| Background and ObjectiveAzithromycin(AZI)has been widely used in pediatrics because of its long half-life,broad antibacterial spectrum and definite curative effect.However,it is prone to gastrointestinal reactions in the course of application,which seriously affects the compliance of patients.Previous studies suggest that erythromycin and its derivatives with motilin receptor agonist,can promote gastrointestinal motility.AZI,a macrolide antibiotic,can also promote gastrointestinal motility?In this study,the changes of gastric electrical parameters and gastrointestinal hormones in children with pneumonia before and after AZI treatment were analyzed to explore the changes of gastric motility and its possible mechanism,and look forward to provide new ideas for clinical prevention AZI gastrointestinal reaction.MethodsFrom November 2015 to May 2016,children with non-critical community-acquired pneumonia according to whether the addition of AZI were divided into two groups,one group received AZI + piperacillin tazobactam sodium anti-infective treatment(group A,n = 43)and the other group only received piperacillin tazobactam sodium anti-infective therapy(group B,n = 43).Simultaneous recruitment of healthy children as a normal control group(group C,n = 45).The incidence of gastrointestinal reactions in the two groups was observed and compared.Gastric electrical parameters and serum gastrointestinal hormones in two groups before and after treatment and group C were recorded and analyzed.The average amplitude(VPP),mean frequency(F)and the percentage of normal slow wave(PNSW)were recorded by using the XDJ-S8B-type gastrointestinal electrogram.Fasting plasma motilin(MLT),vasoactive intestinal peptide(VIP),substance P(SP)and calcitonin gene-related peptide(CGRP)were tested by ELISA.SPSS17.0 statistical software for data processing,the incidence of gastrointestinal reactions between the two groups using c2test,multiple sets of gastric electrical parameters and gastrointestinal hormone and normal group were compared using the variance analysis Dunnett-t test,with the group itself before and after comparison using paired t test,the surface of gastric electrical parameters and serum gastrointestinal hormones using Pearson correlation analysis,P <0.05 was statistically significant.Results1.The incidence of gastrointestinal reaction in group A was 25.58% higher than that of group B(P < 0.05),the difference was statistically significant.2.Analysis of gastric electrical parameters:? Comparison of gastric electrical parameters between groups:(1)Compared with group C,waveform average amplitude(VPP)of group A and B before treatment were higher(P < 0.05).The VPP of group A after treatment was significantly higher(P < 0.01),while VPP of group B after treatment has no obvious change(P > 0.05).(2)The mean frequency(F)of group A after treatment was significantly higher than that of group C(P < 0.01),while F of group A before treatment and group B before and after treatment have no obvious change(all P > 0.05).(3)The percentage of normal slow wave(PNSW)of group A after treatment was significantly lower than that of group C(P <0.01),while PNSW of group A before treatment and group B before and after treatment have no obvious change(all P > 0.05);? Comparison before and after treatment of group A: After treatment,gastric electrical waveform average frequency of group A significantly increased(P < 0.01),and the percentage of normal slow wave decreased significantly(P < 0.01),while VPP had no obvious change(all P > 0.05);? Comparison before and after treatment of group B: After treatment,VPP,F and PNSW of group B had no significant difference(all P > 0.05).3.Gastrointestinal hormone analysis: ? Comparison of gastrointestinal hormones between groups:(1)Compared with group C,the content of VIP of the two other groups before and after treatment were higher(P < 0.05),the difference was statistically significant.(2)The content of CGRP of A and B groups before and after treatment were significantly decreased(P < 0.01),the difference was highly statistically significant.(3)MLT content of group A after treatment was higher(P < 0.05),while MLT content of group A before treatment and group B before and after treatment have no obvious change(all P > 0.05).(4)SP content of group A after treatment was significantly higher than that of group C(P < 0.01),while SP content in group A before treatment and group B before and after treatment have no obvious change(all P > 0.05);?Comparison before and after treatment of group A: After treatment,serum motilin(MLT)level of group A increased(P < 0.05),substance P(SP)level increased significantly(P < 0.01),while VIP and CGRP had no obvious change(all P> 0.05);?Comparison before and after treatment of group B: After treatment,MLT,SP,VIP and CGRP of group B had no significant difference(all P > 0.05).4.Correlation analysis between fasting gastric electrical parameters and fasting serum gastrointestinal hormones of group A : The average wave amplitude is positively correlated with SP(r=0.703,P<0.01),while negatively correlated with the VIP(r=-0.587,P<0.01),but had no correlation with CGRP and MLT(P > 0.05).The average frequency of the waveform is positively correlated with MLT(r=0.538,P<0.01),while negatively correlated with VIP(r=-0.456,P<0.05),but had no correlation with SP and CGRP(all P > 0.05).The percentage of normal slow wave was positively correlated with VIP(r=0.475,P<0.05),but had no significant correlation with MLT,SP and CGRP(all P > 0.05).Conclusion(1)AZI increases the incidence of gastrointestinal adverse reactions in children with pneumonia.(2)In children with pneumonia,there was an abnormal increase of VPP and VIP in serum,while CGRP decreased.The gastric electrical activity in children with pneumonia may be affected by many factors.(3)AZI can speed up the gastric electrical rhythm in children with pneumonia,decrease PNSW.The effect of AZI on gastric motility may be related to its release promotion of excitatory gastrointestinal hormones,such as MLT,SP,the dominant factor is MLT. |
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