大剂量甲基强的松龙冲击治疗小儿急性肺损伤

目的：采用大剂量甲基强的松龙冲击治疗小儿急性肺损伤（ALI），评价其疗效。方法：选择1999年1月－2001年6月入住本院儿童ICU急性肺损伤48例，随机分为两组即大剂量甲基强的松龙治疗组和常规治疗组，连续监测血氧饱和度，血气分析，FiO2，X线胸片，呼吸机撤机时间及死亡率。结果：大剂量甲基强的松龙治疗组PaO2/FiO2恢复及胸部X片阴影消退，呼吸机撤离及住院时间均明显缩短，发展为ARDS及死亡率明显下降，结论：大剂量甲基强的松龙冲击治疗小儿ALI安全有效。     

不同剂量丙种球蛋白联合糖皮质激素治疗小儿中重度急性吉兰-巴雷综合征的疗效比较

目的 观察并比较静脉注射小剂量丙种球蛋白与大剂量丙种球蛋白联合糖皮质激素冲击治疗小儿中重度急性吉兰-巴雷综合征（GBS）的临床疗效与安全性。方法 将100例中重度急性GBS患儿随机分为小剂量组（48例）和大剂量组（52例）。小剂量组和大剂量组分别采用0.2 g/（kg·d）和0.4 g/（kg·d）丙种球蛋白联合甲基强的松龙治疗。比较治疗后两组症状改善时间、外周血炎性因子水平的变化、有创通气比例、治疗有效性及不良反应。结果 治疗5 d后,小剂量组和大剂量组血清TNF-α、IL-6、CRP水平均较治疗前明显下降,两组TNF-α、IL-6、CRP下降幅度差异均无统计学意义。两组患儿呼吸机麻痹恢复时间、肌力提升1级时间、感觉障碍恢复时间及住院时间比较差异均无统计学意义。小剂量组和大剂量组总体有效率（90% vs 92%）比较差异无统计学意义。两组患儿发热、头痛、恶心、心慌发生率比较差异均无统计学意义。结论 小剂量与大剂量丙种球蛋白联合甲基强的松龙冲击治疗小儿中重度急性GBS临床疗效与安全性相当。     

大剂量甲基强的松龙冲击治疗毛细支气管炎并呼吸衰竭的临床观察

目的　评价大剂量甲基强的松龙冲击治疗毛细支气管炎并呼吸衰竭的疗效与安全性。方法　选择毛细支气管炎 10 0例 ,并呼吸衰竭 4 5例。随机分为治疗组 5 0例 ,并呼吸衰竭 2 4例 ,除常规抗感染、对症、给氧等综合治疗外 ,加用大剂量甲基强的松龙冲击治疗 ;对照组 5 0例 ,并呼吸衰竭 2 1例 ,只采用常规治疗。临床观察喘息、气促、紫绀、肺部哮鸣音及痰鸣音好转情况、血气分析动态检测、需要人工吸痰的次数及住院日。结果　治疗组患儿在喘息、气促、肺部体征及血气分析好转情况明显优于对照组 ,需要人工吸痰的次数明显减少 ,住院日缩短 ,经统计学检验存在显著性差异 (P <0 0 1)。结论　大剂量甲基强的松龙冲击治疗毛细支气管炎并呼吸衰竭的疗效显著     

不同剂型、剂量的肾上腺皮质激素治疗小儿特发性血小板减少性紫癜疗效观察

三种不同剂型、剂量的肾上腺皮质激素治疗小儿特发性血小板减少性紫癜 ,结果表明 :对出血症状的控制速度 ,地塞米松冲击组优于甲基强的松龙冲击组 ,也优于强的松组 ;血小板计数的升高幅度也是冲击组优于常规剂量组 ,差异有显著意义 ;治疗后 PAIg G的下降在冲击治疗组优于常规剂量组。建议 :对于急性出血症状明显、且 PAIg G增高也较明显的患儿 ,应首选大剂量糖皮质激冲击治疗。     

不同剂型,剂量的肾上腺皮质激素治疗小儿特发性血小板减少性紫癜 …

三种不同剂型、剂量的肾上腺皮质激素治疗小儿特发性血小板关怀紫癜，结果表明，对出血症状的控制速度，地塞米松冲击组优于甲基强的松龙冲击组，也优于强的松组；血小板计数的升高幅度也是冲击组优于常规剂量组，差异有显著意义；治疗后ＰＡＩｇＧ的下降在冲击治疗组优于常规剂量组。建议；对于急性出血症状明显、且ＰＡＩＧｇＧ增高也较明显的患儿，应着选大剂量糖皮质扩冲击治疗。     

