XIE Chunyan, ZHANG Chuancang, WANG Zhaoping, ZHAN Shudi
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Objective To explore the efficacy of N-acetylcysteine (NAC) nebulizer therapy for severe Mycoplasma pneumoniae pneumonia (SMPP) in children. Methods A total of 130 children with SMPP admitted to Navy 971 Hospital were enrolled as study subjects and assigned to NAC-free conventional therapy (65 cases) or NAC add-on therapy (65 cases) group based on a random number table. The patients in the conventional group received conventional antimicrobial treatment plus low-dose methylprednisolone (MTH), while the patients in the NAC add-on therapy group received NAC in addition to the same conventional therapy. The patients in the two groups were compared in terms of efficacy, time to symptom improvement, lung function tests such as forced vital capacity (FVC), maximum mid-expiratory flow (MMEF), forced expiratory volume in one second (FEV1), airway inflammation biomarkers including interleukin (IL)-8, C-reactive protein (CRP), tumor necrosis factor (TNF)-α, immune function tests, and adverse events. Results The overall efficacy rate of NAC add-on therapy was 93.85% , significantly higher than that of the conventional therapy (81.54%) (P< 0.05). NAC add-on therapy was associated with significantly shorter time to the disappearance of cough, lung rales, opacities, and defervescence compared with the conventional therapy (P < 0.05). NAC add-on therapy also resulted in significantly higher levels of FVC, MMEF, FEV1, CD3+, CD4+, and CD4+/CD8+ than the conventional therapy(P < 0.05). However, NAC add-on therapy was associated with significantly lower levels of IL-8, TNF-α, and CRP than the conventional therapy (P < 0.05). The overall incidence of adverse events was 13.85% in NAC add-on therapy group and 12.31% in the conventional therapy group (P > 0.05). Conclusions NAC nebulizer add-on to conventional antimicrobial agents and low-dose MTH has shown good clinical efficacy in treating SMPP in children. NAC add-on therapy can effectively and safely improve the outcomes of patients by shortening the time to the improvement of relevant clinical symptoms, inhibiting the secretion of airway inflammatory biomarkers, alleviating lung damage, improving immune dysfunction, and enhancing lung function recovery.