| 摘要: |
| 目的:探讨早期换用多西环素治疗儿童大环内酯类药物无反应性肺炎支原体肺炎(MUMPP)的疗效与安全性。方法:选
取扬州大学附属泰州第二人民医院2021 年2 月至2025 年4 月收治的MUMPP 患儿共90 例,按随机数表法分为阿奇霉素组(采
用阿奇霉素延长治疗)与多西环素组(采用多西环素换药治疗) 各45 例。比较两组患儿临床疗效、糖皮质激素使用情况、48 h
退热率、72 h 退热率、退热时间、住院时间、肺功能、炎症因子水平、不良反应发生情况等。结果:治疗1 周后,阿奇霉素组与多西
环素组临床总有效率比较差异有统计学意义(P<0. 05)。两组患儿糖皮质激素使用情况差异无统计学意义(P>0. 05)。多西环
素组48 h 退热率、72 h 退热率均高于阿奇霉素组(P<0. 05),退热时间、住院时间均短于阿奇霉素组(P<0. 05)。与调整治疗前
比较,两组患儿调整治疗后第一秒用力呼气容积(FEV1)、用力肺活量(FVC)、呼气峰流速(PEF)水平均升高(P<0. 05),且多西
环素组水平均高于阿奇霉素组(均P<0. 05)。与调整治疗前比较,两组患儿调整治疗后白细胞介素( IL)-4、IL-6、C 反应蛋白
(CRP)、白细胞(WBC)水平均降低(均P<0. 05),且多西环素组水平均低于阿奇霉素组(均P<0. 05)。调整治疗期间,两组患儿
均未出现其他非预期不良事件,包括胃肠道反应、注射部位疼痛、皮疹在内的常见不良反应总发生率比较差异无统计学意义
(均P>0. 05)。结论:在调整治疗阶段,早期换用多西环素可迅速发挥药效,缩短MUMPP 患儿退热时间及住院时间,提升短期
退热率及临床疗效,并改善肺功能,减轻炎症反应,且安全性较高。 |
| 关键词: 肺炎支原体肺炎 大环内酯类药物 无反应 多西环素 肺功能 |
| DOI：doi:10.13407/j.cnki.jpp.1672-108X.2026.10.014 |
|
| 基金项目:江苏省卫生健康委科研项目,编号M2021119 |
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| Efficacy and Safety of Early Switch to Doxycycline in Children with Macrolide-Unresponsive MycoplasmaPneumoniae Pneumonia |
| Ling Juan1, Hong Guang1, Xu Cheng2 ( |
| ((1. Taizhou Second People’s Hospital Affiliated to Yangzhou University, Jiangsu Taizhou 225500, China; 2. First People’s Hospital of Xuzhou City, Jiangsu Xuzhou 221002, China)) |
| Abstract: |
| Objective: To probe into the efficacy and safety of early switch to doxycycline in the treatment of macrolide-unresponsive
Mycoplasma pneumoniae pneumonia (MUMPP) in children. Methods: A total of 90 children with MUMPP admitted into Taizhou
Second People’ s Hospital Affiliated to Yangzhou University from Feb. 2021 to Apr. 2025 were enrolled to be divided into the
azithromycin group (treated with extended azithromycin therapy) and the doxycycline group (treated with doxycycline replacement
therapy) via the random number table method, with 45 patients in each group. Clinical efficacy, glucocorticoid use, 48-hour fever relief
rate, 72-hour fever relief rate, disappearance time of fever, length of stay, pulmonary function, inflammatory marker levels, and adverse
drug reactions were compared between two groups. Results: After 1 week of treatment, there was statistically significant difference in the
total clinical efficacy between the azithromycin group and doxycycline group (P<0. 05). No significant difference in glucocorticoid use
was observed between two groups (P >0. 05). The 48-hour fever relief rate and 72-hour fever relief rate in doxycycline group were
significantly higher than those in azithromycin group (P < 0. 05), whereas the disappearance time of fever and length of stay were
significantly shorter than those in azithromycin group (P<0. 05). Compared with pre-treatment levels, forced expiratory volume in one
second (FEV1), forced vital capacity (FVC), and peak expiratory flow (PEF) increased significantly after adjustment in both groups
(P<0. 05), and these parameters were significantly higher in doxycycline group than those in azithromycin group (P<0. 05). Serum
levels of interleukin-4 (IL-4), IL-6, C reactive protein (CRP), and white blood cell (WBC) decreased significantly after adjustment in
both groups compared with baseline levels (P <0. 05), with greater reductions observed in doxycycline group (P <0. 05). During
adjustment treatment, no unexpected adverse events occurred in either group, and no significant difference was identified in the overall
incidence of common adverse drug reactions, including gastrointestinal reactions, injection-site pain, and rash (P>0. 05). Conclusion:
During the adjustment treatment stage, early switch to doxycycline may accelerate clinical recovery in children with MUMPP, shorten the
duration of fever and length of stay, improve short-term clinical efficacy and pulmonary function, attenuate inflammatory responses, and
demonstrate favorable safety. |
| Key words: Mycoplasma pneumoniae pneumonia macrolides unresponsive doxycycline pulmonary function |