甲基强的松龙冲击前后肾小球疾病患儿尿Ⅳ型胶原含量的变化

目的 了解大剂量甲基强的松龙冲击前后肾小球疾病患儿尿Ⅳ型胶原含量的变化，探讨其临床意义。方法 应用ELISA法监测大剂量甲基强的松龙冲击前后8例肾小球疾病患儿尿Ⅳ型胶原含量的变化。结果 冲击前其尿Ⅳ型胶原含量明显高于对照组，经过一个疗程甲基强的松龙冲击治疗后1d，患儿尿Ⅳ型胶原含量较冲击前明显下降（P＜0．01），结论 甲基强的松龙冲击治疗可影响肾小球疾病尿Ⅳ型胶原含量。     

甲泼尼龙对急性肺损伤早期血管内皮生长因子影响的研究

目的研究不同剂量甲泼尼龙(MP)对急性肺损伤(ALI)早期血管内皮生长因子(VEGF)的影响,为临床治疗提供理论依据。方法选择2005年3月至2008年12月温州医学院附属育英儿童医院收治的符合ALI诊断标准的儿童重症监护病房(PICU)患儿48例,随机分为3组:ALI组11例,HALI组(大剂量MP干预)22例,LALI组(小剂量MP干预)15例,正常对照组(NC)8例。应用ELISA法检测入院0、24、48、72h血清VEGF,采用美国NOVA生化血气分析仪检测血气分析,日本血乳酸测定仪(便携式)检测血乳酸。结果 (1)ALI组、HALI组、LALI组各时间血清VEGF、血乳酸高于NC组,氧合指数(PaO2/FiO2)低于NC组,差异均有统计学意义(P0.05);(2)24、48、72h时HALI组、LALI组血清VEGF、血乳酸低于ALI组,高于ALI组,差异均有统计学意义(P0.05);(3)24、48、72hHALI组与LALI组血清VEGF、血乳酸及PaO2/FiO2差异均无统计学意义(PO.05);(4)72h内HALI组、LALI组发展为急性呼吸窘迫综合征(ARDS)病例百分率少于ALI组,差异有统计学意义(P0.05),HALI组与LALI组发展为ARDS病例百分率差异无统计学意义(PO.05)。结论 ALI早期VEGF表达增加,小剂量MP通过抑制血清VEGF表达,从而抑制ALI病情进展。     

急性肺损伤患儿氧交换指标动态监测的临床意义

目的　探讨急性肺损伤 (ALI)患儿的氧交换指标动态监测在临床的意义。方法　回顾性分析临床诊断ALI需呼吸支持的 33例患儿 ,根据其转归分为生存组和死亡组 ,分别在通气后 0 5h、2 4h、72h取动脉血做血气分析 ,并记录相同时点的吸入氧体积分数 (FiO2 ) ,以此计算不同时段的氧合指数 (PaO2 /FiO2 )、肺泡气 动脉血氧分压差 [P( A a)DO2 ]和动脉血氧分压 /肺泡氧分压(PaO2 /PAO2 )的数值。结果　生存组P(A a)DO2 在治疗 2 4h、72h后逐渐下降 ,与死亡组比较差异有显著性意义(P <0 0 5 ) ;PaO2 /FiO2 、PaO2 /PAO2 的数值变化在治疗 72h后才与死亡组比较差异有显著性 (2 4h ,P >0 0 5 ;72h ,P <0 0 5 )。PaO2 随治疗时间的推移 ,在生存组与死亡组间比较均无统计学意义 (P >0 0 5 )。提示PaO2 /FiO2 、PaO2 /PAO2 和P(A a)DO2 是对ALI早期治疗反应的敏感指标 ;PaO2 对预后的预警作用较为滞后。结论　在ALI呼吸支持患儿中 ,氧交换指标P(A a)DO2 、PaO2 /FiO2 和PaO2 /PAO2 更能反映肺损伤的程度 ,对预后的估计价值更大 ;动态监测氧交换指标可为临床预后的评估提供参考信息。     

