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    《Chinese Journal of Critical Care Medicine》 2019-02
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    The clinical efficacy and the effect on lymphocyte subsets of different doses of methylprednisolone in the treatment of children with septic shock in decompensation stage

    Lin Hai;Wang Zi-jing;Wang Shi-biao;Kang Yu-lan;Lin Min;Weng Bin;Sun Peng-ming;Department of Pediatric Intensive Care Unit,Fujian Provincial Maternity and Children's Hospital,Affiliated Hospital of Fujian Medical University;  
    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.
    【Fund】: 福建省自然科学基金资助项目(2014J01400);; 福建省妇幼保健院科学基金资助项目(13-32)
    【CateGory Index】: R720.597
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    ?2006 Tsinghua Tongfang Knowledge Network Technology Co., Ltd.(Beijing)(TTKN) All rights reserved
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