Effects of
alveolar lavage combined with dexamethasone on pulmonary function and serum
inflammatory factors in children with lobar pneumonia

doi:10.3760/cma.j.issn.1007-1245.2022.06.016

Abstract

Abstract: Objective　To observe the effects of alveolar lavage combined with dexamethasone on pulmonary function and serum inflammatory factors in children with lobar pneumonia. Methods　A total of 50 children with lobar pneumonia in Children's Hospital Affiliated to Zhengzhou University from July 2017 to February 2021 were selected retrospectively and were divided into two groups according to the treatment plans. In the control group (24 cases), there were 10 females and 14 males, aged (6.97±1.02) years; in the combined group, there were 11 females and 15 males, aged (7.27±1.28) years. The control group was treated with dexamethasone, and the combined group was treated with alveolar lavage on the basis of the control group. The treatment effect, symptom relief time, length of hospital stay, and pulmonary function and serum inflammatory factors levels before and after treatment were compared between the two groups. The measurement data were compared between groups by independent sample t test, paired t test within groups, and the count data by χ² test. Results　There was no statistically significant difference in the total effective rate between the combined group and the control group [92.31% (24/26) vs. 70.83% (17/24)] (P>0.05). The antipyretic time [(4.18±1.67) d], cough relief time [(7.22±2.50) d], lung wet rales disappearance time [(8.53±1.84) d], large patchy shadow dissipation time [(8.11±2.34) d], and length of hospital stay [(9.18±2.37) d] in the combined group were shorter than those in the control group [(7.25±3.84) d, (10.38±4.25) d, (12.20±3.78) d, (11.95±3.62) d, and (12.69±4.05) d] (all P<0.01). After 7 days of treatment, the forced expiratory volume in one second (FEV₁) [(1.38±0.30) L], peak expiratory flow (PEF) [(4.09±0.96) L/s], and forced vital capacity (FVC) [(1.55±0.28) L] in the combined group were higher than those in the control group [(1.13±0.25) L, (3.35±0.85) L/s, and (1.26±0.32) L] (all P<0.01); the serum soluble intercellular adhesion molecule 1 (sICAM-1) [(15.31±3.29) μg/L], interleukin 6 [(5.19±1.37) pg/ml], and high mobility group protein B1 (HMGB1) levels [(60.35±15.62) μg/L] in the combined group were lower than those in the control group [(24.11±5.82) μg/L, (8.64±3.06) pg/ml, and (73.84±20.67) μg/L] (all P<0.05). Conclusion　Alveolar lavage combined with dexamethasone is helpful to reduce inflammatory reaction in children with lobar pneumonia, improve pulmonary function, and shorten symptom relief time and length of hospital stay.

Key words: Alveolar lavage, Dexamethasone, Lobar pneumonia, Pulmonary function, Soluble intercellular adhesion molecule 1, High mobility group protein B1

摘要： 目的　观察肺泡灌洗术联合地塞米松对大叶性肺炎患儿肺功能及血清炎性因子的影响。方法　回顾性选取2017年7月至2021年2月郑州大学附属儿童医院大叶性肺炎患儿50例，根据治疗方案不同分为2组。对照组（24例）女10例，男14例，年龄（6.97±1.02）岁；采用地塞米松治疗。联合组（26例）女11例，男15例，年龄（7.27±1.28）岁；在对照组基础上联合肺泡灌洗术。比较2组治疗效果、症状缓解时间、住院天数、治疗前后肺功能、血清炎性因子水平。计量资料组间行独立样本t检验、组内行配对t检验，计数资料行χ²检验。结果　联合组总有效率92.31%（24/26）与对照组70.83%（17/24）比较差异无统计学意义（P>0.05）。联合组退热时间（4.18±1.67）d、咳嗽减轻时间（7.22±2.50）d、肺部湿啰音消失时间（8.53±1.84）d、大片状影消散时间（8.11±2.34）d及住院天数（9.18±2.37）d短于对照组（7.25±3.84）d、（10.38±4.25）d、（12.20±3.78）d、（11.95±3.62）d、（12.69±4.05）d（均P<0.01）。联合组治疗7 d后第1秒用力呼气容积（FEV₁）（1.38±0.30）L、最高呼气流量（PEF）（4.09±0.96）L/s、用力肺活量（FVC）（1.55±0.28）L高于对照组（1.13±0.25）L、（3.35±0.85）L/s、（1.26±0.32）L（均P<0.01）；联合组治疗7 d后血清可溶性细胞间黏附分子1（sICAM-1）（15.31±3.29）μg/L、白细胞介素6（IL-6）（5.19±1.37）pg/ml、高迁移率族蛋白B1（HMGB1）（60.35±15.62）μg/L低于对照组（24.11±5.82）μg/L、（8.64±3.06）pg/ml、（73.84±20.67）μg/L（均P<0.05）。结论　肺泡灌洗术联合地塞米松有助于减轻大叶性肺炎患儿炎性反应，提高肺功能，缩短症状缓解时间、住院天数。

关键词: 肺泡灌洗术, 地塞米松, 大叶性肺炎, 肺功能, 可溶性细胞间黏附分子1, 高迁移率族蛋白B1

Sun Shuangshuang.

