细菌溶解产物联合甲强龙对支气管肺炎患儿的疗效

doi:10.3760/cma.j.issn.1007-1245.2024.04.003

摘要/Abstract

摘要：

目的　探究细菌溶解产物联合甲强龙对支气管肺炎患儿肺功能、免疫球蛋白（Ig）、炎症因子水平的影响。方法　选取2021年4月至2023年4月许昌市人民医院收治的98例支气管肺炎患儿为研究对象，依据双色球法将其随机分为对照组（49例）、观察组（49例）。对照组男25例，女24例，年龄（7.59±1.52）岁；观察组男27例，女22例，年龄（8.01±1.72）岁。对照组给予甲强龙治疗，静脉滴注，1 mg/kg，qd，连续滴注3 d，观察组在此基础上给予细菌溶解产物胶囊治疗，3.5 mg/次，qd，每日空腹口服，连续服用10 d。比较两组临床疗效，临床症状恢复时间，治疗前后用力肺活量（FVC）、第1秒用力呼气容积（FEV₁）、最大呼气流量（PEF）、IgA、IgM、IgG、C反应蛋白（CRP）、转化生长因子-β1（TGF-β1）、肿瘤坏死因子-α（TNF-α）、白细胞介素-4（IL-4）水平及不良反应发生率。采用t检验、χ²检验。结果　治疗后观察组总有效率97.96%（48/49），高于对照组83.67%（41/49），差异有统计学意义（P<0.05）。观察组高热、咳嗽、气促及啰音恢复时间均短于对照组，差异均有统计学意义（均P<0.05）。治疗后，观察组PEF、FVC、FEV₁水平分别为（3.01±0.48）L/s、（1.56±0.22）L、（1.39±0.28）L，高于对照组的（2.72±0.39）L/s、（1.38±0.19）L、（1.23±0.18）L，差异均有统计学意义（均P<0.05）。治疗后，观察组IgA、IgM、IgG水平分别为（1.35±0.12）g/L、（1.44±0.31）g/L、（10.37±1.68）g/L，高于对照组的（1.08±0.09）g/L、（1.11±0.36）g/L、（8.35±0.79）g/L，差异均有统计学意义（均P<0.05）。治疗后，观察组TGF-β1、CRP、IL-4及TNF-α水平降低幅度大于对照组，差异均有统计学意义（均P<0.05）。两组不良反应发生率比较，差异无统计学意义（P>0.05）。结论　细菌溶解产物联合甲强龙治疗支气管肺炎患儿疗效显著，可改善肺功能，抑制炎症因子表达，提高免疫力，安全性良好。

关键词:

支气管肺炎, 儿童, 细菌溶解产物, 甲强龙, 肺功能, 免疫球蛋白

Abstract:

