四环素类和大环内酯类抗生素对儿童肺炎支原体感染的凝血功能及安全性分析

Analysis and comparison of effects of tetracyclines and macrolides on coagulation function and their safety in treatment of Mycoplasma pneumoniae infection in children

摘要

目的 探究四环素类和大环内酯类抗生素对肺炎支原体感染患儿凝血功能和安全性指标的影响。方法 选取2022年5月至2024年5月在我院收治的150例肺炎支原体感染患儿,分为四环素组(n=75)和大环内酯组(n=75)。观察并比较两组患儿的临床疗效、生命体征、肝肾功能、免疫功能、凝血功能指标及不良反应发生情况。计量资料符合正态分布者采用独立样本t检验或配对t检验,不符合正态分布者采用 Mann-Whitney U 检验或 Wilcoxon符号秩和检验;计数资料采用χ² 检验;等级资料采用秩和检验。结果 与治疗前相比,治疗后两组体温、脉搏、呼吸频率及血压均显著降低(Z=2.051~3.245,P 均<0.05)。治疗后组间比较显示,四环素组免疫球蛋白 G、免疫球蛋白 M、D-二聚体、肌酸激酶同工酶及乳酸脱氢酶均显著低于大环内酯组( t=2.135~15.751,Z=2.261~8.011,P 均<0.05)。治疗后凝血功能方面,四环素组血清维生素K、凝血因子Ⅱ、Ⅶ、Ⅸ、Ⅹ均显著高于大环内酯组( t=2.234~7.255,P 均<0.05),活化部分凝血活酶时间、血小板计数、凝血酶原时间均显著低于大环内酯组( t=2.105~5.595,P 均<0.05)。四环素组治疗总有效率高于大环内酯组(Z=3.758,P<0.001)。结论 四环素类抗生素在改善免疫功能和凝血功能方面表现出显著的效果,且安全性良好。在临床实践中,应严格遵循一线药物优先的原则,但对于大环内酯类耐药、无效或存在禁忌的患儿,四环素类可作为有效的二线治疗选择。

Abstract

Objective To analyze and compare effects of tetracyclines and macrolides antibiotics on coagulation function and safety in children with Mycoplasma pneumoniae (MP) infection. Methods A total of 150 children with MP infection who admitted to our hospital from May 2022 to May 2024 were selected and divided into two treatment regimen groups:tetracyclines treatment group (n=75) and macrolides treatment group (n=75).The clinical therapeutic efficacy,vital signs,liver and kidney functions,immune function,coagulation function,and adverse reactions of the children with MP infection were compared between the two groups.For quantitative data, independent sample t-test or paired t-test was used for these data following a normal distribution,while Mann-Whitney U test or Wilcoxon signed-rank test was used for those data not following a normal distribution.Chi-square (χ ²) test was used to analyze count data and rank sum test was used to analyze ordinal data. Results Compared with before treatment,body temperature,pulse rate,respiratory rate and blood pressure of the children with MP infection in both groups significantly descended after treatment (Z=2.051-3.245,all P<0.05).After treatment,the serum levels of alanine aminotransferase (ALT),aspartate aminotransferase (AST),urinary nitrogen,and creatinine (Cr) in both groups were significantly lower than those before treatment ( t=6.016-9.814,all P<0.001).Between-group comparison after treatment showed that the serum levels of immunoglobulin G (IgG), immunoglobulin M (IgM),D-dimer (D-D),creatine kinase-myocardial band (CK-MB) and lactate dehydrogenase (LDH) of the children with MP infection in the tetracyclines treatment group were significantly lower than those in the macrolides treatment group ( t=2.135-15.751,Z=2.261-8.011,all P <0.05).In terms of coagulation function,after treatment,the serum levels of vitamin K,coagulation factor Ⅱ (FⅡ),coagulation factor Ⅶ,coagulation factor Ⅸ (FⅨ),and coagulation factor Ⅹ (FⅩ) of the children with MP infection in the tetracyclines treatment group were significantly higher than those in the macrolides treatment group ( t=2.234-7.255,all P<0.05),while activated partial thromboplastin time (APTT),platelet count,and prothrombin time (PT) were significantly lower than those in the macrolides treatment group ( t=2.105-5.595,all P<0.05).The total effective rate in the tetracyclines treatment group was higher than that in the macrolides treatment group (Z=3.758,P<0.001). Conclusion Tetracyclines antibiotics exert more significant therapeutic effects in improving immune function and coagulation function of the children with MP infection compared to macrolides antibiotics,with a favorable safety profile.In clinical practice,the principle of prioritizing first-line drugs should be strictly followed.However,for those children who are resistant,unresponsive,or have contraindications to macrolides antibiotics,tetracyclines antibiotics treatment regimen can serve as an effective second-line treatment option.

关键词

儿童 / 肺炎支原体感染 / 四环素类抗生素 / 大环内酯类抗生素 / 凝血功能 / 安全性

Key words

children / Mycoplasma pneumoniae infection / tetracyclines antibiotics / macrolides antibiotics / coagulation function / safety

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基金资助

华侨大学医学院院校联合创新项目(YX2024016)