Effects of alveolar lavage combined with dexamethasone on pulmonary function and serum inflammatory factors in children with lobar pneumonia [J]. International Medicine and Health Guidance News, 2022, 28(6): 800-804.

孙爽爽. 肺泡灌洗术联合地塞米松对大叶性肺炎患儿肺功能及血清炎性因子的影响[J]. 国际医药卫生导报, 2022, 28(6): 800-804.

References

[1] 廖笑玲,吴亮.地塞米松辅助治疗小儿大叶性肺炎的临床疗效及对炎症因子、血沉的影响[J].中华全科医学,2017,15(5):817-819. DOI:10.16766/j.cnki.issn.1674-4152. 2017.05.027.

[2] de Benedictis FM, Kerem E, Chang AB, et al. Complicated pneumonia in children[J]. Lancet, 2020, 396(10253):786-798. DOI: 10.1016/S0140-6736(20)31550-6.

[3] 徐俊梅,史大伟,李雪华,等.儿童肺炎支原体感染大叶性肺炎的危险因素分析[J].中国医刊,2020,55(5):567-569. DOI:10.3969/j.issn.1008-1070.2020.05.030.

[4] 楚玉波.糖皮质激素治疗儿童肺炎支原体大叶性肺炎的价值[J].河北医药,2018,40(7):1077-1079. DOI:10.3969/j.issn.1002-7386.2018.07.030.

[5] 张世坤,赵轲.血清炎症相关因子检测在小儿大叶性肺炎中的临床意义[J].临床肺科杂志,2019,24(5):835-838. DOI:10.3969/j.issn.1009-6663.2019.05.015.

[6] 于畅,张晗,尚云晓.儿童难治性肺炎支原体肺炎支气管肺泡灌洗液细胞因子检查意义及与血清C反应蛋白相关性研究[J].国际儿科学杂志,2019,46(11):845-851. DOI:10.3760/cma.j.issn.1673-4408.2019.11.017.

[7] 李燕妮,徐旭,张根.地塞米松治疗小儿支原体感染致大叶性肺炎的疗效[J].安徽医学,2020,41(1):88-91. DOI:10.3969/j.issn.1000-0399.2020.01.027.

[8] Qiu JL, Huang L, Shao MY, et al. Efficacy and safety of azithromycin combined with glucocorticoid on refractory Mycoplasma pneumoniae pneumonia in children: a PRISMA-compliant systematic review and meta-analysis[J]. Medicine (Baltimore), 2020, 99(22):e20121. DOI: 10.1097/MD.0000000000020121.

[9] 谢紫阳,赵光宇,田恬.外周血淋巴细胞亚群及血清细胞因子水平与大叶性肺炎患儿预后及转归的相关性[J].临床和实验医学杂志,2021,20(18):1994-1998. DOI:10.3969/j.issn.1671-4695.2021.18.025.

[10] Yang DY, Lu BT, Shi TT, et al. Total and double-stranded DNA-specific immunoglobulin E in bronchoalveolar lavage fluid of children with human adenovirus pneumonia[J]. J Infect Chemother, 2020, 26(9):986-991. DOI: 10.1016/j.jiac.2020.04.024.

[11] 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,2015:1253-1288.

[12] 方丹枫.阿奇霉素联合小剂量糖皮质激素治疗儿童大叶性肺炎的临床疗效[J].中国妇幼保健,2018,33(1):127-128. DOI:10.7620/zgfybj.j.issn.1001-4411.2018.01.45.

[13] 邓群花,王润青.甲泼尼龙联合阿奇霉素对小儿大叶性肺炎患儿血清炎性因子水平的影响[J].实用临床医药杂志,2019,23(17):75-78. DOI:10.7619/jcmp.201917021.

[14] Florin TA, Ambroggio L, Brokamp C, et al. Biomarkers and disease severity in children with community-acquired pneumonia[J]. Pediatrics, 2020, 145(6):e20193728. DOI: 10.1542/peds.2019-3728.

[15] Same RG, Amoah J, Hsu AJ, et al. The association of antibiotic duration with successful treatment of community-acquired pneumonia in children[J]. J Pediatric Infect Dis Soc, 2021, 10(3):267-273. DOI: 10.1093/jpids/piaa055.

[16] 张志梅.头孢曲松钠针联合阿奇霉素针对儿童大叶性肺炎的疗效[J].山西医药杂志,2019,48(17):2153-2155. DOI:10.3969/j.issn.0253-9926.2019.17.028.