大剂量甲基强的松龙冲击治疗急重型病毒性脑炎

甲基强的松龙近几年已逐步应用于神经免疫性疾病 ,对重症肌无力、格林 巴利综合征疗效颇佳 ,报道亦较多 ,但应用甲基强的松龙治疗急性重型病毒性脑炎的报道国内尚少 ,急性重型病毒性脑炎为临床病死率、致残率较高的中枢感染性疾病之一 ,为进一步探讨该病临床可靠、有效及预后较好的治疗措施 ,我科于 1998年 10月— 2 0 0 2年 12月使用大剂量甲基强的松龙 (MPTT)治疗急性重型病毒性脑炎 2 0例 ,收到满意疗效 ,现报道如下。1　资料与方法1 1　临床资料　MPTT组 2 0例 ,其中女 8例 ,男 12例 ,年龄 10月～ 13岁 ,其中 10月～ 3岁 2例 ,～ 6…     

大剂量甲基强的松龙冲击与静注丙种球蛋白联合治疗小儿脱髓鞘疾病疗效评价

目的　评价大剂量甲基强的松龙冲击 (HDMP)和静注丙种球蛋白 (IVIG)联合治疗小儿脱髓鞘疾病的疗效。方法　 2 5例脱髓鞘疾病的住院患儿随机分为观察组和常规组。观察组 15例应用HDMP和IVIG联合治疗。常规组 10例应用IVIG和地塞米松治疗。结果　观察组 2 4h总有效率 10 0 % ,常规组 2 4h总有效率 5 0 % ;观察组肌力、行走恢复正常所需时间平均 15 89天 ,常规组 2 7 5 6天 ,两组均有显著性差异 (P <0 0 1)。结论　HDMP和IVIG联合治疗小儿脱髓鞘疾病 ,疗效显著 ,值得临床常规应用     

Partial liquid ventilation reduces release of leukotriene B4 and interleukin-6 in bronchoalveolar lavage in surfactant-depleted newborn pigs.

Perfluorocarbons have been shown to reduce the inflammatory process generated by alveolar macrophages in vitro. The aim of this study was to evaluate the impact of different ventilator modalities such as partial liquid ventilation (PLV), conventional ventilation (CV), and high-frequency oscillatory ventilation (HFOV) on the release of inflammatory mediators in vivo. Acute lung injury was induced in 30 male piglets by repeated saline lavage (arterial oxygen tension, <60 mm Hg; fraction of inspired oxygen, 1.0). Thereafter, animals were randomly assigned to one of five groups of six animals each: 1) 24 h of CV; 2) 24 h of CV plus surfactant therapy (S+CV); 3) 24 h of HFOV plus surfactant therapy (S+HFOV); 4) 1 h of PLV followed by 23 h of CV (PLV); and 5) 24 h of CV without previous lung injury (control group). Piglets randomized to S+CV or S+HFOV received natural surfactant (100 mg/kg). PLV with FC-77 was started in an initial dose of 30 mL/kg over 30 min followed by 0.5 mL x kg(-1) x min(-1) for another 30 min. After 1 h of PLV the animals were conventionally ventilated for 23 h. Before acute lung injury and after 24 h the number of inflammatory cells and the levels of IL-6, leukotriene B4, and tumor necrosis factor-alpha were measured in the bronchoalveolar lavage fluid. Additionally, the oxygenation index and the histopathologic damage were evaluated. Before acute lung injury, the number of inflammatory cells and the levels of mediators in bronchoalveolar lavage fluid were not different among the groups. After 24 h, the number of granulocytes in the PLV group was as low as in the control group. leukotriene B4 and IL-6 levels were found to be elevated in all groups except the control group (p < 0.01). The release of leukotriene B4 and IL-6 was lowest in the PLV group when compared with S+HFOV, S+CV, or CV (p < 0.05). No differences among the groups were detected for tumor necrosis factor-alpha. Although the concentrations of leukotriene B4 and IL-6 after PLV were lowest in the PLV group, histopathologic evidence of damage and the oxygenation index in the PLV group did not differ from that found in the S+CV or S+HFOV groups. In conclusion, PLV with perfluorocarbons may protect the lung from acute pulmonary inflammation more effectively than CV or HFOV does.     

