中华儿科杂志
中華兒科雜誌
중화인과잡지
Chinese Journal of Pediatrics
2015年
10期
779-783
,共5页
蓝引乐%杨德华%陈志敏%唐兰芳%徐迎春%成云改
藍引樂%楊德華%陳誌敏%唐蘭芳%徐迎春%成雲改
람인악%양덕화%진지민%당란방%서영춘%성운개
肺炎支原体%肺炎%支气管肺泡灌洗液%细胞因子%激素
肺炎支原體%肺炎%支氣管肺泡灌洗液%細胞因子%激素
폐염지원체%폐염%지기관폐포관세액%세포인자%격소
Mycoplasma pneumonia%Pneumonia%Bronchoalveolar lavage fluid%Cytokine%Steroid
目的 探讨甲泼尼龙对难治性肺炎支原体肺炎(RMPP)的疗效及其肺泡灌洗液(BALF)中细胞因子水平的改变.方法 选取2012年2月至2013年2月在浙江大学医学院附属儿童医院呼吸科诊断为RMPP的患儿(60例)为研究对象,应用随机数余数法分成激素治疗组与非激素治疗组(各30例),激素治疗组中,予甲泼尼龙2 mg/(kg·d)静脉滴注,连用3d,治疗后退热患儿归为退热组,持续发热的患儿归为未退热组,随后行软式支气管镜与肺泡灌洗术,测定BALF中白细胞介素(IL)-1β、IL-2、IL-4、IL-6、IL-8、IL-10、IL-12、干扰素(IFN)-γ、肿瘤坏死因子(TNF)-α水平.同时设置同期因异物入院行软式支气管镜术的患儿为对照组(20例).结果 (1)激素治疗组3d后退热9例(30％),非激素治疗组无一例退热(0/30)(x2=14.073,P=0.002).激素治疗组治疗后发热时间(4.7 d)短于非激素治疗组(6.7 d),但差异尚未达到显著界值(t=-1.351,P=0.182).激素治疗组咳嗽时间5.1d,非激素治疗组7.0d(t=-2.276,P=0.027).(2)与对照组相比,激素治疗组和非激素治疗组BALF中IL-1β、IL-4、IL-6、IL-8、IL-10、IFN-γ均明显升高,但激素治疗组和非激素治疗组之间各细胞因子水平差异无统计学意义.激素治疗后退热组BALF中IL-2、IL-8水平明显低于非退热组(t=2.771、2.054,P=0.010、0.049),其他细胞因子两组间差异无统计学意义.结论 (1)甲泼尼龙2 mg/(kg·d)静脉滴注3d对部分RMPP患儿有退热效果,并缩短咳嗽时间.(2)RMPP患儿BALF中IL-1β、L-4、IL-6、IL-8、IL-10、IFN-γ均高于对照组,IL-2、IL-8持续高水平可能与RMPP患儿激素治疗后持续发热有关.
目的 探討甲潑尼龍對難治性肺炎支原體肺炎(RMPP)的療效及其肺泡灌洗液(BALF)中細胞因子水平的改變.方法 選取2012年2月至2013年2月在浙江大學醫學院附屬兒童醫院呼吸科診斷為RMPP的患兒(60例)為研究對象,應用隨機數餘數法分成激素治療組與非激素治療組(各30例),激素治療組中,予甲潑尼龍2 mg/(kg·d)靜脈滴註,連用3d,治療後退熱患兒歸為退熱組,持續髮熱的患兒歸為未退熱組,隨後行軟式支氣管鏡與肺泡灌洗術,測定BALF中白細胞介素(IL)-1β、IL-2、IL-4、IL-6、IL-8、IL-10、IL-12、榦擾素(IFN)-γ、腫瘤壞死因子(TNF)-α水平.同時設置同期因異物入院行軟式支氣管鏡術的患兒為對照組(20例).結果 (1)激素治療組3d後退熱9例(30％),非激素治療組無一例退熱(0/30)(x2=14.073,P=0.002).激素治療組治療後髮熱時間(4.7 d)短于非激素治療組(6.7 d),但差異尚未達到顯著界值(t=-1.351,P=0.182).激素治療組咳嗽時間5.1d,非激素治療組7.0d(t=-2.276,P=0.027).(2)與對照組相比,激素治療組和非激素治療組BALF中IL-1β、IL-4、IL-6、IL-8、IL-10、IFN-γ均明顯升高,但激素治療組和非激素治療組之間各細胞因子水平差異無統計學意義.激素治療後退熱組BALF中IL-2、IL-8水平明顯低于非退熱組(t=2.771、2.054,P=0.010、0.049),其他細胞因子兩組間差異無統計學意義.結論 (1)甲潑尼龍2 mg/(kg·d)靜脈滴註3d對部分RMPP患兒有退熱效果,併縮短咳嗽時間.(2)RMPP患兒BALF中IL-1β、L-4、IL-6、IL-8、IL-10、IFN-γ均高于對照組,IL-2、IL-8持續高水平可能與RMPP患兒激素治療後持續髮熱有關.
