Volume 4,Issue 5
阿奇霉素联合甲泼尼龙对儿童难治性肺炎支原体肺炎外周血乳酸脱氢酶、D-二聚体的影响
目的:探究阿奇霉素联合甲泼尼龙方案,对难治性支原体肺炎患儿外周血乳酸脱氢酶及D-二聚体水平的干预效果。研究方法:选取2023年8月至12月于上海市松江区中心医院儿科住院治疗的难治性肺炎支原体肺炎患儿80例作为研究样本,通过随机数字表法将其分为对照组与观察组,每组各纳入40例患儿。对照组使用阿奇霉素治疗,观察组在阿奇霉素基础上联合甲泼尼龙治疗,比较两组患儿不良反应、临床疗效、症状消失时间、住院时间、乳酸脱氢酶、D-二聚体。结果:观察组的不良反应发生率明显低于对照组(p<0.05)。观察组热退时间、咳嗽缓解时间、相较于对照组,观察组患儿的肺部啰音消失时间、胸部X线片肺炎病灶吸收时间以及整体住院时间均更短,组间比较差异有统计学意义(P<0.05);完成规范化治疗后,观察组患儿外周血中的乳酸脱氢酶水平、D-二聚体水平均明显低于对照组,组间差异具有统计学意义(P<0.05)。结论:阿奇霉素联合甲泼尼龙治疗儿童难治性肺炎支原体疗效优于阿奇霉素单药治疗,且能更有效降低外周血乳酸脱氢酶、D-二聚体水平。
[1] 赵顺英 , 钱素云 , 陈志敏 , 等. 儿童肺炎支原体肺炎诊疗指南(2023 年版) [J]. 传染病信息, 2023, 36 (04): 291-297.
[2]Rivaya B, Jordana-Lluch E, Fernández-Rivas G, et al. Macrolide resistance and molecular typing of Mycoplasma pneumoniae infections during a 4 year period in Spain. J Antimicrob Chemother. 2020;75(10):2752-2759.
[3] 刘晓萌, 张燕北, 于海明, 等. 甲泼尼龙琥珀酸钠治疗儿童重症支原体肺炎的效果及对炎症因子的影响 [J]. 中国医药导报, 2021, 18 (29): 98-101.
[4] 罗浪,王进,曹赛红,等.PCT、CRP、NEU% 及WBC 在血流感染早期诊断中的应用研究[J]. 检验医学与临床,2023,20(23):3545-3548.
[5]Cerda-Mancillas MC, Santiago-Germán D, Andrade-Bravo B, et al. D-dimer as A Biomarker of Severity and Adverse Outcomes in Patients with Community Acquired Pneumonia. Arch Med Res. 2020;51(5):429-435.
[6]Lv J, Fan F. Efficacy of Methylprednisolone plus Azithromycin in the Treatment of RMPP and Its Effect on the Changes of T Lymphocyte Subsets [retracted in: Evid Based Complement Alternat Med. 2023 Dec 13;2023:9898404]. Evid Based Complement Alternat Med. 2022;2022:1833195.
[7]Zhu, Y.G.; Tang, X.D.; Lu, Y.T.; Zhang, J.; Qu, J.M. Contemporary Situation of Community-acquired Pneumonia in China: A Systematic Review. J. Transl. Int. Med.2018, 6, 26–31.
[8]Miyashita, N.; Kawai, Y.; Inamura, N.; Tanaka, T.; Akaike, H.; Teranishi, H.; Wakabayashi, T.; Nakano, T.; Ouchi, K.; Okimoto, N.Setting a standard for the initiation of steroid therapy in refractory or severe Mycoplasma pneumoniae pneumonia in adolescents and adults. J. Infect. Chemother. 2015, 21, 153–160.
[9]Esposito, S.; Argentiero, A.; Gramegna, A.; Principi, N. Mycoplasma pneumoniae: A pathogen with unsolved therapeutic problems.Expert Opin. Pharm. 2021, 22, 1193–1202.
[10] Mandell, L.A.; Wunderink, R.G.; Anzueto, A.; Bartlett, J.G.; Campbell, G.D.; Dean, N.C.; Dowell, S.F.; File, T.M., Jr.; Musher,D.M.; Niederman, M.S.; et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on themanagement of community-acquired pneumonia in adults. Clin. Infect. Dis. Off. Publ.Infect. Dis. Soc. Am. 2007, 44 (Suppl. S2),S27–S72.
[11] Meduri GU, Shih MC, Bridges L, et al. Low-dose methylprednisolone treatment in critically ill patients with severe community-acquired pneumonia. Intensive Care Med.2022;48(8):1009-1023.
[12] Zhang, Y.; Zhou, Y.; Li, S.; Yang, D.; Wu, X.; Chen, Z. The Clinical Characteristics and Predictors of Refractory Mycoplasma pneumoniae Pneumonia in Children. PLoSONE 2016, 11, e0156465
[13] Cerda-Mancillas MC, Santiago-Germán D, Andrade-Bravo B, et al. D-dimer as A Biomarker of Severity and Adverse Outcomes in Patients with Community Acquired Pneumonia. Arch Med Res. 2020;51(5):429-435.