Objective　To investigate the effect of bacterial lysates combined with methylprednisolone on the lung function, immunoglobulin (Ig), and inflammatory factors in children with bronchopneumonia. Methods　A total of 98 children with bronchopneumonia admitted to Xuchang People's Hospital from April 2021 to April 2023 were selected as the research objects, and were randomly divided into a control group (49 cases) and an observation group (49 cases) according to the two-color sphere method. The control group included 25 boys and 24 girls, aged (7.59±1.52) years. The observation group included 27 boys and 22 girls, aged (8.01±1.72) years. The control group was given methylprednisolone treatment, intravenous infusion, 1 mg/kg, qd, continuous infusion for 3 days, and on the basis the observation group was given bacterial lysate capsules, 3.5 mg/time, qd, oral fasting daily for 10 days. The clinical efficacy, recovery time of clinical symptoms, forced vital capacity (FVC), forced expiratory volume in the first second (FEV₁), maximum expiratory flow (PEF), IgA, IgM, IgG, C-reactive protein (CRP), transforming growth factor-β1 (TGF-β1), tumor necrosis factor-α (TNF-α), and interleukin-4 (IL-4) levels before and after treatment, incidence of adverse reactions were compared between the two groups. t test and χ² test were used. Results　After treatment, the total effective rate of the observation group was 97.96% (48/49), which was higher than that of the control group [83.67% (41/49)], with a statistically significant difference (P<0.05). The recovery time of high fever, cough, shortness of breath, and rales in the observation group were shorter than those in the control group, with statistically significant differences (all P<0.05). After treatment, the PEF, FVC, and FEV₁ levels in the observation group were (3.01±0.48) L/s, (1.56±0.22) L, and (1.39±0.28) L, which were higher than those in the control group [(2.72±0.39) L/s, (1.38±0.19) L, and (1.23±0.18) L], with statistically significant differences (all P<0.05). After treatment, the levels of IgA, IgM, and IgG in the observation group were (1.35±0.12) g/L, (1.44±0.31) g/L and (10.37±1.68) g/L, which were higher than those in the control group [(1.08±0.09) g/L, (1.11±0.36) g/L, and (8.35±0.79) g/L], with statistically significant differences (all P<0.05). After treatment, the levels of TGF-β1, CRP, IL-4, and TNF-α in the observation group were decreased more than those in the control group, 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). Conclusions　Bacterial lysates combined with methylprednisolone is effective in the treatment of children with bronchopneumonia, which can improve the lung function, inhibit the expressions of inflammatory factors, and improve the immunity, with good safety.

Key words:

Bronchopneumonia, Children, Bacterial lysates, Methylprednisolone, Pulmonary function, Immunoglobulin

刘红杰李星程晓.

细菌溶解产物联合甲强龙对支气管肺炎患儿的疗效 [J]. 国际医药卫生导报, 2024, 30(4): 540-544.

Liu Hongjie, Li Xing, Cheng Xiao.

Effect of bacterial lysates combined with methylprednisolone on children with bronchopneumonia [J]. International Medicine and Health Guidance News, 2024, 30(4): 540-544.