목적 탐토갑발니룡대난치성폐염지원체폐염(RMPP)적료효급기폐포관세액(BALF)중세포인자수평적개변.방법 선취2012년2월지2013년2월재절강대학의학원부속인동의원호흡과진단위RMPP적환인(60례)위연구대상,응용수궤수여수법분성격소치료조여비격소치료조(각30례),격소치료조중,여갑발니룡2 mg/(kg·d)정맥적주,련용3d,치료후퇴열환인귀위퇴열조,지속발열적환인귀위미퇴열조,수후행연식지기관경여폐포관세술,측정BALF중백세포개소(IL)-1β、IL-2、IL-4、IL-6、IL-8、IL-10、IL-12、간우소(IFN)-γ、종류배사인자(TNF)-α수평.동시설치동기인이물입원행연식지기관경술적환인위대조조(20례).결과 (1)격소치료조3d후퇴열9례(30％),비격소치료조무일례퇴열(0/30)(x2=14.073,P=0.002).격소치료조치료후발열시간(4.7 d)단우비격소치료조(6.7 d),단차이상미체도현저계치(t=-1.351,P=0.182).격소치료조해수시간5.1d,비격소치료조7.0d(t=-2.276,P=0.027).(2)여대조조상비,격소치료조화비격소치료조BALF중IL-1β、IL-4、IL-6、IL-8、IL-10、IFN-γ균명현승고,단격소치료조화비격소치료조지간각세포인자수평차이무통계학의의.격소치료후퇴열조BALF중IL-2、IL-8수평명현저우비퇴열조(t=2.771、2.054,P=0.010、0.049),기타세포인자량조간차이무통계학의의.결론 (1)갑발니룡2 mg/(kg·d)정맥적주3d대부분RMPP환인유퇴열효과,병축단해수시간.(2)RMPP환인BALF중IL-1β、L-4、IL-6、IL-8、IL-10、IFN-γ균고우대조조,IL-2、IL-8지속고수평가능여RMPP환인격소치료후지속발열유관.
Objective To investigate cytokine level in bronchoalveolar lavage fluid (BALF) in children with refractory Mycoplasma pneumoniae pneumonia (RMPP) and the effects of methylprednisolone on RMPP.Method Sixty cases with RMPP and 20 cases with bronchial foreign body with no respiratory tract infection as control group hospitalized in Department of Pulmonary Diseases,the Children's Hospital Affiliated to Medical School of Zhejiang University from February 2012 to February 2013 were enrolled.The RMPP patients were divided into two groups randomly (30 cases in each).Steroid group were given methylprednisolone 2 mg/(kg · d) intravenously for 3 days,and the cases in non steroid group were not given steroid therapy.Patients whose fever relieved after steroid treatment were classified as defervesced group while the others were classified as non defervesced group.Each patient was examined with fiberoptic bronchoscopy and bronchoalveolar lavage 3 days after admission and cytokine level in BALF of each patient was detected.Result (1) In steroid group,the proportion of patients whose fever disappeared within 3 days after steroid therapy was 9/30 cases (30％),and in non steroid group no one responded within 3 days after medication,showing statistically significant difference (x2 =14.073,P =0.002),at the same time,the duration of cough in steroid group was significantly shorter than that in non steroid group (5.1 d vs.7.0 d,t =-2.276,P =0.027).The total fever time of steroid group was 4.7 days,which as compaired with non steroid group (6.7 days) was shorter,but the difference was not significant (t =-1.351,P =0.134).(2) IL-1 β,IL-4,IL-6,IL-8,IL-10,IFN-γ in BALF of steroid group and non steroid group were both significantly higher than that of control group.But the same comparison between steroid group and non steroid group showed no significant difference.(3) In steroid group,IL-2 and IL-8 in BALF of patient whose fever disappeared after steroid therapy were both significantly lower than that of patients who still had fever (t =2.771,2.054,P =0.010,0.049),but no significant difference was found between the two groups in BALF IL-1 β,IL-4,IL-6,IL-1 0,IFN-γ levels (P ＞ 0.05).Conclusion (1) Three days of 2 mg/(kg · d) methylprednisolone therapy had the antipyretic effect in children with RMPP,and could shorten the length of cough.(2) Incresed BALF IL-1 β,IL-4,IL-6,IL-8,IL-10,IFN-γ levels were observed in RMPP and high level of BALF IL-2 and IL-8 might have some relevance with persistent fever of RMPP in children.
