血清乳酸脱氢酶在儿童难治性肺炎支原体肺炎的应用价值

目的探讨血清乳酸脱氢酶在儿童难治性肺炎支原体肺炎(MPP)的应用价值。方法 2012年1月至2014年11月鄂尔多斯市中心医院儿科住院的难治性MPP患儿14例为观察组,另选取同期在鄂尔多斯市中心医院儿科住院治疗的对抗生素治疗有效的MPP患儿42例为对照组。所有患儿于入院时都予以常规实验室检查,包括血常规、C反应蛋白、血生化指标(谷丙转氨酶、谷草转氨酶、乳酸脱氢酶)、白细胞介素6。对大环内酯类抗生素治疗至少7d仍无效,考虑难治性MPP者复查上述实验室检查,并给予糖皮质激素联合治疗,甲强龙2mg/(kg·d),连用3d。治疗后第3天、出院时分别复查血常规、C反应蛋白、血生化指标。结果入院时两组患儿的实验室检查结果无统计学差异,在住院第7天,应用糖皮质激素前观察组患儿血清乳酸脱氢酶、谷丙转氨酶、谷草转氨酶及白细胞介素6水平明显高于对照组,差异有统计学意义(P0.05)。乳酸脱氢酶与白细胞、C反应蛋白、谷丙转氨酶、谷草转氨酶无明显相关关系,只与白细胞介素6有正相关关系。采用受试者操作特征曲线,确定乳酸脱氢酶在应用糖皮质激素治疗的最佳临界点为390IU/L时其灵敏度、特异度及ROC曲线下面积分别为78.57%、100%和0.81。通过有效抗生素联合糖皮质激素治疗后观察组患儿血清乳酸脱氢酶水平下降至正常范围。结论 MPP患儿应用大环内酯类药物治疗至少7d,临床和影像学表现仍恶化,乳酸脱氢酶390IU/L,可作为尽早联合应用糖皮质激素治疗的参考依据。

Application of serum lactate dehydrogenase in children with refractory Mycoplasma pneumoniae pneumonia

Objective To assess the application value of serum lactate dehydrogenase in children with refractory Mycoplasma pneumoniae pneumonia(MPP).Methods Fourteen pediatric patients with refractory MPP hospitalized in Erdos Central Hospital from January 2012 to November 2014 were included as the ob-servation group,and 42 pediatric patients with MPP who responded to antibiotics treatment promptly during the same period in Erdos City Central Hospital as the control group.All patients received blood tests on ad-mission,including routine blood test,C-reactive protein,alanine aminotransferase(ALT),aspartate amin-otransferase(AST),serum lactate dehydrogenase (LDH ),and interleukin (IL)-6 levels.For those who didn't respond to Macrolide antibiotic treatment after 7 days and were considered to be with refractory MPP, the above-mentioned lab tests were performed again,and glucocorticoid combination therapy was used,Sou-medrol 2 mg/(kg·d),for 3 days in a row.The rests were performed again 3 days after treatment and on discharge from hospital,including blood routine,C-reactive protein and biochemical indexes.Results The results of laboratory tests were not statistically different between the two groups at admission.Serum LDH, ALT,AST and IL-6 levels were significantly higher in the observation group than in the control group on day 7 before corticosteroid use(P <0.05).Significant positive correlation was found between serum values of IL-6 and LDH.A serum LDH level of 390 IU/L was calculated from receiver operating characteristic curve analysis.The sensitivity,specificity and the area under ROC curve were 78.57%,100% and 0.81 at this level.The serum levels of LDH in the observation group were decreased to normal range after effective treatment with antibiotics combined with glucocorticoid.Conclusion MPP children who have prolonged fe-ver and deterioration of clinical and radiological findings despite administration of Macrolides antibiotics for at least 7 days,with LDH more than 390 IU/L,may receive combined glucocorticoids treatment as early as possible.