Partial liquid ventilation with low-dose perfluorochemical and high-frequency oscillation improves oxygenation and lung compliance in a rabbit model of surfactant depletion

BACKGROUND: Partial liquid ventilation (PLV) with perfluorochemical (PFC) has been advocated as a new therapy for acute respiratory distress syndrome in both clinical and animal studies, meconium aspiration syndrome, and RDS. PFC is referred to as liquid PEEP because it gets distributed to the most gravity-dependent regions of the lung due to its density. High-frequency oscillation (HFO) has been shown to prevent both acute and chronic lung injury in the management of very low birth weight infants with RDS, with gentle ventilation approach. Specifically, HFO with aggressive and adequate lung volume recruitment has been shown to reduce the incidence of chronic lung disease in very low birth weight infants. We hypothesized that PLV along with HFO might be effective in ARDS in an adult rabbit model. OBJECTIVES: To examine the efficiency of low-dose PLV with with HFO on pulmonary gas exchange and lung compliance in a surfactant-depleted rabbit model. METHODS: After induction of severe lung injury by repeated saline lung lavage, 19 adult white Japanese rabbits were randomized into two groups that received PLV with HFO (n=9) or HFO gas ventilation (n=10). Physiological and blood gas data were compared between the two groups by analysis of variance. RESULTS: The HFO-PLV group showed improved total lung compliance with maintenance of significantly lower mean airway pressure as compared with the HFO-GAS group so as to keep SpO2>90%. CONCLUSIONS: The addition of a low dose of PFC with HFO was effective in achieving adequate oxygenation, with a reduction in further lung injury in neonates.     

甲泼尼龙冲击递减疗法治疗重症过敏性紫癜的临床疗效

目的 探讨甲泼尼龙冲击递减疗法治疗小儿重症过敏性紫癜(HSP)的临床疗效.方法 2005年6月-2010年6月本院儿科收治的HSP患儿78例,选择其中58例重症HSP患儿为观察对象.采用双盲法随机分为治疗组及对照组.治疗组32例.男19例,女13例;年龄3~13岁.对照组26例.男17例,女9例;年龄3~14岁.治疗组32例患儿采用甲泼尼龙冲击递减疗法;对照组26例患儿采用常规甲泼尼龙冲击治疗;病情明显改善后改用相同剂量的泼尼松口服逐渐减量至停用.观察皮疹消退、腹痛缓解、消化道出血及关节肿痛缓解时间,观察肾脏损害恢复时间及皮肤紫癜复发情况.各组检查血常规、尿常规和大便常规;检测肝肾功能、免疫球蛋白和补体(C3、C4);检测其血清IL-6、IL-8及TNF-α水平变化.结果 治疗组皮疹消退、腹痛缓解、消化道出血消退、关节肿痛消退及肾损害恢复时间明显短于对照组(P＜0.05,0.01).治疗组及对照组治疗后免疫球蛋白、补体和细胞因子IL-6、IL-8及TNF-α与治疗前比较差异均有统计学意义(Pa＜0.05).结论 甲泼尼龙冲击递减疗法治疗小儿重症HSP安全有效,是防止复发和减轻肾脏损害较好的治疗措施.     

抗炎多肽对内毒素诱导的小鼠急性肺损伤的保护作用

目的 研究抗炎多肽AF2(antiflammin-2)和重组多肽R2(recombinantant peptide sequence 2)对内毒素(LPS)诱导的小鼠急性肺损伤(ALI)的保护作用,及其对肺组织clara细胞16 000蛋白(CC16)和表面活性蛋白A(SP-A)表达的影响.方法 Balb/c雄性小鼠随机分为5组:对照组,ALI模型组,AF2治疗组,R2治疗组和氢化可的松(HC)治疗组.ALI模型组和各治疗组分别腹腔注射LPS复制小鼠肺损伤模型;治疗组随后注射AF2(2 mg/kg)、R2(2 mg/kg)或氢化可的松(25 mg/kg),对照组和ALI模型组注射等量的生理盐水.在6 h记录动物的呼吸频率;在12 h处死动物,肺组织切片观察肺病理变化;肺组织研磨提取总RNA,半定量法检测CC16和SP-A的表达.结果 (1)各治疗组动物6 h呼吸频率均低于ALI模型组[(112±4)次/30 s],分别为AF2治疗组(108±2)次/30 s、R2治疗组(101±2)次/30 s、HC治疗组(96±2)次/30 s,其中R2和HC治疗组与ALI模型组比较,差异有统计学意义.(2)肺组织病理学观察显示AF2、R2对LPS诱导的小鼠ALI肺组织的渗出、炎症细胞浸润有一定的抑制作用,各治疗组病理评分与ALI模型组比较差别均有统计学意义.(3)与ALI模型组比较,AF2治疗组CC16的表达上调,差异有统计学意义,R2和HC治疗组SP-A的表达上调,差异有统计学意义.结论 抗炎多肽AF2和重组多肽R2对内毒素诱导的小鼠ALI有一定的保护作用.     

