【摘要】 目的探讨不同剂量甲泼尼龙(MP)治疗脓毒性休克(SS)失代偿期患儿的临床疗效,观察外周血淋巴细胞亚群的动态变化。方法将78例SS失代偿期患儿,按照随机区组法分成三个观察组,各组基础治疗相同,根据MP的初始剂量不同,分为每天20 mg/kg治疗组(大剂量组,n=26)、每天5 mg/kg治疗组(中剂量组,n=26)、每天2 mg/kg治疗组(小剂量组,n=26),疗程均为1周减停。观察三组临床疗效、药物副作用及转归。在入院时、第3天、第8天检测外周血淋巴细胞亚群计数,并与26例正常对照组进行对比分析。结果在平均住院时间上,小、中剂量组较大剂量组明显缩短(d:16.760±1.895,16.610±1.852 vs. 18.770±2.707,P=0.002);在休克纠正时间(h:2. 557±0.379,2.419±0.374 vs. 3.992±0.427)、退热时间(d:1.507±0.393,1.500±0.405 vs. 2.334±0.430)、血管活性药使用时间(d:2.707±0.308,2.526±0.294 vs.4. 338±0.456)等指标上,中、大剂量组较小剂量组明显减少(F=35. 502～199. 102,P=0. 000);但三组死亡率差异无统计学意义(P>0.05)。在二重感染例数上,大剂量组较小、中剂量组明显增多(χ~2=10.685,P=0.005)。入院时,3个观察组的外周血淋巴细胞各亚群计数较正常对照组显著下降(F=154. 805～5841. 727,P=0. 000),三组间差异无统计学意义(P>0. 05);第3天,三组的外周血淋巴细胞各亚群计数继续下降,但在CD4~+T、CD3~+T、总淋巴细胞计数上,小、中剂量组的下降幅度较大剂量组明显减缓(F=909. 269～1815. 873,P=0.000);第8天,三组的外周血淋巴细胞各亚群有回升,在CD4~+T、CD8~+T、CD3~+T、总淋巴细胞计数上,小、中剂量组明显高于大剂量组(F=211.492～1991.729,P=0. 000)。三组死亡患儿在入院时、第3天的外周血淋巴细胞各亚群计数均较存活患儿显著降低(F=108.213～3521.472,P=0.000)。结论 SS失代偿期患儿应用小剂量的MP可控制炎症,缩短住院时间,减少以CD4~+T为主的T淋巴细胞凋亡。更多还原

【Abstract】 Objective To investigate the therapeutic effects of different dosages of methylprednisolone(MP) on the children with septic shock(SS) in decompensation stage, and analyze the changes of lymphocyte subsets. Methods 78 children with SS in decompensation stage were randomly divided into three groups according to the MP initial dosages: the high-dosage group [20 mg/( kg · d), n =26],the middle-dosage group [5 mg/(kg · d), n =26] and the low-dosage group [2 mg/( kg · d), n =26]. The MP dosages were reduced gradually after a week. The therapeutic effects of the three groups were recorded. The peripheral blood lymphocyte subsets of the three groups were analyzed on Day 1,3,8 in hospital and compared with those of 26 healthy controls. Results The length of stay of the low-dosage group and the middle-dosage group were statistically shorter than that of the high-dosage group(d: 16.760±1.895,16.610±1.852 vs. 18.770± 2.707,P=0.002). The SS correct time(h: 2.557 ±0.379,2.419±0.374 vs. 3.992±0.427),fever clearance time(d: 1.507±0.393,1.500±0.405 vs.2.334± 0.430) and the time of vasoactive drug used(d: 2.707 ±0.308,2.526±0.294) vs.4.338 ± 0.456) in the middle-dosage group and the high-dosage group were obviously decreased compared with t the low-dosage group( F = 35. 502 ～ 199. 102,P=0. 000). The mortality of the three groups were not statistically significant(P >0. 05). The double infect of the high-dosage group was statistically more than those of the middle-dosage group and the low-dosage group(χ~2 = 10.685, P =0.005). On the first day of admission, the three groups with SS in decompensation stage had statistical decrease of peripheral blood lymphocyte subsets compared with control group(F = 154. 805 ～ 5841.727,P =0.000), but there were not significant differences among the three groups(P >0.05). On the third day of admission, the peripheral blood lymphocyte subsets on the three groups obviously decreased,CD4~+ T, CD3~+ T and lymphocyte count in the low-dosage group and the middle-dosage group were significantly higher than those of the high-dosage group(F = 909. 269-1815. 873, P = 0.000). On the eighth day of admission, the peripheral blood lymphocyte subsets in the three groups increased,CD4~+ T, CD8~+ T, CD3~+ T and lymphocyte count in the low-dosage group and the middle-dosage group were significantly higher than those of the high-dosage group(F = 211. 492 ～ 1991. 729, P =0.000). The peripheral blood lymphocyte subsets in the death children were significantly lower than the survival children in the three groups on day 1 and 3 after admission(F = 108. 213 ～ 3521.472, P =0.000). Conclusion The low-dosage of MP can be used to guide the therapy of children with SS in decompensation stage, which can control the inflammation and shorten hospital stays, decrease apoptosis of CD4~+ T-based.更多还原