[17] 龚春华,刘芳.293例儿童肺炎支原体肺炎的临床分析[J].同济大学学报(医学版),2020,41(3):331-337. DOI:10.16118/j.1008-0392.2020.03.011.

[18] 吴冰霞,张丽,章伟,等.肺炎支原体感染性大叶性肺炎儿童耐药突变位点测定及临床分析[J].中国实用儿科杂志,2020,35(8):626-630. DOI:10.19538/j.ek2020080614.

[19] 李维丽.小剂量糖皮质激素辅助治疗儿童大叶性肺炎的效果及对临床体征、细胞因子水平的影响[J].罕少疾病杂志,2020,27(3):19-21. DOI:10.3969/j.issn.1009-3257.2020. 03.008.

[20] 唐亚飞,季开拓,马勇.糖皮质激素联合纤维支气管镜灌洗治疗大叶性肺炎患儿疗效及对血浆T淋巴细胞免疫球蛋白和炎症因子的影响[J].河北医学,2021,27(5):742-746. DOI:10.3969/j.issn.1006-6233.2021.05.09.

[21] 李海霞,赵秋霞,王立和.糖皮质激素短期疗法联合阿奇霉素对肺炎支原体感染大叶性肺炎患儿症状改善及炎症反应的影响[J].中国药物与临床,2020,20(22):3800-3801. DOI:10.11655/zgywylc2020.22.040.

[22] 吴灵君,朱雯蘋,孔文婷,等.理肺通络合剂联合地塞米松注射液对支原体肺炎免疫指标的影响研究[J].中华中医药学刊,2018,36(12):3039-3042. DOI:10.13193/j.issn.1673- 7717.2018.12.056.

[23] 张红,王立珍,岳妍秋.福多司坦联合地塞米松治疗HAP患者的效果及对血清Ang Ⅱ、FeNO水平的影响[J].国际医药卫生导报,2019,25(11):1803-1806. DOI:10.3760/cma.j.issn.1007-1245.2019.11.038.

[24] 庞华.地塞米松联合肺泡灌洗术治疗大叶性肺炎患儿的疗效及其对血清可溶性细胞间黏附分子1、基质金属蛋白酶抑制因子1的影响[J].儿科药学杂志,2020,26(3):24-28. DOI:10.13407/j.cnki.jpp.1672-108X.2020.03.008.

[25] 王敏,王枫岭.糖皮质激素联合纤维支气管镜灌洗对大叶性肺炎患儿炎症反应的影响[J].儿科药学杂志,2019,25(11):8-12. DOI:10.13407/j.cnki.jpp.1672-108X.2019.11.003.

[26] Qu X, Xu Z, Lin X. Effects of different doses of methylprednisolone on TNF-α, IL-6, and IL-13 in serum and bronchoalveolar lavage fluid of children with severe mycoplasma pneumoniae pneumonia[J]. J Biol Regul Homeost Agents, 2020, 34(5):1889-1895. DOI: 10.23812/20-317-L.

[27] 高永伟,刘庆,胡玉玲,等.麻杏石甘汤联合电子支气管镜肺泡灌洗术治疗对儿童大叶性肺炎炎症因子和肺功能的影响[J].海南医学,2020,31(16):2092-2095. DOI:10.3969/j.issn.1003-6350.2020.16.014.

[28] 曹可,常桂芬,高曼,等.儿童大叶性肺炎严重程度与血浆D-二聚体的相关性[J].中国妇幼保健,2018,33(3):592-594. DOI:10.7620/zgfybj.j.issn.1001-4411.2018.03.39.

[29] Mojtabavi H, Saghazadeh A, Rezaei N. Interleukin-6 and severe COVID-19: a systematic review and meta-analysis[J]. Eur Cytokine Netw, 2020, 31(2):44-49. DOI: 10.1684/ecn.2020.0448.

[30] 左玉,王震文,王栋,等.血清MCP-1、sTREM-1、sICAM-1在肺炎患儿表达水平及其与病情严重程度的相关性分析[J].标记免疫分析与临床,2019,26(7):1186-1189,1195. DOI:10.11748/bjmy.issn.1006-1703.2019.07.025.

[31] Chen L, Long X, Xu Q, et al. Elevated serum levels of S100A8/A9 and HMGB1 at hospital admission are correlated with inferior clinical outcomes in COVID-19 patients[J]. Cell Mol Immunol, 2020, 17(9):992-994. DOI: 10.1038/s41423-020-0492-x.

Effects of alveolar lavage combined with dexamethasone on pulmonary function and serum inflammatory factors in children with lobar pneumonia

肺泡灌洗术联合地塞米松对大叶性肺炎患儿肺功能及血清炎性因子的影响

Knowledge

Abstract

Cite this article

share this article

References

Related Articles 1

Recommended Articles

Metrics