阿奇霉素联合孟鲁司特钠治疗小儿支原体肺炎的临床观察

摘要

目的 探讨阿奇霉素联合孟鲁司特钠治疗支原体肺炎患儿的疗效及对免疫功能和C反应蛋白的影响.方法 选取2016年1月至2017年4月于青海省西宁市第三人民医院和青海省妇女儿童医院就诊的92例支原体肺炎患儿为研究对象,随机分为观察组和对照组.对照组治疗采用阿奇霉素(按10mg·kg —1·d—1加入5% 葡萄糖溶液中静脉滴注,当患儿体温恢复正常后,按10mg·kg —1·d—1口服阿奇霉素干混悬剂),观察组在对照组的基础上联合使用孟鲁司特钠(不足6岁的患儿每次服用4mg,6岁及以上的患儿每次服用5mg),比较两组的临床疗效、免疫功能及C反应蛋白(CRP)的变化情况.结果 观察组与对照组的总有效率比较差异有统计学意义(χ2=5.209,P<0.001).治疗前,观察组与对照组在CD4+、CD8+、CD4+/CD8+水平上的差异均无统计学意义(均 P>0.05);治疗后,观察组和对照组的CD4+、CD4+/CD8+水平均显著高于治疗前(t值分别为8.109、3.295、6.204、2.381,均 P<0.05),但观察组的CD4+、CD4+/CD8+水平均高于对照组(t值分别为5.360、4.989,均 P<0.05);治疗后,观察组和对照组的CD8+水平均显著低于治疗前(t值分别为10.235、6.924,均 P<0.05),但观察组的CD8+水平较对照组更低,差异有统计学意义(t=5.623,P<0.05).治疗前,观察组与对照组在IgA、IgG、IgM 水平上的差异均无统计学意义(均 P>0.05);治疗后,观察组和对照组的IgA、IgM水平均显著低于治疗前(t值分别为3.527、3.038、3.039、2.026,均 P<0.05),但观察组的IgA、IgM水平较对照组更低(t值分别为5.562、5.826,均 P<0.05);治疗后,观察组和对照组的IgG均高于治疗前(t值分别为3.819、3.218,均 P<0.05),但观察组的IgG水平较对照组更高,差异有统计学意义(t=6.210,P<0.05).治疗前,两组的CRP水平差异无统计学意义(P>0.05);治疗后,观察组和对照组的CRP水平均显著低于治疗前(观察组治疗前后比较 t=23.657、对照组治疗前后比较 t= 15.428,均 P< 0.05),但观察组的 CRP 水平较对照组更低,差异有统计学意义(t= 21.120,P< 0.05).结论 阿奇霉素联合孟鲁司特钠可有效改善支原体肺炎患儿的免疫功能,减轻炎症反应,从而降低CRP水平.%Objective To investigate the efficacy of azithromycin combined with montelukast sodium in treatment of children with mycoplasma pneumonia and its influence on immune function and C reactive protein(CRP).Methods A total of 92 children with mycoplasma pneumonia treated in Third People's Hospital of Xining City and Qinghai Women's and Children's Hospital from January 2016 to April 2017 were selected as study subjects,and they were randomly divided into observation group and control group.Patients in the control group were treated with azithromycin[10mg/(kg.d)administered intravenously with 5% glucose solution,and 10mg/(kg.d)azithromycin suspension administered orally when body temperature restored to normal],and children in the observation group were treated with montelukast sodium(4mg each time for children under 6 and 5mg for children aged 6 and older)based on the treatment received by the control group.Clinical efficacy,immune function and changes of CRP were compared between two groups.Results Difference in total effective rate between the observation group and the control group was statistically significant(χ2=5.209,P<0.001).Before treatment there were no significant differences in CD4+,CD8+and CD4+/CD8+levels between two groups(all P>0.05).CD4+and CD4+/CD8+levels in two groups after treatment were significantly higher than those before treatment(t value was 8.109,3.295,6.204 and 2.381 respectively,all P<0.05),and CD4+and CD4+/CD8+levels in the observation group were higher than those in the control group(t value was 5.360 and 4.989,respectively,P<0.05).CD8+level in two groups after treatment was significantly lower than that before treatment(t value was 10.235 and 6.924 respectively,both P< 0.05),but CD8+in the observation group was lower than that in the control group after treatment and difference had statistical significance(t=5.623,P<0.05).Before treatment,there were no significant differences in IgA,IgG and IgM between two groups(all P> 0.05).Levels of IgA and IgM after treatment in both groups were lower than those before treatment(t value was 3.527,3.038,3.039 and 2.026 respectively,all P<0.05),but levels of IgA and IgM in the observation group were lower than those in the control group after treatment(t value was 5.562 and 5.826,respectively,both P<0.05).IgG in two groups after treatment was significantly higher than that before treatment(t value was 3.819 and 3.218,respectively,both P<0.05),but IgG in the observation group was higher than that in the control group after treatment(t=6.210,P<0.05).Before treatment difference in CRP level between two groups was not statistically significant(P>0.05).After treatment,CRP level in two groups was lower than that before treatment(t value was 23.657 and 15.428,respectively,both P<0.05),but the level of CRP in the observation group was lower than that in the control group after treatment(t = 21.120,P < 0.05).Conclusion Azithromycin combined with montelukast sodium can effectively improve the immune function of children with mycoplasma pneumonia and reduce inflammatory response,thereby reducing CRP level.