甲泼尼龙在儿童难治性支原体肺炎治疗中的临床分析

摘要

Objective To investigate the clinical efficacy of different dose of methylpred-nisolone for children with refractory Mycoplasma pneumoniae pneumonia ( RMPP ) . Methods Ninety children with RMPP, who were admitted to our hospital between September 2013 and August 2015, were allocated randomly into 3 groups: control group (antibiotics treatment, n=30), low dose methylprednisolone group [methylprednisolone 2 mg/(kg·d) and antibiotics, n=30], high dose methylprednisolone group [methylprednisolone 10 mg/(kg·d) and antibiotics, n=30]. Days that fever and respiratory symptom ( cough) recovery, length of hospitalization, chest CT or X ray recovery and adverse drug reactions were compared among the 3 groups. Results The symptom re-covery days and hospitalization days were shorter in the methylprednisolone groups than those in the control group;high dose methylprednisolone group were shorter than the low dose methylprednisolo-ne group. The differences were statistically significant ( P<0. 05 ) . After 2-weeks treatment, 20 ( 66. 7﹪) children in the high dose methylprednisolone group showed inflammation absorption in the iconography, while 16 (53. 3﹪) in the low dose methylprednisolone group, 5 (16. 7﹪) in the con-trol group ( P<0. 05 ) . There were no severe adverse events. Conclusion Methylprednisolone showed well efficacy in the treatment of the children with refractory Mycoplasma pneumoniae pneu-monia, high dose 10 mg/( kg·d) therapy was more effective than low dose 2 mg/( kg·d) therapy, with no more adverse drug reactions.%目的：探讨分析不同剂量甲泼尼龙在儿童难治性支原体肺炎( refractory Mycoplasma pneumoniae pneumonia,RMPP)治疗中的作用。方法选取2013年9月—2015年8月儿科住院的RMPP 90例,随机分为小剂量治疗组、大剂量治疗组、对照组,每组各30例,对照组给予抗支原体等常规治疗,治疗组在常规治疗的基础上分别加用小剂量甲泼尼龙2 mg/( kg·d)及大剂量甲泼尼龙10 mg/( kg·d),比较3组热退时间、咳嗽缓解时间、住院时间、胸部影像学改变及不良反应。结果2个治疗组患儿热退时间、咳嗽缓解时间、住院时间较对照组均明显缩短,大剂量治疗组较小剂量治疗组缩短更明显,差异均有统计学意义( P＜0.05)；治疗2周时复查胸部影像学,小剂量治疗组16例(53.3﹪)炎症大部分吸收,大剂量治疗组20例(66.7﹪)炎症大部分吸收,对照组5例(16.7﹪)炎症大部分吸收,2个治疗组与对照组比较差异有统计学意义(P＜0.05)；治疗组患儿均未发生严重不良反应。结论小儿RMPP治疗中,在常规治疗基础上,联合应用短期大剂量或小剂量甲泼尼龙均可缩短大部分患儿的热退时间、咳嗽缓解时间及住院时间,提高胸部影像学炎症吸收率,且未见严重不良反应；而应用甲泼尼龙大剂量与小剂量相比,两者总有效率无明显差异,但在热退时间、咳嗽缓解时间、缩短住院时间、提高胸部影像学炎症吸收率方面,前者较后者具有显著优势。