Abstract:

Objective　To study the improvement effect of methylprednisolone on serum Periostin, galectin-3 (Gal-3), and stromal cell derived factor-1 (SDF-1) in children with severe pneumonia (SP) and the influencing factors of therapeutic effect. Methods　A total of 103 children with SP who were admitted to Ankang Central Hospital from May 2020 to May 2023 were selected, and were randomly divided into a coordination group (51 cases) and a azithromycin group (52 cases) according to the order of admission. In the azithromycin group, there were 37 boys and 15 girls, the age was (6.84±1.56) years old, the course of disease was (5.15±1.27) d, and the species of pathogenic bacteria were (1.50±0.42). In the coordination group, there were 35 boys and 16 girls, the age was (6.78±1.55) years old, the course of disease was (5.11±1.24) d, and the species of pathogenic bacteria were (1.48±0.41). The azithromycin group was treated with intravenous drip with 10 mg/kg of azithromycin once a day, and the coordination group was treated with intravenous drip with 1-2 mg/kg of methylprednisolone once a day on the basis of azithromycin. Both groups received continuous administration for 7 days. The efficacy, symptom disappearance time, and serum Periostin, Gal-3, and SDF-1 levels were compared between the two groups. Univariate analysis (t test and χ² test) and multivariate logistic regression analysis were used to identify the influencing factors of treatment ineffectiveness in SP children. Results　The total effective rate of the coordination group was higher than that of the azithromycin group [88.24% (45/51) vs. 63.46% (33/52)] (χ²=8.597, P=0.003). The disappearance time of cough, fever, and lung rales in the coordination group were shorter than those in the azithromycin group [(4.61±0.82) d vs. (7.08±1.24) d, (3.20±0.56) d vs. (5.19±0.87) d, (5.09±1.34) d vs. (7.12±1.80) d] (t=11.900, 13.774, and 6.482, all P<0.001). After treatment, the levels of serum Periostin, Gal-3, and SDF-1 in both groups were lower than those before treatment, and those in the coordination group were lower than those in the azithromycin group [(71.34±10.40) ng/L vs. (92.51±18.56) ng/L, (12.35±2.71) ng/L vs. (20.84±3.49) ng/L, (132.58±21.77) ng/L vs. (170.49±30.61) ng/L] (t=7.122, 13.771, and 7.231, all P<0.001). Multivariate logistic regression analysis confirmed that the lesion involving multiple lung lobes, pathogen species >1, and no methylprednisolone treatment were all risk factors for treatment failure in SP children (all P<0.05). Conclusions　Methylprednisolone is effective in the treatment of SP children, and can down-regulate the levels of serum Periostin, Gal-3, and SDF-1. The influencing factors of its curative effect include lesion involving multiple lung lobes, pathogen species >1, and no methylprednisolone treatment.

Key words:

Methylprednisolone, Azithromycin, Severe pneumonia, Periostin, Galectin-3, Stromal cell derived factor 1, Children

摘要：

目的　研究甲泼尼龙对重症肺炎患儿血清骨膜蛋白、半乳糖凝集素-3（Gal-3）、基质细胞衍生因子-1（SDF-1）的改善作用及疗效影响因素。方法　选取安康市中心医院2020年5月至2023年5月收治的103例重症肺炎患儿，将其以入院先后次序单双号随机分为阿奇霉素组（52例）、配合组（51例）。阿奇霉素组男37例、女15例，年龄（6.84±1.56）岁，病程（5.15±1.27）d，致病菌种类（1.50±0.42）种；配合组男35例、女16例，年龄（6.78±1.55）岁，病程（5.11±1.24）d，致病菌种类（1.48±0.41）种。阿奇霉素组予以阿奇霉素治疗，剂量10 mg/kg，给药方式为静脉滴注，给药频率为1次/d；配合组则在阿奇霉素组的基础上联合甲泼尼龙治疗，甲泼尼龙剂量1～2 mg/kg，给药方式为静脉滴注，给药频率为1次/d。两组均持续给药7 d。对比两组疗效、症状消失时间、血清骨膜蛋白、Gal-3、SDF-1水平。以单因素分析（采用t检验、χ²检验）、多因素logistic回归分析明确重症肺炎患儿治疗无效的影响因素。结果　配合组治疗总有效率高于阿奇霉素组［88.24%（45/51）比63.46%（33/52）］（χ²=8.597，P=0.003）。配合组的咳嗽、发热及肺部啰音消失时间均短于阿奇霉素组［（4.61±0.82）d比（7.08±1.24）d、（3.20±0.56）d比（5.19±0.87）d、（5.09±1.34）d比（7.12±1.80）d］（t=11.900、13.774、6.482，均P<0.001）。治疗后两组血清骨膜蛋白、Gal-3、SDF-1水平均低于治疗前，且配合组均低于阿奇霉素组［（71.34±10.40）ng/L比（92.51±18.56）ng/L、（12.35±2.71）ng/L比（20.84±3.49）ng/L、（132.58±21.77）ng/L比（170.49±30.61）ng/L］（t=7.122、13.771、7.231，均P<0.001）。多因素logistic回归分析证实，病变累及多个肺叶、致病菌种类>1种及未接受甲泼尼龙治疗均是重症肺炎患儿治疗无效的危险因素（均P<0.05）。结论　甲泼尼龙治疗重症肺炎患儿的效果较佳，可下调血清骨膜蛋白、Gal-3、SDF-1水平。其疗效影响因素包括病变累及多个肺叶、致病菌种类>1种及未接受甲泼尼龙治疗。

关键词:

甲泼尼龙, 阿奇霉素, 重症肺炎, 骨膜蛋白, 半乳糖凝集素-3, 基质细胞衍生因子-1, 儿童