甲泼尼龙联合克拉霉素治疗闭塞性细支气管炎的疗效及其对患儿MMP-9、TIMP-1的影响

目的 探讨甲泼尼龙联合克拉霉素治疗对闭塞性细支气管炎(BO)患儿基质金属蛋白酶-9(MMP-9)、金属蛋白酶抑制剂-1(TIMP-1)表达的影响.方法 回顾性分析2011年5月至2016年5月在保定市第二中心医院儿科治疗的31例BO患儿的临床资料,按照治疗方案不同分为观察组(甲泼尼龙+克拉霉素)17例和对照组(甲泼尼龙)14例,观察两组患儿临床疗效、治疗后康复时间、治疗前后血清MMP-9和TIMP-1水平变化以及治疗期间不良反应发生情况.结果 观察组和对照组患儿的治疗总有效率(100.00％vs 78.60％)比较,观察组明显高于对照组,差异有统计学意义(P<0.05);观察组和对照组患儿的咳嗽/喘息平均消失时间(6.19±0.77)d vs(7.40±0.85)d]、气促/吸气性三凹症平均消失时间(7.10±0.69)d vs 8.42±0.76)d]、平均退热时间(8.35±1.06)d vs(12.02±1.17)d]、平均住院时间(15.28±3.26)d vs(18.97±3.50)d]比较,观察组均明显低于对照组,差异均有统计学意义(P<0.05);观察组和对照组患儿的血清MMP-9(1366.26±20.97)ng/mL vs(1504.07±21.30)ng/mL]及MMP-9/TIMP-1(5.12±0.94)vs(5.48±1.01)]比较,观察组均明显低于对照组,差异均有统计学意义(P<0.05);两组患儿治疗期间不良反应发生率(17.65％vs 14.29％)比较,差异无统计学意义(P>0.05).结论 甲泼尼龙联合克拉霉素治疗BO效果显著,其可有效改善患儿临床症状和血清MMP-9和TIMP-1水平,且不良反应发生率低,可作为优选治疗方案.

Clinical efficacy of methylprednisolone combined with clarithromycin in the treatment of patients with bronchiolitis obliterans and its effect on MMP-9, TIMP-1

Objective To explore the clinical efficacy of methylprednisolone combined with clarithromycin in the treatment of patients with bronchiolitis obliterans (BO) and its effect on matrix metalloproteinase-9 (MMP-9), tissue inhibitor of metalloproteinase-1 (TIMP-1) of the patients. Methods Thirty-one patients with BO treated in the Second Central Hospital of Baoding from May 2011 to May 2016 were assigned into observation group (treated with methylpred-nisolone combined with clarithromycin, 17 cases) and control group (treated with methylprednisolone, 14 cases). The clinical efficacy, recovery time, MMP-9, TIMP-1 levels before and after treatment, and adverse reactions were ob-served. Results The total effective rate in the observation group were significantly higher than that in the control group, (100.00％vs 78.60％, P<0.05). The time for disappearance of cough/gasp, time for disappearance of anhelation/three depression sign, defervescence time and length of hospital stay were (6.19±0.77) d, (7.10±0.69) d, (8.35±1.06) d, (15.28±3.26) d in the observation group, versus (7.40±0.85) d, (8.42±0.76) d, (12.02±1.17) d, (18.97±3.50) d in the con-trol group (P<0.05). The level of MMP-9 and MMP-9/TIMP-1 were (1366.26 ± 20.97) ng/mL and (5.12 ± 0.94) in the observation group, significantly lower than (1504.07 ± 21.30) ng/mL and (5.48 ± 1.01) in the control group (P<0.05). There was no significant difference in the rate of adverse reactions between the two groups (17.65％ vs 14.29％, P>0.05). Conclusion Methylprednisolone combined with clarithromycin has significant efficacy in the treatment of pa-tients with bronchiolitis obliterans. It can improve the clinical symptoms and the levels of MMP-9 and TIMP-1, with very few adverse reactions, which can be used as the preferred treatment.