标题：甲泼尼龙联合布地奈德治疗小儿支原体肺炎的疗效及对患儿心肌酶指标和炎症因子水平的影响

      作者：李洪，熊超，王胜刚，周银    安康市人民医院儿科，陕西 安康 725000

      卷次： 2023年34卷12期

      【摘要】 目的 观察甲泼尼龙联合布地奈德治疗小儿支原体肺炎(MPP)的疗效，并探讨其对患儿心肌酶指标和炎症因子水平的影响。方法 选取2020年 1月至2022年 1月安康市人民医院收治的98例MPP患儿为研究对象，按随机数表法分为观察组和对照组各49例。对照组患儿应用布地奈德气雾剂治疗，观察组患儿在对照组治疗的基础上予以甲泼尼龙注射治疗，疗程为7 d。比较两组患儿治疗后的疗效、临床症状积分改善时间、住院时间以及治疗前后的心肌酶指标[谷草转氨酶(AST)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)]和炎症因子水平[白细胞介素-6 (IL-6)、γ-干扰素(IFN-γ)、C反应蛋白(CRP)、肿瘤坏死因子α (TNF-α)]，并比较两组患儿治疗期间的不良反应发生情况。结果 治疗后，观察组患儿的治疗总有效率为95.92%，明显高于对照组的75.21%，差异有统计学意义(P<0.05)；观察组患儿的发热、咳嗽、肺部啰音、肺部阴影等症状的改善时间及住院时间明显短于对照组，差异均有统计学意义(P<0.05)；治疗7 d后，两组患儿的AST、CK、CK-MB、LDH指标均较治疗前明显下降，且观察组分别为(26.39±2.25) U/L、(107.48±2.49) U/L、(26.51±3.59) U/L、(230.37±22.16) U/L，明显低于对照组的(31.44±2.27) U/L、(128.12±2.68) U/L、(37.45±4.43) U/L、(259.44±27.22) U/L，差异均有统计学意义(P<0.05)；治疗7 d后，两组患儿的 IL-6、IFN-γ、CRP、TNF-α水平较治疗前均明显下降，且观察组分别为(13.28±5.44) pg/mL、(16.49±1.33) ng/L、(19.25±4.21) mg/L、(43.87±5.23) pg/mL，明显低于对照组的(21.73±8.57) pg/mL、(20.51±1.29) ng/L、(13.84±3.26) mg/L、(51.06±5.35) pg/mL，差异均有统计学意义(P<0.05)；治疗期间，观察组患儿的总不良反应发生率为10.20%，略高于对照组的6.12%，但差异无统计学意义(P>0.05)。结论 甲泼尼龙联合布地奈德治疗小儿MPP的疗效显著，能在更短时间内改善其临床症状，降低心肌酶表达和炎症因子水平，安全性可靠。
      【关键词】 儿童；支原体肺炎；布地奈德；甲泼尼龙；心肌酶；炎症因子；疗效
      【中图分类号】 R725.6 【文献标识码】 A 【文章编号】 1003—6350（2023）12—1732—05

Efficacy of methylprednisolone combined with budesonide in the treatment of children with Mycoplasmapneumoniae pneumonia and the influence on myocardial enzymes and inflammatory factors.
LI Hong, XIONGChao, WANG Sheng-gang, ZHOU Yin. Department of Pediatrics, Ankang People's Hospital, Ankang 725000, Shaanxi,CHINA
【Abstract】 Objective To observe the efficacy of methylprednisolone combined with budesonide in the treat-ment of children with Mycoplasma pneumoniae pneumonia (MPP), and investigate the influence on myocardial enzymesand inflammatory factors. Methods A total of 98 children with MPP admitted to Ankang People's Hospital from Janu-ary 2020 to January 2022 were selected as the research subjects and divided into an observation group and a controlgroup by random number table method, with 49 cases in each group. Children in the control group were treated withbudesonide aerosol, and those in the observation group were treated with methylprednisolone injection on the basis ofthe treatment of control group. Both groups received 7 d of treatment. Efficacy, improvement time of clinical symptoms,length of hospital stay, the levels of myocardial enzymes [aspartate aminotransferase (AST), creatine kinase (CK), cre-atine kinase isoenzyme (CK-MB), and lactate dehydrogenase (LDH)], and inflammatory factors [interleukin-6 (IL-6), in-terferon-gamma (IFN-γ), C-reactive protein (CRP), and tumor necrosis factor α (TNF-α)], and the incidence of adversereactions during treatment were compared between the two groups. Results The total treatment response rate in the ob-servation group was 95.92%, significantly higher than 75.21% in the control group (P<0.05). The improvement time offever, cough, lung rales, and lung shadows in the observation group was significantly shorter than that in the controlgroup (P<0.05). After 7 d of treatment, the levels of AST, CK, CK-MB, and LDH in the two groups decreased, and lev-els in the observation group were (26.39±2.25) U/L, (107.48±2.49) U/L, (26.51±3.59) U/L, and (230.37±22.16) U/L, sig-nificantly lower than (31.44±2.27) U/L, (128.12±2.68) U/L, (37.45±4.43) U/L, and (259.44±27.22) U/L in the controlgroup (P<0.05). After 7 d of treatment, the levels of IL-6, IFN-γ, CRP, and TNF-α in the two groups decreased, and lev-els in the observation group were (13.28±5.44) pg/mL, (16.49±1.33) ng/L, (19.25±4.21) mg/L, and (43.87±5.23) pg/mL,significantly lower than (21.73±8.57) pg/mL, (20.51±1.29) ng/L, (13.84±3.26) mg/L, and (51.06±5.35) pg/mL in thecontrol group (P<0.05). The total incidence of adverse reactions in the observation group (10.20%) was slightly high-er than that in the control group (6.12%), with no statistically significant differences (P>0.05). Conclusion Methyl-prednisolone combined with budesonide is effective in the treatment of children with MPP, which can improve clini-cal symptoms in a shorter time and lower the levels of myocardial enzymes and inflammatory factors. Besides, it issafe and reliable.
      【Key words】 Child; Mycoplasma pneumoniae pneumonia; Budesonide; Methylprednisolone; Myocardial enzyme;Inflammatory factor; Efficacy