamma globulin on the basis of the control group′s regimen.The therapeutic effect, symptom and sign disappearance time, hospitalization time, changes of immune function indexes, inflammatory cytokines[tumor necrosis factor-α(TNF-α),interleukin(IL)-6,IL-17,IL-33] and pulmonary function indexes[forced vital capacity(FVC),forced expiratory volume inthe first second(FEV_(1)),FEV_(1)/FVC] before and after treatment, as well as the incidence of adverse reactions of the two groups were compared.Results The total effective rate of the observation group was significantly higher than that of the control group[93.65%(59/63) vs 76.19%(48/63)](P<0.05).In terms of time of fever duration, cough remission, disappearance of moist rales in lungs, disappearance of wheezing, absorption of chest radiograph, and length of hospitalization in the observation group was significantly lower than the control group[(2.95±0.35) d vs(4.45±0.73) d,(3.56±0.52) d vs(6.65±0.85) d,(3.34±0.65) d vs(6.28±0.86) d,(3.15±0.47) d vs(6.55±0.88) d,(10.25±1.64) d vs(13.95±2.45) d,(6.15±2.25) d vs(10.05±3.21) d](P<0.01).There were significant differences in the main effects of serum CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+),IgA,IgG,IgM,TNF-α,IL-6,IL-17,IL-33 and FVC,FEV_(1),FEV_(1)/FVC before and after treatment(P<0.05).Without considering the measurement time, the main effects of the above indicators were statistically significantly different between the t
作者
陈海丹
张华
CHEN Haidan;ZHANG Hua(Department of Pediatrics,Hainan Third People's Hospital,Sanya 572000,China)
出处
《医学综述》
CAS
2021年第17期3525-3530,共6页
Medical Recapitulate
关键词
支原体肺炎
肺炎支原体
甲泼尼龙
丙种球蛋白
炎症反应
免疫功能
肺功能
Mycoplasma pneumonia
Mycoplasma pneumoniae
Methylprednisolone
Gamma globulin
Inflammatory response
Immune function
Lung function
