关键词:

难治性肺炎支原体肺炎, 患儿, 支气管镜肺泡灌洗术, 甲泼尼龙, 炎症因子, 不良反应

Abstract:

 Objective　To investigate the effect of bronchoscopic alveolar lavage combined with methylprednisolone on children with refractory Mycoplasma pneumoniae pneumonia (RMPP). Methods　It was a randomized controlled trial. A total of 90 children with RMPP who were treated in Children's Hospital Affiliated to Zhengzhou University from June 2019 to August 2021 were enrolled as the research objects. They were divided into two groups by the random number table method, with 45 cases in each group. In the control group, 26 males and 19 females, aged (5.84±0.87) years, were treated with azithromycin for anti-infection; in the study group, 28 males and 17 females, aged (5.92±0.85) years, were treated with bronchoscopic alveolar lavage combined with methylprednisolone on the basis of the control group. Both groups were treated for 4 weeks. The clinical efficacy, duration of symptom disappearance, levels of inflammatory factors [C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interferon-γ (IFN-γ)], and adverse reactions were compared between the two groups. t test, χ² test, and Fisher exact probability method were used. Results　The total effective rate of the study group was 95.56% (43/45), which was higher than that of the control group [71.11% (32/45)], with a statistically significant difference (χ²=9.680, P=0.002). The disappearance time of fever, the disappearance time of lung rales, the disappearance time of cough, and the time of chest radiography returning to normal in the study group were (5.42±0.86) d, (6.85±0.49) d, (10.38±1.26) d, and (14.31±3.58) d, respectively, which were shorter than those in the control group [(9.86±0.88) d, (10.80±0.52) d, (14.57±1.37) d, and (19.67±3.69) d], with statistically significant differences (all P<0.05). After treatment, the levels of CRP [(13.21±3.27) mg/L], TNF-α [(15.82±3.61) ng/L], IL-6 [(14.46±4.83) ng/L], and IFN-γ [(7.62±0.48) ng/L] in the study group were lower than those in the control group [(28.85±4.15) mg/L, (26.49±3.59) ng/L, (37.49±4.42) ng/L, and (15.46±1.39) ng/L], with statistically significant differences (all P<0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion　The application of bronchoscopic alveolar lavage combined with methylprednisolone in the treatment of children with RMPP can effectively reduce the levels of inflammatory factors, shorten the course of disease, and obtain better clinical effects, without obvious adverse reactions, with high safety, which is worth popularizing.

Key words:

 , Refractory Mycoplasma pneumoniae pneumonia, Children, Bronchoscopic alveolar lavage, Methylprednisolone, Inflammatory factors,  , Adverse reactions