参考文献

[1] 白冬梅,魏国烨.盐酸氨溴索辅助治疗小儿急性支气管肺炎临床疗效及安全性分析[J].贵州医药,2022,46(8):1242-1243. DOI:10.3969/j.issn.1000-744X.2022.08.040.
[2] 刘小红.疏风清肺汤联合糖皮质激素治疗慢性支气管炎的效果及对FeNO、CysLTs的影响[J].武警后勤学院学报(医学版),2021,30(11):96-98. DOI:10.16548/j.2095-3720. 2021.11.010.
[3] 孟坤,王磊,段园菊.细菌溶解产物联合阿奇霉素治疗反复儿童呼吸道感染的临床研究[J].现代药物与临床,2022,37(5):1033-1036. DOI:10.7501/j.issn.1674-5515.2022. 05.019.
[4] 江载芳,申昆玲,沈颖.诸福棠实用儿科学[M].8版.北京:人民卫生出版社,2015:1199-1200.
[5] 王贝贝,高灵红,张巧灵.布地奈德联合异丙托溴铵和特布他林雾化吸入治疗小儿支气管肺炎的临床疗效及影响因素分析[J].中国妇幼保健,2022,37(17):3218-3221. DOI:10.19829/j.zgfybj.issn.1001-4411.2022.17.032.
[6] 王晓燕,尚莉丽,刘蓉蓉.耳穴埋豆联合氨溴特罗口服液对小儿支气管肺炎患儿临床症状及生活质量的影响[J].西部中医药,2023,36(1):113-116. DOI:10.12174/j.issn.2096- 9600.2023.01.26.
[7] 秦永平.盐酸氨溴索联合阿奇霉素治疗小儿支气管肺炎的效果及其对中性粒细胞功能的影响[J].国际医药卫生导报,2018,24(14):2158-2161. DOI:10.3760/cma.j.issn.1007- 1245.2018.14.032.
[8] 李福英,曹志玲.吸入用乙酰半胱氨酸溶液治疗小儿支气管肺炎的效果分析[J].中国药物与临床,2021,21(3):435-436. DOI:10.11655/zgywylc2021.03.032.
[9] 汪珊,韦红,李启先.甲泼尼龙琥珀酸钠治疗儿童重症支原体肺炎的疗效及对炎症因子的影响[J].蚌埠医学院学报,2022,47(1):44-46. DOI:10.13898/j.cnki.issn.1000-2200. 2022.01.011.
[10] 杨斯博.细菌溶解产物联合沙美特罗替卡松在支气管哮喘患儿中的应用效果[J].中国微生态学杂志,2020,32(6):669-673. DOI:10.13381/j.cnki.cjm.202006011.
[11] Ferrara F, Rial A, Suárez N, et al. Polyvalent bacterial lysate protects against pneumonia independently of neutrophils, IL-17A or caspase-1 activation[J]. Front Immunol, 2021, 12:562244. DOI: 10.3389/fimmu.2021. 562244.
[12] 傅大干,李海霞,周伟,等.细菌溶解产物防治儿童迁延性细菌性支气管炎疗效研究[J].临床肺科杂志,2022,27(9):1312-1316. DOI:10.3969/j.issn.1009-6663.2022.09.004.
[13] 郑世嵘,徐慧,陈莹,等.甲强龙联合BAL对儿童重症支原体肺炎的疗效[J].西南国防医药,2020,30(7):647-650. DOI:10.3969/j.issn.1004-0188.2020.07.014.
[14] 陈玉,冯标婵,钟李英,等.清金化痰益肺汤在治疗支气管肺炎中的应用价值及对呼吸功能的影响[J].中华中医药学刊,2021,39(8):251-254. DOI:10.13193/j.issn.1673-7717. 2021.08.061.
[15] 朱云芳,彭林强,薛满,等.血清25羟维生素D、免疫球蛋白水平与小儿支气管肺炎严重程度及转归的关系研究[J].海南医学,2022,33(20):2661-2664. DOI:10.3969/j.issn.1003-6350.2022.20.021.
[16] 那飞扬,郭琪,张蓉芳.维生素AD联合细菌溶解产物胶囊对支气管哮喘患儿的疗效及免疫功能的影响[J].中国处方药,2021,19(7):14-16. DOI:10.3969/j.issn.1671- 945X.2021.07.007.
[17] 吴晓旭.泛福舒联合丙酸倍氯米松雾化吸入治疗支气管哮喘急性发作期患儿的效果[J].中国医药导报,2020,17(3):102-105.
[18] 王玲莉,瞿色华,王德志.布地奈德、异丙托溴铵联合沙丁胺醇雾化吸入治疗小儿支气管肺炎的效果及对TGF-β1、CRP的影响[J].湖南师范大学学报(医学版),2021,18(4):230-233. DOI:10.3969/j.issn.1673-016X.2021.04.067.
[19] 刘乐,王君霞,甘新茹,等.布地奈德雾化联合氨溴索治疗小儿支气管肺炎疗效及对血清CRP PCT水平的影响[J].河北医学,2023,29(4):681-685. DOI:10.3969/j.issn.1006- 6233.2023.04.031.
[20] Ye J, Ye H, Wang M, et al. Total serum IL-6 and TNF-C levels in children with bronchopneumonia following treatment with methylprednisolone in combination with azithromycin[J]. Am J Transl Res, 2021, 13(8):9458-9464.
[21] 黎鸣桃,黄淑芹,张可妃,等.细菌溶解产物胶囊联合布地奈德雾化吸入治疗对咳嗽变异性哮喘患儿免疫功能、气道功能的影响[J].临床和实验医学杂志,2023,22(2):175-179. DOI:10.3969/j.issn.1671-4695.2023.02.019.
[22] 靳倩,李淑芳.细菌溶解产物胶囊辅助治疗支气管哮喘急性发作期患儿的效果[J].河南医学研究,2021,30(28):5322-5325. DOI:10.3969/j.issn.1004-437X.2021.28.045.