[1]韩金芬,王会娟,唐晓燕,等.人免疫球蛋白联合阿奇霉素治疗小儿肺炎支原体肺炎合并中枢神经系统损伤疗效观察[J].新乡医学院学报,2022,39(1):034-38.[doi:10.7683/xxyxyxb.2022.01.008]
　HAN Jinfen,WANG Huijuan,TANG Xiaoyan,et al.Efficacy of human immunoglobulin combined with azithromycin in the treatment of mycoplasma pneumoniae pneumonia complicated with central nervous system involvement in children[J].Journal of Xinxiang Medical University,2022,39(1):034-38.[doi:10.7683/xxyxyxb.2022.01.008]
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人免疫球蛋白联合阿奇霉素治疗小儿肺炎支原体肺炎合并中枢神经系统损伤疗效观察
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
39
期数:
2022年1
页码:
034-38
栏目:
临床研究
出版日期:
2022-01-05

文章信息/Info

Title:
Efficacy of human immunoglobulin combined with azithromycin in the treatment of mycoplasma pneumoniae pneumonia complicated with central nervous system involvement in children
作者:
韩金芬1; 王会娟1; 唐晓燕1; 王家勤2
（1.新乡医学院第三附属医院儿科，河南　新乡　453003；2.新乡医学院第三附属医院儿童康复科，河南　新乡　453003）
Author(s):
HAN Jinfen1; WANG Huijuan1; TANG Xiaoyan1; WANG Jiaqin2
（1.Department of Paediatrics，the Third Affiliated Hospital of Xinxiang Medical University，Xinxiang 453003，Henan Province，China2.Department of Recovery，the Third Affiliated Hospital of Xinxiang Medical University，Xinxiang 453003，Henan Province，China）
关键词:
儿童; 肺炎支原体肺炎; 中枢神经系统损伤; 阿奇霉素; 人免疫球蛋白
Keywords:
childrenmycoplasma pneumoniae pneumoniacentral nervous system involvementazithromycinhuman immunoglobulin
分类号:
R563.1
DOI:
10.7683/xxyxyxb.2022.01.008
文献标志码:
A
摘要:
目的　探讨人免疫球蛋白联合阿奇霉素治疗小儿肺炎支原体肺炎合并中枢神经系统损伤的疗效。方法　选择2018年1月至2020年3月新乡医学院第三附属医院儿科收治的60例肺炎支原体肺炎合并中枢神经系统损伤患儿为研究对象，采用随机数字表法将患儿分为对照组和观察组，每组30例。对照组患儿给予退热、止咳、袪痰、止痉、降颅压等常规对症治疗，同时给予阿奇霉素10 mg·kg-1，静脉滴注，每日1次，连用5 d后停药3 d，给药2轮后改为阿奇霉素10 mg·kg-1，口服，每日1次；总疗程为3周。在对照组治疗基础上，观察组患儿给予人免疫球蛋白 400 mg·kg-1，静脉注射，每日1次，持续用药5 d，总疗程为3周。治疗3周后，观察并比较2组患儿的临床治疗效果及不良反应发生率。入院24 h内及治疗3周后，行腰椎穿刺采集患儿的脑脊液，采用电化学发光法测定脑脊液中白细胞介素（IL）-6、IL-8水平。入院24 h内及治疗3周后，采集患儿外周静脉血3 mL，采用免疫比浊法检测血清C-反应蛋白（CRP）、免疫球蛋白（Ig）G、IgA、IgM水平，免疫荧光法检测血清降钙素原（PCT）水平。结果　治疗3周后，对照组患儿显效11例（36.67%），有效13例（43.33%），无效6例（20.00%），总有效率为80.00%（24/30）；观察组患儿显效14例（46.67%），有效15例（50.00%），无效1例（3.33%），总有效率为96.67%（29/30）；观察组患儿总有效率显著高于对照组（χ2= 4.043，P<0.05）。观察组患儿发热、咳嗽、头痛、嗜睡、抽搐等症状消失时间均短于对照组（P<0.05）。治疗前，2组患儿脑脊液中IL-6、IL-8水平及血清CRP、PCT、IgG、IgA、IgM水平比较差异无统计学意义（P>0.05）。治疗3周后，2组患儿脑脊液中IL-6、IL-8水平及血清CRP、PCT水平均较治疗前显著降低（P<0.05），血清IgG、IgA、IgM水平均较治疗前显著增高（P<0.05）；治疗3周后，观察组患儿脑脊液中IL-6、IL-8水平及血清CRP、PCT水平显著低于对照组（P<0.05），血清IgG、IgA、IgM水平均显著高于对照组（P<0.05）。对照组患儿出现腹泻1例、腹痛1例，不良反应发生率为6.67%（2/30）；观察组患儿出现恶心1例，不良反应发生率为3.33%（1/30）；2组患儿不良反应发生率比较差异无统计学意义（χ2=0.351，P>0.05）。结论　人免疫球蛋白联合阿奇霉素治疗肺炎支原体肺炎合并中枢神经系统损伤患儿的效果良好，可有效改善患儿脑脊液的异常，调节免疫功能，且不良反应少。
Abstract:
Objective　To investigate the therapeutic effect of human immunoglobulin combined with azithromycin for mycoplasma pneumoniae pneumonia complicated with central nervous system involvement in children.Methods　Sixty children with mycoplasma pneumoniae pneumonia complicated with central nervous system involvement admitted to the Department of Paediatrics，the Third Affiliated Hospital of Xinxiang Medical University from January 2018 to March 2020 were selected as the study objects.The children were divided into control group(n=30) and observation group(n=30) by random number table.The children in the control group were given routine symptomatic support treatment such as antipyretic,cough relieving,expectorant,antispasmodic and intracranial pressure reductionat the same time,the children were given azithromycin (10 