Characteristics of refractory Mycoplasma pneumoniae pneumonia and efficacy of the therapy with glucocorticoids in children / 国际儿科学杂志

ABSTRACT

Objective To investigate the clinical,laboratory and imaging characterstics of refractory Mycoplasma pneumoniae pneumonia(RMPP) with lobar pneumonia change and efficacy of the therapy with different doses of glucocorticoids in children.Methods The clinical data of 103 children with Mycoplasma pneumoniae pneumonia(MPP) between September 2015 and February 2016 were investigated.Among the 103 children,there were 52 cases of RMPP and 51 cases of non-refractory MPP.The clinical features,laboratory examination and imaging characteristics were compared between the two groups.For the children with RMPP,the change of clinical symptoms and imaging were observed after the treatment with routine dose and large dose of glucocorticoids.Then,for the children with poor imaging,fiber bronchoscope can be used,the differences of airway mucosa injury and immune cells in the bronchoavleolar lavage fluid were compared after the treatment with routine dose and large dose of glucocorticoids.Results The children in the RMPP group had longer febrile time and hospital stay and were more likely to suffer from extrapulmonary complications.Peripheral blood neutrophil count,CRP,PCT,LDH and D-dimers were higher than these in the MPP group.At the same time it was more common that two or more pulmonary lobes were involved synchronally or pleural effusion appeared,the differences were statistically significant(P ＜ 0.05);There were no statistical differences that the clinical symptoms,imaging change,airway mucosa injury and the proportion of immune cells in BALF between the children in the RMPP group after the treatment with routine dose and large dose of glucocorticoids (P ＞ 0.05).Conclusion It should be alert to the occurence of RMPP in children with MPP when there was a persistent fever,extrapulmonary complications,increased levels of inflammatory index significantly,pleural effusion or two or more pulmonary lobes involvement.Compared with the treatment with routine dose of glucocorticoids in children with RMPP,it does not show a clear advantage with large dose of glucocorticoids on the clinical symptoms and inhibition of airway mucosa injury.