米诺环素联合甲泼尼龙治疗儿童耐大环内酯类肺炎支原体肺炎的临床疗效观察

Clinical Observation of the Efficacy of Minocycline Combined with Methylprednisolone in the Treatment of Macrolide-Resistant Mycoplasma Pneumoniae in Children

摘要: 目的：探究米诺环素联合甲泼尼龙治疗儿童重症耐大环内酯类肺炎支原体肺炎(MRMPP)的安全性和短期疗效。方法：回顾性分析2023年6月~2024年6月于青岛大学附属医院治疗的121例重症MRMPP患儿，分为A组(阿奇霉素 + 甲泼尼龙)和B组(米诺环素 + 甲泼尼龙)，比较两组临床疗效、发热持续时间、炎症指标、血常规组合炎症指数变化、血小板参数变化、肝肾功能变化、肺功能及不良反应情况。结果：B组治疗有效率高于A组；B组发热持续时间(2.54 ± 0.79天)短于A组(3.89 ± 1.07天)；治疗后两组炎症指标(CRP、ESR、PCT、D-二聚体、LDH)均较治疗前下降，ESR、PCT、D-二聚体降低值B组更大，CRP、LDH、血小板参数(PLT、PCt、MPV、PDW)、肝肾功能(ALT、AST、肌酐)两组间比较无显著差异。B组治疗第4天血常规组合炎症指数中性粒细胞/淋巴细胞(NLR)、血小板/淋巴细胞(PLR)、全身免疫炎症指数(SII)较A组明显降低，且差异有统计学意义(P < 0.05)，治疗7天后两组未见明显统计学差异；B组喘息患儿肺功能改善更好；两组不良反应发生率均较低，差异无统计学意义(P = 0.093)。结论：米诺环素联合甲泼尼龙治疗儿童重症MRMPP短期未见明显不良反应，临床疗效显著，炎症指标下降快，而抗炎治疗可能是影响预后的重点。

Abstract: Objective: To investigate the safety and short-term efficacy of minocycline combined with methylprednisolone in the treatment of severe macrolide-resistant mycoplasma pneumoniae pneumonia (MRMPP) in children. Methods: A retrospective analysis was conducted on 121 children with severe MRMPP treated at the Affiliated Hospital of Qingdao University from June 2023 to June 2024. They were divided into group A (azithromycin + methylprednisolone) and group B (minocycline + methylprednisolone). Clinical efficacy, duration of fever, inflammatory markers, changes in combined inflammatory indices of complete blood count, platelet parameters, liver and kidney function, pulmonary function, and adverse reactions were compared between the two groups. Results: The effective rate of treatment in group B was higher than that in group A; the duration of fever in group B (2.54 ± 0.79 days) was shorter than that in group A (3.89 ± 1.07 days); after treatment, the inflammatory markers (CRP, ESR, PCT, D-dimer, LDH) in both groups decreased compared with before treatment, with a greater decrease in ESR, PCT, and D-dimer in group B. There were no significant differences between the two groups in CRP, LDH, platelet parameters (PLT, PCt, MPV, PDW), and liver and kidney function (ALT, AST, creatinine). On day 4 of treatment, the combined inflammatory indices of neutrophils/lymphocytes (NLR), platelets/lymphocytes (PLR), and systemic immune inflammatory index (SII) in group B were significantly lower than those in group A, and the differences were statistically significant (P < 0.05). After 7 days of treatment, no significant statistical differences were observed between the two groups; the lung function of children with wheezing improved better in group B; the incidence of adverse reactions was low in both groups, with no statistically significant difference (P = 0.093). Conclusion: Minocycline combined with methylprednisolone showed no significant adverse reactions in the short term for the treatment of severe MRMPP in children, with significant clinical efficacy and rapid decrease in inflammatory markers. Anti-inflammatory treatment may be the key factor affecting prognosis.