【摘要】 目的 观察阿奇霉素联合阿昔洛韦治疗小儿肺炎支原体(MP)感染合并传染性单核细胞增多症(IM)的临床效果。方法 选取2023年6月—2024年12月九江市妇幼保健院收治的MP感染合并IM患儿60例，采用随机数字表法分为观察组和对照组，各30例。2组均接受基础治疗，对照组给予阿昔洛韦治疗，观察组在对照组基础上给予阿奇霉素治疗。比较2组临床疗效，治疗前后实验室指标[丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、白细胞计数、淋巴细胞计数、T淋巴细胞占比、CD4~+/CD8~+]、炎性因子[白介素-6(IL-6)、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)]水平，症状改善时间及不良反应。结果 观察组总有效率为93.33%,高于对照组的70.00%(χ~2=5.455,P=0.020)。治疗后，2组ALT、AST、白细胞计数、淋巴细胞计数、T淋巴细胞占比低于治疗前，CD4~+/CD8~+高于治疗前，且观察组低/高于对照组(P<0.01);2组IL-6、CRP、TNF-α水平低于治疗前，且观察组低于对照组(P<0.01)。观察组咽峡炎、发热、淋巴结肿大、眼睑水肿和肝脾肿大的症状改善时间均短于对照组(P<0.05或P<0.01)。观察组与对照组不良反应总发生率比较无统计学差异(3.33%vs. 10.00%,χ~2=1.017,P=0.301)。结论 阿奇霉素联合阿昔洛韦治疗小儿MP感染合并IM临床效果较佳，有效改善炎症状态及免疫功能，加速症状缓解，且用药安全性较高。更多还原

【Abstract】 Objective To observe the clinical efficacy of azithromycin combined with acyclovir in treating pediatric Mycoplasma pneumoniae(MP) infection complicated with infectious mononucleosis(IM). Methods A total of 60 children with co-infection of MP and IM, admitted to Jiujiang Maternal and Child Health Hospital between June 2023 and December 2024, were selected and randomly divided into an observation group and a control group using a random number table, with 30 cases in each group. Both groups received conventional basic treatment. The control group was administered acyclovir, while the observation group received azithromycin in addition to the control group’s regimen. The clinical efficacy, laboratory indicators(ALT,AST,WBC count, lymphocyte count, T-lymphocyte percentage, CD4~+/CD8~+), inflammatory cytokine levels(IL-6, CRP,TNF-α), symptom improvement time, and adverse reactions were compared between the two groups. Results The total effective rate was 93.33% in the observation group, which was significantly higher than 70.00% in the control group(χ~2=5.455,P=0.020). After treatment, levels of ALT, AST, WBC, lymphocyte count, and the T-lymphocyte percentage were significantly lower than those before treatment, while the CD4~+/CD8~+ ratio was higher in both groups, moreover, these improvements were more pronounced in the observation group than in the control group(P<0.01). The levels of IL-6, CRP, and TNF-α decreased significantly in both groups after treatment and were lower in the observation group compared to the control group(P<0.01). The time to improvement of symptoms such as pharyngitis, fever, lymphadenopathy, eyelid edema, and hepatosplenomegaly was significantly shorter in the observation group than in the control group(P<0.05 or P<0.01). However, there was no statistically significant difference in the overall incidence of adverse reactions between the observation group and the control group(3.33% vs. 10.00%, χ~2=1.017, P=0.301). Conclusion Azithromycin combined with acyclovir in the treatment of pediatric MP infection with IM significantly enhances clinical efficacy, effectively improves inflammatory status and immune function, accelerates symptom resolution, and demonstrates a favorable safety profile.更多还原