目的：比较研究阿奇霉素联合头孢哌酮舒巴坦钠治疗儿童细菌感染性重症肺炎的临床疗效、免疫功能变化及炎症反应差异。方法：回顾性纳入本院2023年4月至2025年3月期间收治的细菌感染性重症肺炎患儿作为研究对象。根据实际用药方案分为标准治疗组（阿奇霉素单药）和联合治疗组（阿奇霉素联合头孢哌酮舒巴坦钠）。为控制潜在混杂偏倚，采用倾向性评分匹配（PSM）法，以年龄、病程及肺炎严重程度指数（PSI）评分为协变量进行1∶1匹配，最终纳入标准治疗组41例、联合治疗组41例。比较两组患儿的临床总有效率、康复进程指标、治疗前后免疫功能及炎症相关指标的动态变化，并评估用药安全性。连续型重复测量结局采用2（时间）×2（组别）重复测量方差分析比较。结果：联合治疗组的临床总有效率为97.56%，标准治疗组为80.49%，联合治疗方案显示出更高的临床有效性［相对危险度（RR）=1.21，95%置信区间（CI）：1.03-1.43］。在康复进程方面，联合治疗组患儿主要临床症状消失时间及住院时间均短于标准治疗组（P<0.05）。免疫功能分析显示，两组治疗后CD3⁺、CD4⁺细胞比例及CD4⁺/CD8⁺比值均升高，CD8⁺细胞比例下降，且时间×组别交互作用均具有统计学意义（P<0.05），提示联合治疗组免疫功能改善幅度明显。炎症与感染指标方面，两组治疗后D-二聚体（D-D）、降钙素原（PCT）、C反应蛋白（CRP）及可溶性细胞间黏附分子（sICAM-1）水平均下降，且联合治疗组下降趋势更为显著（P<0.05）。两组不良反应发生率分别为17.07%和14.63%，差异无统计学意义（P>0.05）。结论：本研究中，与阿奇霉素单药治疗相比，阿奇霉素联合头孢哌酮舒巴坦钠治疗儿童细菌感染性重症肺炎显示出更高的临床有效率、更快的症状缓解及更优的免疫调节和炎症控制效果，且未观察到用药安全性风险增加。本研究结果为该联合治疗方案的临床应用提供了真实世界证据支持，并为后续前瞻性随机对照研究提供了依据。

 Objective： To compare the clinical efficacy， changes in immune function， and inflammatory responses in azithromycin combined with cefoperazone-sulbactam in children with severe bacterial pneumonia.Methods： Children with severe bacterial pneumonia admitted in our hospital between April 2023 and March 2025 were retrospectively enrolled. According to the actual treatment regimen， patients were divided into a standard treatment group （azithromycin monotherapy） and a combination therapy group （azithromycin plus cefoperazone-sulbactam）. To control potential confounding bias， propensity score matching （PSM） was performed using age， disease course， and the pneumonia severity index （PSI） score as covariates， with 1∶1 matching. Finally， 41 patients were included in each group. The clinical overall response rate， recovery-related indicators，dynamic changes in immune function and inflammation-related markers before and after treatment， and drug safety were compared between the two groups. Continuous repeated-measures outcomes were analyzed using a 2 （time）×2 （group） repeated-measures analysis of variance.Results： The overall clinical response rate was 97.56% in the combination therapy group and 80.49% in the standard treatment group， indicating superior clinical efficacy of the combination regimen ［relative risk （RR）=1.21， 95% confidence interval （CI）： 1.03-1.43］. Regarding recovery， the durations of major clinical symptoms and length of hospital stay were significantly shorter in the combination therapy group than in the standard treatment group （P<0.05）. Immune function analysis showed that， after treatment， the proportions of CD3⁺ and CD4⁺ cells and the CD4⁺/CD8⁺ ratio increased significantly， while the proportion of CD8⁺ cells decreased significantly in both groups； moreover， the time×group interaction effects were statistically significant （P<0.05）， indicating a greater magnitude of immune improvement in the combination therapy group. In terms of inflammatory and infection-related markers， levels of D-dimer （D-D）， procalcitonin （PCT）， C-reactive protein （CRP）， and soluble intercellular adhesion molecule-1 （sICAM-1） decreased significantly after treatment in both groups， with a more pronounced downward trend in the combination therapy group （P<0.05）. The incidences of adverse reactions were 17.07% and 14.63% in the combination therapy and standard treatment groups， respectively， with no significant difference （P>0.05）.Conclusion： In this real-world retrospective study， compared with azithromycin monotherapy， azithromycin combined with cefoperazone-sulbactam was associated with a higher clinical response rate， faster symptom relief， and more favorable immune modulation and inflammation control in children with severe bacterial pneumonia， without an increased risk of adverse drug reactions. These findings provide real-world evidence supporting the clinical application of this combination regimen and offer a basis for future prospective randomized controlled trials.