不同剂量甲泼尼龙对小儿难治性肺炎支原体肺炎的疗效分析

目的 探讨应用不同剂量甲泼尼龙对小儿难治性肺炎支原体肺炎(Mycoplasma pneumoniae pneumonia，MMP)的治疗效果。 方法 选取2018年1—12月阜阳市妇女儿童医院儿科收住的诊断为难治性肺炎支原体肺炎的患儿120例作为研究对象，依照给药剂量的不同分为小剂量组、中剂量组和大剂量组，每组40例。每组患儿均应用阿奇霉素治疗，并且给予相应的对症支持治疗，如退热、止咳、化痰等，此为基础治疗，在此基础上，小剂量组给予甲泼尼龙2 mg/(kg·d)，静脉滴注，1次/d；中剂量组给予甲泼尼龙5 mg/(kg·d)，静脉滴注，1次/d；大剂量组给予甲泼尼龙10 mg/(kg·d)，静脉滴注，1次/d。比较3组患儿的总有效率、体温恢复正常时间、咳嗽好转时间、肺部啰音消失时间、住院时间、胸片改善情况、炎症反应指标及不良反应发生情况。 结果 大剂量组的总有效率明显高于中剂量组和小剂量组；大剂量组患儿的热退时间、咳嗽消失时间、肺部啰音消失时间和住院时间，显著短于中剂量组和小剂量组；大剂量组的肺部病灶吸收率明显高于中剂量组和小剂量组。治疗后复查3组患儿的C-反应蛋白(CRP)、IL-6、IL-10、TNF-α，大剂量组最低，其次是中剂量组和小剂量组。3组患儿的不良反应发生情况比较差异无统计学意义(P＞0.05)。 结论 应用大剂量甲泼尼龙治疗小儿难治性肺炎支原体肺炎可显著改善症状，提高疗效，且较为安全。 

Effect of different doses of methylprednisolone on refractory Mycoplasma pneumoniae pneumonia in children

Objective To investigate the therapeutic effect of different doses of methylprednisolone on refractory Mycoplasma pneumoniae pneumonia in children. Methods Total 120 children diagnosed as refractory Mycoplasma pneumoniae pneumonia in children's Hospital of Fuyang City from January 2018 to December 2018 were selected as the study object. They were divided into small dose group, medium dose group and large dose group according to the dose, 40 cases in each group. Each group was treated with azithromycin, and corresponding symptomatic support treatment was given, such as antipyretic, cough, phlegm, etc. On this basis, methylprednisolone was given 2 mg/(kg·d) in the low dose group, 5 mg/(kg·d) in the medium dose group, 10 mg/(kg·d) in the high dose group, once a day by intravenous drip. The total efficiency, normal time of body temperature recovery, cough improvement time, time of absence of lungs, time of hospitalization, improvement of chest film, index of inflammatory reaction and occurrence of adverse reactions were compared among the three groups. Results The total effective rate of the large dose group was higher than that of the medium dose group and the small dose group. The time of heat retreat, loss of cough, loss of lung voice, time of hospitalization, of the large dose group were significantly shorter than those in the medium dose group and the small dose group. The absorption rate of lung lesions in the large dose group was significantly higher than that in the medium dose group and the small dose group. After treatment, the C-reactive protein (CRP), IL-6, IL-10, and TNF-α were reexamined. The large dose group was the lowest, followed by the middle dose group and the low dose group. There was no statistically significant difference in adverse reactions among the three groups (P>0.05). Conclusion The treatment of refractory Mycoplasma pneumoniae pneumonia in children with large dose of methylprednisolone can significantly improve symptoms, improve curative effect, and have low adverse reaction and high safety factor, which is worthy of clinical promotion.