阿奇霉素联合孟鲁司特钠治疗小儿肺炎支原体肺炎的疗效观察

目的探讨阿奇霉素序贯联合孟鲁司特钠治疗肺炎支原体肺炎(MPP)患儿临床效果及对免疫指标、血清炎症因子及肺功能的影响。方法选取2016年6月-2019年6月杭州市干区人民医院儿科门诊收治的160例MPP患儿,均结合症状体征、X线胸片和实验室检查等确诊MPP,采用计算机随机分组法将MPP患儿分为常规组和研究组各80例;所有患儿均接受止咳化痰、解痉平喘、退热和支气管扩张等基础对症治疗,常规组患儿给予阿奇霉素序贯治疗,研究组患儿给予阿奇霉素序贯联合孟鲁司特钠治疗;所有患儿均谨遵医嘱治疗21 d,治疗期间保持电话随访,治疗结束后来院门诊复查。记录两组MPP患儿临床症状和体征缓解时间,比较治疗前后免疫指标(免疫球蛋白Ig G、Ig M、Ig A和补体C3、C4)、血清炎症因子[C-反应蛋白(CRP)、降钙素原(PCT)]以及肺功能指标[1 s用力呼气容积(FEV1)、用力肺活量(FVC)和最大呼气流量(PEF)]。结果研究组MPP患儿发热、咳嗽、憋喘和肺部湿啰音缓解时间分别短于常规组患儿,差异有统计学意义(P<0. 05)。与治疗前相比,两组治疗后血清Ig G和肺功能FEV1、FVC、PEF均明显提高,血清Ig M、Ig A和补体C3、C4以及血清炎症因子CRP、PCT均显著下降,差异均有统计学意义(P<0. 05);研究组治疗后血清Ig G和肺功能FEV1、FVC、PEF高于常规组,血清Ig M、Ig A和补体C3、C4水平以及血清炎症因子CRP、PCT低于常规组,差异均有统计学意义(P<0. 05)。两组治疗均未出现明显不良反应。结论阿奇霉素序贯联合孟鲁司特钠能显著减轻MPP患儿机体炎症状态,改善免疫功能和促进肺功能恢复,是一种疗效显著且安全性好的治疗方案。

Observation on the clinical effect of azithromycin combined with montelukast sodium in treatment of Mycoplasma pneumoniae pneumonia in children

Objective To explore the clinical effect of azithromycin combined with montelukast sodium in treatment of Mycoplasma pneumoniae pneumonia( MPP) in children and the impact on immune indexes, serum inflammatory factors, and lung function.Methods From June 2016 to June 2019,160 children were diagnosed as MPP definitely based on symptoms,signs,X-ray,and laboratory examination,then they were treated in Pediatric Outpatient in People’s Hospital of Jianggan District,according to computer random method,these MPP children were divided into routine group and study group,80 children in each group. All the children in the two groups were treated by basic therapy,such as antitussive and expectorant therapy,antispasmodic and antiasthmatic therapy,antipyretic therapy and bronchiectasis. The children in routine group were treated by azithromycin sequential therapy,the children in study group were treated by azithromycin sequential therapy combined with montelukast sodium. The children in the two groups were treated for 21 days and followed up by phone in the course of treatment,after treatment,reexamination in Pediatric Outpatient was performed. The remission time of symptoms and signs in the two groups was recorded. The immune indexes( Ig G,Ig M,Ig A,C3,C4),serum inflammatory factors [C-reactive protein( CRP),procalcitonin( PCT) ],and lung function indexes [one-second forced expiratory volume( FEV1),forced vital capacity( FVC),and peak expiratory flow( PEF) ] before and after treatment were compared. Results The remission time of fever,cough,wheezing,and lung wet rale in MPP group was statistically significantly shorter than that in routine group( P<0. 05). Compared with before treatment,serum Ig G levels,FEV1,FVC,and PEF after treatment in the two groups increased significantly,serum Ig M and Ig A levels,C3 and C4 levels,CRP and PCT levels decreased significantly,there were statistically significant differences( P<0. 05). After treatment,serum Ig G level,FEV1,FVC,PEF in study group were higher than those in routine group,serum Ig M and Ig A levels,C3 and C4 levels,CRP and PCT levels were lower than those in routine group,there were statistically significant differences( P<0. 05). In the course of treatment,no significant adverse reaction was observed. Conclusion Azithromycin combined with montelukast sodium can significantly relieve inflammatory state of MPP children,improve immune function,and promote the recovery of lung function,which is a therapeutic scheme with significant efficacy and high safety.