Efficacy of sequential treatment with methylprednisolone combined with azithromycin on paediatric refractory mycoplasma pneumoniae pneumonia
Objective To investigate the efficacy of methylprednisolone combined with azithromycin sequential therapy on pediatric refractory mycoplasma pneumoniae pneumonia(RMPP)and the effects on serum chitinase-like protein(YKL-40),amyloid A(SAA),and lung surface-active substance-associated protein-A(SP-A).Methods A total of 126 children with RMPP recruited by Zhengzhou Ninth People's Hospital during June 2022 and June 2023 were included in the study,and were divided into a control group(azithromycin)and an observation group(methylprednisolone+azithromycin)by the random number table method,with 63 cases in each group.In the observation group,there were 33 boys and 30 girls,aged 4 to 11(8.34±3.61)years,and the time from onset to admission was 8 to 49(34.59±10.13)h.In the control group,there were 36 boys and 27 girls,aged 5 to 10(8.06±3.34)years,and the time from onset to admission was 11 to 50(34.26±10.24)h.The control group was given intravenous drip with azithromycin aspartate at a dose of 10 mg/kg once a day;after 3 days of treatment,it was changed to oral azithromycin,at a dose of 10 mg/kg,once a day,with 7 days as a course of treatment.The observation group was given methylprednisolone sodium succinate intravenous drip on the basis of the control group,the initial dose was 2 mg/kg,once a day,and the dose was adjusted to 1 mg/kg after 5 days of continuous treatment,and continued for 2 days,with 7 days as a course of treatment.Both groups were treated for 2 consecutive courses.The two groups were compared in terms of therapeutic effects,differences in serum factor levels and lung function indexes before and after treatment,and the safety was analyzed.t test and x2 test were used.Results The total effective rate of the observation group was higher than that of the control group[95.24％(60/63)vs.79.37％(50/63)],with a statistically significant difference(x2=7.159,P=0.008).In the observation group,the disappearance time of cough and sputum sound,dry and wet rales,and wheezing and hospital stay were(3.24±0.78)d,(3.47±0.71)d,(5.06±1.37)d,and(3.47±0.83)d,which were shorter than(6.04±1.31)d,(5.87±1.52)d,(7.58±1.21)d,and(6.11±1.12)d in the control group,with statistically significant differences(t=14.577,11.355,10.943,and 15.032,all P＜0.001).After treatment,the levels of forced vital capacity(FVC),forced expiratory volume in the first second(FEV1),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),high-sensitivity C-reactive protein(hs-CRP),SAA,YKL-40,and SP-Ain the observation group were(2.96±0.54)L,(2.56±0.42)L,(63.47±2.11)ng/L,(1.34±0.18)ng/L,(7.02±1.13)mg/L,(26.34±6.61)mg/L,(30.64±5.41)μg/L,and(36.07±6.58)μg/L,those in the control group were(2.02±0.51)L,(1.53±0.31)L,(123.36±2.14)ng/L,(2.69±0.22)ng/L,(9.63±1.51)mg/L,(112.35±19.54)mg/L,(36.17±5.87)μg/L,and(45.62±7.03)μg/L,with statistically significant differences(all P＜0.001).Conclusion Methylprednisolone combined with azithromycin can effectively improve the lung function and downregulate serum SAA,YKL-40,and SP-A levels in children with RMPP,which is safe and worthy of promotion.
万方数据
维普
