阿奇霉素联合孟鲁司特钠治疗小儿肺炎支原体肺炎的疗效及其对患儿T淋巴细胞亚群、免疫球蛋白及补体C3、C4的影响

摘要

目的 观察阿奇霉素联合孟鲁司特钠治疗小儿肺炎支原体肺炎的疗效及其对患儿T淋巴细胞亚群、免疫球蛋白及补体C3、C4的影响.方法 选取肺炎支原体肺炎患儿400例,采用随机数字表法分为对照组和观察组,每组200例.对照组采用阿奇霉素序贯疗法进行治疗,观察组采用阿奇霉素序贯疗法联合孟鲁司特钠治疗,比较两组患儿临床总有效率、临床症状与体征消失时间,治疗前后T淋巴细胞亚群、免疫球蛋白及补体C3、C4的变化情况.结果 观察组总有效率为94.5％,高于对照组的77％(P<0.05).观察组临床症状和体征消失时间明显短于对照组(P<0.05).两组治疗后免疫球蛋白Ig E、Ig G水平明显降低,Ig A水平显著增高(P<0.05);CD3+、CD4+及CD4+/CD8+比值均降低,而CD8+升高(P<0.05);C3、C4轻度升高,差异未见统计学意义(P>0.05).同时,观察组上述变化趋势更显著,但差异未见统计学意义(P>0.05).两组均未见严重不良反应.结论 阿奇霉素联合孟鲁司特钠方案能够明显提高小儿支原体肺炎的临床效果,安全、有效;观测患儿外周血T淋巴细胞亚群、免疫球蛋白及补体C3、C4的水平对临床治疗具有一定的参考意义.%Objective To observe the efficacy of azithromycin combined with montelukast in the treatment of children with mycoplasma pneumoniae pneumonia and its effects on T lymphocyte subsets , immunoglobulin, complement C3 and C4 in children.Methods Four hundred cases of mycoplasma pneumoniae pneumonia were selected .The children were divided into the control group and the observa-tion group by the random digital table , with 200 cases in each group .The control group was treated with azithromycin sequential therapy , and the observation group was treated with azithromycin sequential ther-apy combined with montelukast sodium .The total clinical effective rate , the time of clinical symptoms and signs disappearance , the changes of T lymphocyte subsets , immunoglobulin , complement C3 and C4 before and after treatment were compared between the two groups .Results The total clinical efficiency in observation group ( 94.5％) after treatment was significantly higher than that of control group ( 77％) (P<0.05).The clinical symptoms and signs disappeared time in observation group (1 d) was signifi-cantly shorter than those of control group (3.5 d) (P<0.05).The IgE, IgG, CD3 +,CD 4 +and CD 4+/CD 8 +ratio levels were significantly reduced in the two groups , after treatment the IgA ,CD 8 levels were significantly increased ( P<0.05 ) , but C3 , C4 were mildly increased and the differences were not significant .In addition , the levels in the observation group were more significant than those of the control group , but the differences were not significant ( P>0.05 ) .No serious adverse reactions were found in the two groups .Conclusions Azithromycin combined with montelukast can dramatically im-prove the treatment of mycoplasma pneumoniae pneumonia in children ,and is safe,effective.Observing the T lymphocyte subsets, immunoglobulin, and complement C3 and C4 changes in the peripheral blood is worthy of clinical application .