目的 探讨嗜碱性粒细胞与肺炎支原体肺炎(MPP)发病的关系,以及糖皮质激素在治疗中对嗜碱性粒细胞的影响.方法 60例难治性MPP患儿随机分成治疗组和对照组,另选择30例非难治性MPP患儿和30例正常对照儿童.难治性MPP治疗组接受阿奇霉素 + 地塞米松(Dx)治疗,阿奇霉素剂量为10 mg/(kg·d)(最大量不超过0.5 g/d),Dx为0.2 mg/(kg·d)(最大量不超过5 mg/d),疗程5 d;难治性MPP对照组和非难治性MPP患儿仅接受阿奇霉素治疗,剂量同上,疗程5 d.采用流式细胞仪检测所有MPP组患儿治疗前、后及正常对照组儿童外周血CRTH2+CD63+双阳性细胞百分率.结果 MPP组CRTH2+CD63+双阳性细胞百分率均高于正常对照组(P ＜ 0.05);难治性MPP组CRTH2+CD63+双阳性细胞百分率明显高于非难治性MPP组(P ＜ 0.05);难治性MPP患儿在常规用阿奇霉素治疗同时加用地塞米松治疗后CRTH2+CD63+双阳性细胞百分率明显下降至正常水平,未加用地塞米松的难治性MPP患儿CRTH2+CD63+双阳性细胞百分率仍显著高于正常对照儿童(P ＜ 0.01);治疗5 d后,难治性MPP治疗组患儿咳嗽评分明显低于难治性MPP对照组患儿.结论 嗜碱性粒细胞可能参与了MPP的发病;糖皮质激素能够有效抑制难治性MPP嗜碱性粒细胞的活化,改善临床症状.%Objective To explore whether basophilic granulocyte takes part in the pathogenesis of Mycoplasma pneumoniae pneumonia (MPP), and to study the influence of glucocorticoid via basophilic granulocyte. Methods Sixty refractory MPP patients were randomly divided into two groups : group 1 (n= 30) and group 2 (n= 30). Patients of group 1 were administered with both azithromycin (10 mg/kg·d, ≤ 0.5 g/d) and dexamethasone (0.2 mg/kg-1·d-1,≤ 5 mg/d) for five days. The patients of group 2 were administered only with azithromycin (10 mg/kg-1·d-1 , ≤ 0.5 g/d)for five days. The 30 non-refractory MPP patients were included to group 3 and administered with only azithromycin (10 mg/kg-1·d-1, ≤ 0.5 g/d) for 5 days, and another 30 healthy subjects were included to group 4 as controls. The percentage of CRTH2+CD63+ cells of all subjects in peripheral blood was determined using flow cytometry. Results Patients with MPP had a significantly higher percentage of CRTH2+CD63 + cell than that of the healthy subjects. Significantly higher percentage of the CRTH2+CD63+ cell was found in patients with refractory MPP than that of non-refractory MPP patients. The percentage of CRTH2+CD63+ cell in patients of group 1 decreased significantly and was close to that of the healthy subjects after treatment. However the percentage of CRTH2+CD63+ cell in group 2 was still markedly higher than that of the control subjects. After 5 days treatment, the cough score of patients in group 1 was lower than that of patients in group 2. Conclusions Basophilic granulocyte may take part in the pathogenesis of MPP. And the glucocorticoid cau suppress the activation of basophilic granulocyte to improve patients' clinical symptoms.
展开▼
