丙种球蛋白在儿童重症支原体肺炎治疗中的应用及对补体、心肌酶谱的影响

目的研究阿奇霉素联合丙种球蛋白治疗儿童重症支原体肺炎的疗效及其对血清补体水平、心肌酶谱及患儿生活质量的影响,探讨其在儿童重症支原体肺炎治疗中的临床意义。方法选择舟山市妇女儿童医院儿科2016年7月至2020年6月住院接受治疗的重症支原体肺炎患儿144例,根据随机数字法分为对照组(阿奇霉素治疗)和观察组(阿奇霉素联合丙种球蛋白治疗),每组72例患儿。治疗前后,测定患儿血清补体C3、C4水平和心肌酶肌酸激酶同工酶(CK-MB)、肌酸磷酸激酶(CK)、乳酸脱氢酶(LDH)水平,采用儿科生活质量问卷(PAQLQ)评估患儿生活质量。结果治疗后,观察组退热、咳嗽缓解、肺部啰音消失、肺部阴影消失时间及住院时间均短于对照组(t值分别为8.125、17.781、8.740、8.106、8.711,均P<0.05)。两组血清补体C3、C4水平及CK-MB、CK、LDH水平均低于治疗前(观察组治疗前后比较:t值分别为11.375、10.783、15.132、13.672、14.173;对照组治疗前后比较:t值分别为6.241、5.894、13.183、11.735、11.675,均P<0.05),且治疗后观察组血清补体C3、C4水平及CK-MB、CK、LDH水平均低于对照组(t值分别为8.465、8.456、12.188、7.494、6.558,均P<0.05)。两组治疗后PAQLQ量表的症状、活动、情感得分均高于治疗前(观察组治疗前后比较:t值分别为7.195、9.742、8.117;对照组治疗前后比较:t值分别为5.894、8.195、7.331,均P<0.05),且治疗后观察组PAQLQ量表的症状、活动、情感得分均高于对照组(t值分别为13.053、13.316、11.248,均P<0.05)。结论阿奇霉素联合丙种球蛋白治疗儿童重症支原体肺炎的疗效显著,可显著降低患儿血清补体水平、心肌酶谱水平,提高患儿生活质量。

Application of gamma globulin in the treatment of severe mycoplasma pneumonia in children and its effects on complement and myocardial enzyme spectrum

Objective To study the efficacy of azithromycin combined with gamma globulin in the treatment of severe mycoplasma pneumonia in children and its influences on serum complement level,myocardial enzyme spectrum and quality of life of children,so as to explore its clinical significances in the treatment of severe mycoplasma pneumonia in children.Methods A total of 144 children with severe mycoplasma pneumonia who were hospitalized for treatment in the pediatric department of Zhoushan Women and Children’s Hospital from July 2016 to June 2020 were selected and divided into control group(azithromycin treatment)and observation group(azithromycin combined with gamma globulin treatment)according to the random number method,72 cases in each group.Before and after treatment,the children’s serum levels of complement C3 and C4 and the levels of creatine kinase-myocardial band(CK-MB),creatine kinase(CK)and lactate dehydrogenase(LDH)were measured,and the Pediatric Quality of Life Questionnaire(PAQLQ)was used to assess the quality of life of the children.Results After treatment,the time of fever abatement,cough relief,disappearance of pulmonary rales,disappearance of pulmonary shadow and duration of hospital stay in the observation group were shorter than those in the control group(t values were 8.125,17.781,8.740,8.106 and 8.711,respectively,all P<0.05).Serum complement C3,C4 levels and CK-MB,CK,LDH levels were lower in both groups after treatment than before treatment(observation group:t values were 11.375,10.783,15.132,13.672 and 14.173,respectively;control group:t values were 6.241,5.894,13.183,11.735 and 11.675,respectively,all P<0.05).And serum complement C3 and C4 levels and CK-MB,CK and LDH levels in observation group were lower than those in control group(t values were 8.465,8.456,12.188,7.494 and 6.558,respectively,all P<0.05).After treatment,the scores of symptom,activity and emotion of PAQLQ in both groups were higher than those before treatment(observation group:t values were 7.195,9.742 and 8.117,respectively;control group:t values were 5.894,8.195 and 7.331,respectively,all P<0.05),and symptoms,activity and emotion scores of PAQLQ in the observation group were higher than those in the control group(t values were 13.053,13.316 and 11.248,respectively,all P<0.05).Conclusion Azithromycin combined with gamma globulin is effective in treating severe mycoplasma pneumonia in children.It can significantly reduce the level of serum complement and myocardial enzyme spectrum and improve the quality of life of children.