激素常规疗法无效果 RMPP 儿童的临床特点和治疗方案研究

目的：探讨激素常规疗法无效果难治性肺炎支原体肺炎（RMPP）儿童的临床特点，并分析影响治疗的因素，为其临床研究提供可参考依据。方法共纳入120例诊断为 RMPP 的患儿作为研究对象，所有患儿初始均给予常规2 mg·kg－1·d－1甲泼尼龙治疗，根据治疗3 d 效果分为有效组与无效组，详细记录其相关信息及临床症状，筛选出影响疗效的相关因素，应用多因素 Logistic 回归分析治疗无效的相关危险因素。结果120例 RMPP 患儿在给予常规2 mg·kg－1·d－1甲泼尼龙治疗后，有28例疗效不佳（占23．3％），其中混合感染10例（占35．7％），患儿出现坏死性肺炎13例（占46．4％）；分泌物阻塞13例（占46．4％），内膜坏死10例（占35．7％）。92例效果较好（占76．7％），其中混合感染5例（占5．4％），分泌物阻塞10例（占10．9％），内膜坏死率5例（占5．4％），未出现肺不张及坏死性肺炎，两组比较差异有统计学意义（P ＜0．05）。白细胞计数（WBC）、嗜中性粒细胞百分比（N）、高敏 C-反应蛋白（hs-CRP）、红细胞沉降率（ESR）、乳酸脱氢酶（LDH）、降钙素原（PCT）、IL-6、IL-8、瘦素（LP）、血清铁蛋白（SF）、清蛋白（ALB）、D-二聚体与常规激素治疗效果存在相关性，两组比较差异有统计学意义（P ＜0．05）。多因素分析显示 N、hs-CRP、LDH、IL-8、IL-6是影响常规激素治疗效果的独立危险因素（P ＜0．05）。常规激素治疗疗效不佳的患儿，在增加激素剂量或合用丙种球蛋白治疗后症状好转。有效组抗菌药物使用天数明显低于无效组，差异有统计学意义（P ＜0．05）；无效组抗菌药物二联使用比例明显高于观察组，差异有统计学意义（P ＜0．05）。结论多种因素影响常规2 mg·kg－1·d－1甲泼尼龙治疗效果，N、hs-CRP、LDH、IL-8、IL-6水平升高可以作为预测疗效不佳的指标，增加激素剂量或合用丙种球蛋白可以提高疗效。

Clinical features and treatment of refractory mycoplasma pneumoniae pneumonia unresponded to conventional dose methylprednisolone in children

Objective To analyze the clinical manifestations of refractory mycoplasma pneumoniae pneumonia (RMPP)which unresponded to methylprednisolone in the dosage of 2 mg·kg-1 ·d-1 for 3 day.Methods Retrospective analysis was performed on the clinical data of 120 children with RMPP.The patients were divided into effective group and ineffective group according to ini-tial effeet of 2 mg· kg-1 · d-1 methylprednisolone.The elinical manifestations,laboratory examination,radiological features and bronchofibroscopic findings of the children were compared.Results Twenty-eight patients in 120 were poor curative effect after regular 2 mg·kg-1 ·d-1 methyl prednisolone therapy,accounted for 23.3%.There were 10 patients in 28 with mixed infection,ac-counted for 35.7%;13 patients with appeared necrotizing pneumonia,accounted for 46.4%;13 patients with secretion obstruction, accounted for 46.4%;10 patients with endometrium necrosis,accounted for 35.7%.92 patients in 120 were good curative effect af-ter regular 2 mg·kg-1 ·d-1 methyl prednisolone therapy,accounted for 76.7%.There were 5 patients in 92 with mixed infection, accounted for 5.4%;10 patients with secretion obstruction,accounted for 10.9;5 patients with secretion obstruction,accounted for 5.4%.The difference was statistically significant (P <0.05).There were correlation between effect of hormone therapy and the levels of WBC,N,hs-CRP,LDH,PCT,IL-6,IL-8,LP,SF,D-dimmer.Multiple factors analysis showed that N,hs-CRP,LDH,IL-8, IL-6 were independent risk factors influence the effect of regular hormone therapy (P <0.05).The effective were improved after in-creasing hormone doses or share ivig.Antibiotic use days in effective group was obviously lower than that in ineffective group,.The difference was statistically significant (P <0.05).Duplex control antibiotics use ratio in ineffective group was significantly higher than that in effective group.The difference was statistically significant (P <0.05).Conclusion Treatment with 2 mg·kg-1 ·d-1 methvlprednisolone could improve clinical symptoms and radiological manifestations of most children with RMPP quickly.But it may be ineffective in some situations such as N,hs-CRP,LDH,IL-8 and IL-6.