Oral megadose methylprednisolone therapy for refractory Diamond-Blackfan anemia. International Diamond-Blackfan Anemia Study Group

PURPOSE: Several reports describe children with refractory transfusion-dependent Diamond-Blackfan anemia who responded to extremely large doses of methylprednisolone. Limitations in available data prompted further exploration of this treatment approach. PATIENTS AND METHODS: This prospective treatment protocol was designed to test the efficacy and toxicity of oral megadose methylprednisolone in children with Diamond-Blackfan anemia who had previously failed to respond to standard doses of prednisone and who were dependent on regular packed red blood cell transfusions. Patients were treated with oral methylprednisolone, starting at a dose of 100 mg/kg per day, tapering slowly to 5 mg/kg per day at the end of 4 weeks and to 2 mg/kg per day after 7 weeks of induction therapy. Therapy was continued for a total of 23 weeks. Efficacy was assessed by increase in peripheral blood reticulocytes and increase or stabilization in hemoglobin concentration, which was maintained during and after steroid tapering. RESULTS: Nine children with Diamond-Blackfan anemia were registered on the study, and all were evaluable. Disease in four of the children failed to respond to megadose methylprednisolone therapy. The other five patients demonstrated a partial or complete response during the initial 4 to 8 weeks of therapy, but all subsequently experienced relapse during the ensuing 2 months as the corticosteroid dose was tapered. All patients required resumption of transfusions, although one later remitted spontaneously. Toxicity of megadose methylprednisolone was modest. CONCLUSION: None of nine children with refractory Diamond-Blackfan anemia treated with oral megadose methylprednisolone exhibited a clinically significant response. Alternative therapeutic strategies are required.     

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??Abstract??Objective??To explore the effects of methylprednisolone ??MP?? of different doses on vascular endothelial growth factor ??VEGF?? of early acute lung injury??ALI????providing a theoretical basis for clinical treatment. Methods??Totally 48 cases who met ALI diagnostic criteria from PICU were randomly divided into 3 groups?? group ALI?? group HALI ??treated by high-dose MP???? group LALI ??treated by low-dose MP??. Eight heathy individuals were selected as control group??NC??. Results????1??As compared with group NC?? the serum VEGF and blood lactate were significantly higher??while oxygenation index was significantly lower than in other groups ??P <0.05??. ??2??Contents of serum VEGF?? blood lactate of group HALI and LALI stepped significantly down??but oxygenation index stepped significantly up than group ALI after 24 h??P < 0.05???? ??3??Between group HALI and LALI??the serum VEGF??blood lactate??oxygenation index at 24 h?? 48 h and 72 h had no significant differences??P > 0.05??. ??4??Compared with group ALL?? ARDS??acute respiratory distress syndrome?? patients within 72h were stepped up significantly than group HALI and LALI??P < 0.05????but there were no significant differences between the two groups??P > 0.05??. Conclusion??The expression of VEGF is increased in early ALI?? low-dose MP can inhibit the progression of ALI by inhibiting the expression of serum VEGF.     

Randomized trial of high-dose methylprednisolone versus intravenous immunoglobulin for the treatment of acute idiopathic thrombocytopenic purpura in children

BACKGROUND: Idiopathic thrombocytopenic purpura (ITP) is an acquired disorder characterized by immune-mediated platelet destruction. The authors performed a prospective, randomized trial comparing intravenous immunoglobulin (IVIG) with high-dose intravenous methylprednisolone in the treatment of children with acute ITP. The primary aim of the study was to compare the rate of platelet increase produced by either intervention. A decision to treat was based on the clinical presentation and not an arbitrary platelet count. In general, enrolled patients exhibited extensive bruising and platelet counts less than 10 x 10 /L (10,000/microL). PATIENTS AND METHODS: Seventy-seven consecutive patients, for whom the attending hematologist determined acute treatment was warranted, were studied. Forty-two patients received IVIG (1 g/kg/dose x2) and 35 received methylprednisolone (30 mg/kg/dose x3). Patients who exhibited an increase in platelet count of more than 50,000/microL after the first IVIG dose or the second methylprednisolone dose did not receive the second IVIG dose or the third methylprednisolone dose, respectively. Patients' ages ranged from 6 months to 15 years. Platelet counts were evaluated at presentation, 24, 48, 72 hours, 1 week, and 2 to 4 weeks. RESULTS: Eighty percent of patients treated with IVIG and 60% of patients treated with methylprednisolone demonstrated an increase in platelet count of 50,000/microL or more within 48 hours. Both IVIG and methylprednisolone therapy increased platelet counts significantly above pretreatment values. In the methylprednisolone group, the mean baseline platelet count was 4,600/microL, which rose to 14,000/microL after 24 hours, 38,000/microL after 48 hours, and 65,000/microL after 72 hours. The IVIG group had a mean baseline platelet count of 4,200/microL, which rose to 32,000/microL after 24 hours, 69,000/microL after 48 hours, and 146,000/microL after 72 hours. When compared with methylprednisolone, IVIG therapy produced a greater rise in platelet counts at 24, 48, and 72 hours, with no difference at 1 week or later time points. No serious bleeding was noted in either treatment group. CONCLUSIONS: Both IVIG and methylprednisolone produce a significant early rise in platelet count that is somewhat greater with IVIG. However, the higher platelet counts produced by IVIG may not justify the additional cost and potential risks of this agent.     

