关键词:

甲泼尼龙, 阿奇霉素, 难治性肺炎支原体肺炎, 临床疗效, 儿童

Abstract:

Objective　To investigate the efficacy of methylprednisolone combined with azithromycin sequential therapy on pediatric refractory mycoplasma pneumoniae pneumonia (RMPP) and the effects on serum chitinase-like protein (YKL-40), amyloid A (SAA), and lung surface-active substance-associated protein-A (SP-A). Methods　A total of 126 children with RMPP recruited by Zhengzhou Ninth People's Hospital during June 2022 and June 2023 were included in the study, and were divided into a control group (azithromycin) and an observation group (methylprednisolone + azithromycin) by the random number table method, with 63 cases in each group. In the observation group, there were 33 boys and 30 girls, aged 4 to 11 (8.34±3.61) years, and the time from onset to admission was 8 to 49 (34.59±10.13) h. In the control group, there were 36 boys and 27 girls, aged 5 to 10 (8.06±3.34) years, and the time from onset to admission was 11 to 50 (34.26±10.24) h. The control group was given intravenous drip with azithromycin aspartate at a dose of 10 mg/kg once a day; after 3 days of treatment, it was changed to oral azithromycin, at a dose of 10 mg/kg, once a day, with 7 days as a course of treatment. The observation group was given methylprednisolone sodium succinate intravenous drip on the basis of the control group, the initial dose was 2 mg/kg, once a day, and the dose was adjusted to 1 mg/kg after 5 days of continuous treatment, and continued for 2 days, with 7 days as a course of treatment. Both groups were treated for 2 consecutive courses. The two groups were compared in terms of therapeutic effects, differences in serum factor levels and lung function indexes before and after treatment, and the safety was analyzed. t test and χ² test were used. Results　The total effective rate of the observation group was higher than that of the control group [95.24% (60/63) vs. 79.37% (50/63)], with a statistically significant difference (χ²=7.159, P=0.008). In the observation group, the disappearance time of cough and sputum sound, dry and wet rales, and wheezing and hospital stay were (3.24±0.78) d, (3.47±0.71) d, (5.06±1.37) d, and (3.47±0.83) d, which were shorter than (6.04±1.31) d, (5.87±1.52) d, (7.58±1.21) d, and (6.11±1.12) d in the control group, with statistically significant differences (t=14.577, 11.355, 10.943, and 15.032, all P<0.001). After treatment, the levels of forced vital capacity (FVC), forced expiratory volume in the first second (FEV₁), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), high-sensitivity C-reactive protein (hs-CRP), SAA, YKL-40, and SP-A in the observation group were (2.96±0.54) L, (2.56±0.42) L, (63.47±2.11) ng/L, (1.34±0.18) ng/L, (7.02±1.13) mg/L, (26.34±6.61) mg/L, (30.64±5.41) µg/L, and (36.07±6.58) µg/L, those in the control group were (2.02±0.51) L, (1.53±0.31) L, (123.36±2.14) ng/L, (2.69±0.22) ng/L, (9.63±1.51) mg/L, (112.35±19.54) mg/L, (36.17±5.87) µg/L, and (45.62±7.03) µg/L, with statistically significant differences (all P<0.001). Conclusion　Methylprednisolone combined with azithromycin can effectively improve the lung function and downregulate serum SAA, YKL-40, and SP-A levels in children with RMPP, which is safe and worthy of promotion.

Key words:

Methylprednisolone, Azithromycin, Refractory mycoplasma pneumoniae pneumonia, Clinical efficacy, Children