mg·kg-1) intravenously once a day for 5 days and then stopped for 3 daysafter 2 rounds of administration,azithromycin(10 mg·kg-1) was taken orally once a daythe total course of treatment was 3 weeks.On the basis of treatment of children in the control group,the children in the observation group were given human immunoglobulin 400 mg·kg-1 intravenously,once a day for 5 days,and the total course of treatment was 3 weeks.After 3 weeks of treatment,the clinical treatment effect and incidence of adverse reactions were observed and compared between the two groups.The cerebrospinal fluid was collected by lumbar puncture within 24 hours after admission and after 3 weeks of treatment,and the levels of interleukin (IL)-6 and IL-8 in cerebrospinal fluid were measured by electrochemiluminescence.Within 24 h after admission and after 3 weeks of treatment,3 mL of peripheral venous blood was collected,and the serum C-reactive protein (CRP)，immunoglobulin (Ig)G,IgA and IgM levels were determined by immunoturbidimetrythe serum procalcitonin(PCT) levels was determined by immumofluorescence method.Results　After 3 weeks of treatment,11 cases (36.67%) were significantly effective,13 cases (43.33%) were effective and 6 cases (20.00%) were ineffective in the control group,the total effective rate was 80.00%(24/30)in the observation group,14 cases (46.67%) were significantly effective,15 cases (50.00%) were effective,and 1 case (3.33%) was ineffective,the total effective rate was 96.67% (29/30).The total effective rate of patients in the observation group was significantly higher than that in the control group (χ2= 4.043,P<0.05).The disappearance times of fever,cough,headache,drowsiness and convulsion of patients in the observation group were significantly shorter than those in the control group (P<0.05).There was no significant difference in the levels of IL-6 and IL-8 in cerebrospinal fluid and the serum levels of CRP,PCT,IgG,IgA and IgM of patients between the two groups before treatment (P>0.05).The levels of IL-6 and IL-8 in cerebrospinal fluid and the levels of CRP and PCT in serum of patients after 3 weeks of treatment were significantly lower than those before treatment (P<0.05),while the serum levels of IgG,IgA and IgM were significantly higher than those before treatment (P<0.05).After 3 weeks of treatment,the levels of IL-6 and IL-8 in cerebrospinal fluid and the serum levels of CRP，PCT of patients in the observation group were significantly lower than those in the control group (P<0.05)the serum levels of IgG,IgA and IgM of patients in the observation group were significantly higher than those in the control group (P<0.05).In the control group,there was 1 case of diarrhea and 1 case of abdominal pain,the incidence of adverse reaction was 6.67% (2/30)in the observation group,there was 1 case of nausea,and the incidence of adverse reaction was 3.33% (1/30).There was no significant difference in the incidence of adverse reaction between the two groups (χ2=0.351,P>0.05).Conclusion　The combination of human immunoglobulin and azithromycin in the treatment of mycoplasma pneumoniae pneumonia complicated with central nervous system involvement in children has a good effect,which can effectively improve the abnormal cerebrospinal fluid and regulate immunefunction,with few adverse reactions.

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更新日期/Last Update: 2022-01-05