1、阿奇霉素聯(lián)合轉(zhuǎn)移因子口服溶液治療小兒肺炎支原體肺炎臨床療效觀察         09-08-25 11:19:00     作者：黃名壽，張一寧，趙珊    編輯：studa20【摘要】  目的：探討阿奇霉素聯(lián)合轉(zhuǎn)移因子口服溶液對(duì)小兒肺炎支原體肺炎的療效。方法：肺炎支原體肺炎患兒100例隨機(jī)分為觀察組和對(duì)照組各50例，觀察組采用阿奇霉素聯(lián)合轉(zhuǎn)移因子口服溶液治療，對(duì)照組單用阿奇霉素。療程2周結(jié)束后觀察療效，隨訪2月觀察有無復(fù)發(fā)。

2、結(jié)果：觀察組發(fā)熱、咳嗽、肺部體征消失和X線胸片恢復(fù)時(shí)間和對(duì)照組比較差異均有統(tǒng)計(jì)學(xué)意義（P<0.05）；兩組間治愈率差異有統(tǒng)計(jì)學(xué)意義（P<0.05）；觀察組無復(fù)發(fā)，對(duì)照組3例（6）復(fù)發(fā)。結(jié)論：阿奇霉素聯(lián)合轉(zhuǎn)移因子口服溶液治療小兒肺炎支原體肺炎療程短，治愈率高，復(fù)發(fā)率低，提示聯(lián)合用藥具有明顯的優(yōu)越性。 【關(guān)鍵詞】  肺炎支原體肺炎；免疫調(diào)節(jié)劑；聯(lián)合用藥    Abstract Objective:To investigate the therapeutic efficacy of azithromycin with transfer factor

3、 oral solution in treatment of children with mycoplasma pneumoniae pneumonia (MPP). Methods: 100 cases of children with MPP were randomly divided into two groups with 50 cases each: the observation group received the combined therapy of azithromycin with transfer factor oral solution, while the cont

4、rol group received the therapy of azithromycin only, and then comparison was made between the two groups in clinical effects in the end of the course of 2 weeks treatment and followup visits were made after 2month to see whether there was any recrudescence. Results: There was a significant differenc

5、e between the two groups (P<0.05) in the time of the disappearance of fever, cough and pulmonary signs and of Xray recovery, and there was also a statistic difference in curative rate (P<0.05). No case relapsed in the observation group while 3 cases (6%) in the control group. Conclusions: The

6、combined therapy of azithromycin with transfer factor oral solution has obvious superiority with shorter courses, higher curative rate and lower relapse rate than single azithromycin in treatment of children with MPP.    Key words   Mycoplasma pneumoniae pneumonia; Immunoreg

7、ulant; Drug combination    近年來，隨著肺炎病原學(xué)的變遷，肺炎支原體（Mycoplasma pneumoniae，MP）感染率明顯增加，肺炎支原體已成為兒童肺炎的重要病原，且有流行趨勢(shì)1。小兒肺炎支原體肺炎（Mycoplasma pneumoniae pneumonia，MPP）常年均可發(fā)生，治療不當(dāng)易致病情加重，遷延不愈。我科2002年5月2007年5月采用阿奇霉素聯(lián)合轉(zhuǎn)移因子口服溶液治療小兒肺炎支原體肺炎50例并與單用阿奇霉素治療50例進(jìn)行對(duì)照研究，現(xiàn)報(bào)道如下。    1  資料與方法 

8、;   1.1  一般資料    100例均為本院初診的住院患兒，符合諸福棠實(shí)用兒科學(xué)關(guān)于肺炎支原體肺炎的診斷標(biāo)準(zhǔn)2，無其他嚴(yán)重并發(fā)癥肝臟疾病和肝功異常及大環(huán)內(nèi)酯類藥物過敏史，入院前1周未用大環(huán)內(nèi)酯類或喹諾酮類藥物。將入選病例按入院順序隨機(jī)分為觀察組和對(duì)照組各50例。兩組患兒均有咳嗽，初期多表現(xiàn)為刺激性干咳，后期咳嗽有少許白色粘痰；發(fā)熱觀察組27例，對(duì)照組25例；肺部可聞干濕啰音：觀察組40例，對(duì)照組38例；X線肺部檢查：觀察組肺門陰影增多增粗為主（A）28例，斑片影（B）18例，大片高密度影（B）4例，對(duì)照組肺門陰影增多增粗為主（A

9、）33例，斑片影（B）17例。兩組冷凝集試驗(yàn)均陽性，支原體IgM陽性。兩組病例在性別年齡臨床表現(xiàn)及X線胸片改變等方面差異無統(tǒng)計(jì)學(xué)意義（P>0.05），見表1。    1.2  治療方法    對(duì)照組采用門冬氨酸阿奇霉素針（博抗，海南斯達(dá)制藥有限公司）10 mg/(kg·d)靜脈滴注，最大量小于0.5 g/d，1次/d，每周用3 d停4 d，連用2周，同時(shí)給予退熱止咳化痰等對(duì)癥處理。觀察組在對(duì)照組基礎(chǔ)上加用轉(zhuǎn)移因子口服溶液（長(zhǎng)春精優(yōu)藥業(yè)股份有限公司）10 mL/次，1次/d，2周為一療程。療程結(jié)束后判定療效。表

10、1  兩組MPP患兒一般臨床資料比較    1.3  療效評(píng)定3    痊愈：用藥后3 d內(nèi)體溫恢復(fù)正常，5 d內(nèi)咳嗽停止，10 d內(nèi)肺部干濕啰音及X線胸片檢查肺部陰影完全消失。顯效：用藥后3 d內(nèi)體溫正常，7 d內(nèi)咳嗽緩解，10 d內(nèi)肺部干濕啰音明顯減少，X線胸片檢查肺部陰影基本消失。好轉(zhuǎn)：用藥7 d體溫基本恢復(fù)正常，一療程結(jié)束時(shí)咳嗽癥狀仍存在但較治療前明顯減輕，肺部體征及X線胸片檢查肺部陰影有所減輕。無效：用藥療程結(jié)束時(shí)仍有發(fā)熱或刺激性咳嗽，肺部體征及X線胸片檢查肺部陰影仍存在。痊愈顯效和好轉(zhuǎn)判為有效。    1.4  統(tǒng)計(jì)學(xué)處理    兩組一般資料中計(jì)量資料和治療后主要臨床指標(biāo)比較采用t檢驗(yàn)，一般資料中計(jì)數(shù)資料和療效比較采用2檢驗(yàn)。    2  結(jié)果&