低剂量与高剂量的甲基普雷迪尼索隆对患有严重的Mycoplasma pneumoniae肺炎 (MCMP) 的儿童:一个随机对照试验
Baoping Xu1, Ling Cao2, Yunxiao Shang3
1Department of Respiratory Disease Beijing Children's Hospital, Capital Medical University China National Clinical Research Center of Respiratory Diseases National Center for Children's Health Beijing China.
低剂量甲基普雷迪尼索隆与阿齐思罗米在预防严重的Mycoplasma pneumoniae肺炎 (MPP) 中长期肺病变方面与高剂量一样有效. 低剂量治疗方案提供了更好的安全性,降低了高血压等风险.
科学领域:
- 儿科 儿科 儿科
- 传染性疾病 传染性疾病
- 肺部病理学 肺部病理学
背景情况:
- 严重的Mycoplasma pneumoniae肺炎 (MPP) 可能导致长期的肺部并发症.
- 麦克罗利德和葡萄糖皮质激素治疗在预防这些病变方面是有效的,但最佳的葡萄糖皮质激素剂量仍然不清楚.
研究的目的:
- 为了比较低剂量与高剂量甲基普雷迪尼索隆与阿兹罗米辛结合治疗重症儿科MPP的疗效和安全性.
- 评估不同甲基普雷迪尼索隆剂量对长期肺病变风险的影响.
主要方法:
- 一个随机的,并行控制的多中心临床试验,涉及424名患有严重MPP的儿科患者.
- 患者接受了阿齐思罗米辛加上低剂量 (2毫克/公斤/天) 或高剂量 (10毫克/公斤/天) 甲基普雷迪尼索隆3天,然后逐渐减少12天.
- 主要结局是6个月后复合不良肺结局 (atelectasis,支气管切开症,支气管炎 obliterans) 的发生率.
主要成果:
- 长期肺病变的发生率在低剂量组为24.4%,在高剂量组为31.3% (风险比:1.28,95% CI:0.94-1.75).
- 高血压发生在低剂量组的1.4%,高剂量组的8.1% (风险比:5.72,95% CI:1.70-19.23).
结论:
- 低剂量甲基普雷迪尼索隆与阿齐思罗米结合,对于预防重症儿科MPP肺病变的高剂量治疗,效果不逊色.
- 低剂量疗法提供了优越的安全性,高血压率明显降低.
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