摘要
目的探讨治疗儿童大环内酯类药物无反应性肺炎支原体肺炎(macrolide-nonresponsive Mycoplasma pneumoniae pneumonia,MUMPP)时,多西环素联合甲泼尼龙的临床疗效。方法采用回顾性对照研究设计,纳入172例于苏州市立医院2023年7月至2024年12月就诊的MUMPP患儿,排除不符合标准及治疗过程中脱落病例后,最终纳入150例,根据治疗方案不同将其分为两组,接受阿奇霉素联合甲泼尼龙治疗的患儿纳入阿奇霉素组,接受多西环素联合甲泼尼龙治疗的患儿纳入多西环素组,各75例。评估两组用药前后的炎症水平、免疫水平及用药后的临床疗效、症状改善情况及不良反应发生情况。结果多西环素组治疗总有效率92.00%(69/75)高于阿奇霉素组80.00%(60/75)(χ^(2)=4.485,P<0.05)。用药后,多西环素组退热时间、咳嗽缓解时间、肺部啰音消失时间、住院时间[分别为(4.51±1.37)、(5.62±1.53)、(4.78±1.24)、(8.59±2.36)d]均低于阿奇霉素组[分别为(7.24±2.83)、(8.15±2.46)、(6.92±1.85)、(12.33±3.72)d](t=7.519、7.563、8.321、7.352,均P<0.05)。用药后,多西环素组白细胞介素6、肿瘤坏死因子α、C反应蛋白水平[分别为(11.64±4.36)ng/L、(2.85±0.86)ng/L、(32.33±6.72)mg/L]均低于阿奇霉素组[分别为(17.83±4.75)ng/L、(4.92±1.01)ng/L、(47.52±6.16)mg/L](t=8.314、13.514、14.430,均P<0.05)。用药后,多西环素组CD3^(+)、CD4^(+)/CD8^(+)水平[分别为(74.82±4.08)%、(1.77±0.28)]均高于阿奇霉素组[分别为(68.85±4.53)%、(1.47±0.26)](t=8.481、6.799,均P<0.05)。两组不良反应发生率差异无统计学意义[8.00%(6/75)vs 5.33%(4/75)](χ^(2)=0.429,P>0.05)。结论多西环素联合甲泼尼龙治疗儿童MUMPP,可提升治疗效果,改善临床症状,调控炎症及免疫反应,安全性较好。
Objective To investigate the clinical efficacy of doxycycline combined with methylprednisolone in the treatment of macrolide-nonresponsive Mycoplasma pneumoniae pneumonia(MUMPP)in children.Methods A retrospective controlled study design was adopted.A total of 172 children with MUMPP who visited Suzhou Municipal Hospital from July 2023 to December 2024 were initially screened for this retrospective comparative study.After excluding cases that did not meet the inclusion criteria or were lost to follow-up during treatment,150 cases were ultimately included.Based on different treatment regimens,they were divided into two groups:75 cases receiving azithromycin combined with methylprednisolone were assigned to the azithromycin group,and 75 cases receiving doxycycline combined with methylprednisolone were assigned to the doxycycline group.The inflammatory level,immune level,clinical efficacy,post-treatment symptom improvement and incidence of adverse reactions were evaluated before and after treatment in two groups.Results The total effective rate in the doxycycline group was 92.00%(69/75),higher than that in the azithromycin group(80.00%(60/75))(χ^(2)=4.485,P<0.05).After treatment,the time to fever resolution,cough relief,disappearance of lung rales,and hospitalization length in the doxycycline group((4.51±1.37),(5.62±1.53),(4.78±1.24),(8.59±2.36)days,respectively)were all lower than those in the azithromycin group((7.24±2.83),(8.15±2.46),(6.92±1.85),(12.33±3.72)days,respectively)(t=7.519,7.563,8.321,7.352,all P<0.05).After treatment,the levels of interleukin-6,tumor necrosis factor-α,and C-reactive protein in the doxycycline group((11.64±4.36)ng/L,(2.85±0.86)ng/L,(32.33±6.72)mg/L,respectively)were all lower than those in the azithromycin group((17.83±4.75)ng/L,(4.92±1.01)ng/L,(47.52±6.16)mg/L,respectively)(t=8.314,13.514,14.430,all P<0.05).After treatment,the levels of CD3^(+)and CD4^(+)/CD8^(+)ratio in the doxycycline group((74.82±4.08)%,(1.77±0.28),respectively)were higher than those in the azithromycin group((68.85±4.53)%,(1.47±0.26),respectively)(t=8.481,6.799,both P<0.05).No statistically significant difference was observed in the incidence of adverse reactions between the two groups(8.00%(6/75)vs 5.33%(4/75),χ^(2)=0.429,P>0.05).Conclusion The combination of doxycycline and methylprednisolone is effective in treating MUMPP in children,significantly improving clinical outcomes and symptoms,modulating inflammatory and immune responses,with a favorable safety profile.
作者
杨静霞
段露芬
毛君
谢书艳
YANG Jingxia;DUAN Lufen;MAO Jun;XIE Shuyan(Department of Pediatrics,The Affiliated Suzhou Hospital of Nanjing Medical University(Suzhou Municipal Hospital),Suzhou 215002,China;Department of Pharmacy,The Affiliated Suzhou Hospital of Nanjing Medical University(Suzhou Municipal Hospital),Suzhou 215002,China;Reproduction and Genetics Center,The Affiliated Suzhou Hospital of Nanjing Medical University(Suzhou Municipal Hospital),Suzhou 215002,China)
出处
《中国药物应用与监测》
2026年第2期262-266,共5页
Chinese Journal of Drug Application and Monitoring
基金
江苏省药学会—奥赛康医院药学科研项目(A202429)。