对LPS诱导的急性肺损伤幼鼠肺组织SP-A变化的研究

目的：SP-A在维持肺表面活性物质（PS）功能和肺局部免疫功能方面起着重要作用。该文旨在探讨急性肺损伤（ALI）时肺组织SP-A随时间的变化规律。方法：无病原体的21日龄Sprague-Dawley幼鼠110只被随机分为正常对照组和ALI组（每组又分为6个亚组）。腹腔注射脂多糖（LPS，4 mg/kg）建立ALI模型，正常对照组注射等量生理盐水。LPS注射后6，12，24，36，48和72 h每亚组各处死8只大鼠。 用Western blot方法测定肺组织SP-A的相对含量。结果：与正常对照组相比，ALI时肺组织SP-A的变化在12 h内无明显变化(P＞ 0.05)； 在24 h 至48 h处于上升阶段（P＜ 0.01）， 于36 h达最高点（6.94±0.80）；到72 h时SP-A下降(P＜0.01)。结论：肺组织SP-A在LPS诱导的ALI中的变化为时间依赖性。肺组织SP-A一过性升高，表现出SP-A在某种程度上的代偿能力较强。     

Effects of methylprednisolone on the response to group B streptococcal toxin in sheep

The effects of pretreatment with methylprednisolone on the reaction to a toxin isolated from group B beta-hemolytic streptococci, type III, were studied in seven sheep instrumented for chronic measurements of pulmonary lymph flow and pulmonary artery and left atrial pressure. Each sheep was infused with toxin alone on one day and with methylprednisolone plus toxin on a different day in random order. The toxin alone caused a two-phase reaction. After the infusion of toxin, alone, in the initial phase, pulmonary artery pressure increased from 16 +/- 1 to 45 +/- 5 mm Hg and the rectal temperature rose from 39.5 +/- 0.14 to 40.8 +/- 0.18 degree C. During the second phase, the peripheral blood granulocyte count decreased to 10% of baseline values and the lung lymph protein clearance increased from 5.1 +/- 1.1 to 11.2 +/- 1.8 ml/h, suggesting increased pulmonary vascular permeability. Methylprednisolone pretreatment did not alter the initial phase of pulmonary hypertension or the febrile response but completely abolished the granulocytopenia and the increased pulmonary vascular permeability. These effects are unlikely to be related to inhibition of prostaglandin synthesis. Prevention of the lung vascular injury by methylprednisolone may be related to inhibition of granulocyte accumulation in the lung.     

儿童重型再生障碍性贫血ATG治疗相关急性肺损伤1例并文献复习

目的探讨使用抗胸腺细胞球蛋白(ATG)治疗后出现少见血清病反应—急性肺损伤(ALI)的临床特点,以提高对本病的认识。方法回顾性分析1例重型再生障碍性贫血患儿第二次使用ATG后合并ALI的临床资料,并对相关文献进行复习。结果本例患儿于第二次使用ATG后10 d,出现发热、关节痛、肌痛、皮疹等临床表现,伴随突发烦躁、呼吸困难、低氧血症,肺部CT提示双肺弥漫毛玻璃影,临床诊断为ALI,应用甲泼尼龙治疗好转。通过文献检索发现8例类似报道,病死率较高。结论早期诊断和及时应用糖皮质激素治疗对于ATG相关ALI至关重要。