| 摘要: |
| 目的:探讨纤维支气管镜下肺泡灌洗联合俯卧位治疗儿童重症肺炎支原体肺炎(MPP)合并肺不张的临床疗效,并观察 NLRP3 炎症小体/ IL-1β 通路相关指标变化。 方法:选取我院 2022 年 6 月-2024 年 6 月收治的 113 例重症 MPP 合并肺不张患 儿,按随机数表法分为观察组 57 例和对照组 56 例。 两组均接受规范抗感染、祛痰、氧疗及按病情分层的强化药物治疗,对照组 加用纤维支气管镜下肺泡灌洗,观察组在对照组基础上联合俯卧位。 比较症状缓解、肺复张、病灶吸收、疗效及 TLR4 mRNA、 NLRP3 mRNA、白介素(IL)-1β、IL-18、乳酸脱氢酶(LDH)、D-二聚体(D-D)和 T 淋巴细胞亚群。 结果:观察组咳嗽缓解、退热、气 促消失、啰音消失及住院时间均短于对照组,住院第 7 天肺复张率高于对照组(80. 70% vs. 62. 50%,P< 0. 05)。 两组治疗后 TLR4 mRNA、NLRP3 mRNA、IL-1β、IL-18、LDH、D-D 及 T 淋巴细胞指标较治疗前均改善(P<0. 05),但治疗后组间差异均无统计 学意义(P>0. 05)。 观察组病灶吸收和总体疗效优于对照组(P<0. 05)。 结论:规范药物治疗和纤维支气管镜下肺泡灌洗基础 上联合俯卧位,可促进重症 MPP 合并肺不张患儿症状缓解、肺复张和病灶吸收,但本研究未能证实联合俯卧位较单纯灌洗对外 周血 NLRP3 炎症小体/ IL-1β 通路具有额外抑制作用。 |
| 关键词: 重症 肺炎支原体肺炎 肺不张 支气管肺泡灌洗 俯卧位 NLRP3 炎症小体 |
| DOI：10.13407/j.cnki.jpp.1672-108X.2026.09.012 |
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| 基金项目: |
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| Clinical Efficacy of Bronchoalveolar Lavage via Flexible Bronchoscopy Combined with Prone Positioning in Children with Severe Mycoplasma Pneumoniae Pneumonia Complicated with Atelectasis and Comparison of NLRP3 Inflammasome-Related Indicators |
| Zhao Qiuju, Dong Li |
| (The Seventh Medical Center of the People’s Liberation Army General Hospital, Beijing 100010, China) |
| Abstract: |
| Objective: To probe into the clinical efficacy of bronchoalveolar lavage via flexible bronchoscopy combined with prone positioning in children with severe Mycoplasma pneumoniae pneumonia (MPP) complicated with atelectasis, and to observe the changes in NLRP3 inflammasome / IL-1β pathway-related indicators. Methods: A total of 113 children with severe MPP complicated with atelectasis admitted into our hospital from Jun. 2022 to Jun. 2024 were extracted to be divided into the observation group (57 cases) and control group ( 56 cases) via the random number table method. Both groups received standardized anti-infective therapy, airway clearance, oxygen therapy, and disease-stratified supportive medication. The control group was given bronchoalveolar lavage via flexible bronchoscopy, while the observation group additionally received prone positioning based on the control group. Symptom resolution, lung re-expansion, lesion absorption, clinical response, TLR4 mRNA, NLRP3 mRNA, interleukin ( IL)-1β, IL-18, lactic dehydrogenase (LDH), D-dimer (D-D), and T-lymphocyte subsets were compared between two groups. Results: The cough relief, fever reduction, disappearance time of shortness of breath, disappearance time of rales, and length of stay in observation group were shorter than those in control group. The lung re-expansion rate on the 7th d of hospitalization in observation group was higher than that in control group (80. 70% vs. 62. 50%, P< 0. 05). After treatment, the levels of TLR4 mRNA, NLRP3 mRNA, IL-1β, IL-18, LDH, D-D and T lymphocyte indicators in both groups were improved compared with those before treatment (P< 0. 05), but there were no statistically significant differences after treatment (P>0. 05). The lesion absorption and overall therapeutic effect of observation group were better than those of control group ( P < 0. 05 ). Conclusion: Prone positioning combined with bronchoalveolar lavage on the basis of standardized medication may accelerate symptom relief, lung re-expansion, and lesion absorption in children with severe MPP complicated with atelectasis. This study does not demonstrate an additional inhibitory effect of prone positioning on peripheral blood NLRP3 inflammasome / IL-1β pathway indicators. |
| Key words: severe Mycoplasma pneumoniae pneumonia atelectasis bronchoalveolar lavage prone positioning NLRP3 inflammasome |
