Abstract
BackgroundTo observe the effect of corticosteroids in the treatment of children with refractory Mycoplasma pneumoniae pneumonia (RMPP) under different doses, to summarize the clinical features of children treated with glucocorticoid pulse therapy.MethodsThe clinical data of 125 children with RMPP hospitalized in Tianjin Children’s Hospital from September 2018 to October 2019 were retrospectively analyzed. They were divided into two groups according to the dose of hormone. Compare the clinical features, laboratory findings, and imaging between the two groups, and use meaningful related indicators as ROC curves to find reference indicators for pulse therapy.Results(1) The median age of the group II was older than that of the group I(P < 0.05). (2) We found more severe presentations, higher incidence of extra-pulmonary complications and more serious radiological findings in group II, which needed oxygen more often, higher the hormone, higher usage rate of gamma globulin, higher usage rate of bronchoscopy, and higher incidence of plastic bronchitis(P < 0.05). (3) WBC, CRP, LDH, FER, D-D dimer, APTT, TT, PCT, IL-6 and the percentage of neutrophils in peripheral blood in Group II were higher than those in Group I(P < 0.05). (4) In ROC curve analysis, CRP, LDH, FER, and neutrophils of leukocyte classification were independent related factors that could be used as valuable predictors of methylprednisolone pulse therapy for RMPP in children. The cut-off values were CRP44.45 mg/L, LDH590IU/L, FER411ng/L, and neutrophils in leukocyte classification were 73.75%, respectively.ConclusionCRP ≥ 44.45 mg/L, LDH ≥ 590 IU/L, FER ≥ 411 ng/L, neutrophil≥73.75%, lung consolidation, and pleural effusion may be predictors that guide the treatment of RMPP with pulse dose of GC.
Highlights
To observe the effect of corticosteroids in the treatment of children with refractory Mycoplasma pneumoniae pneumonia (RMPP) under different doses, to summarize the clinical features of children treated with glucocorticoid pulse therapy
Creactive protein (CRP) ≥ 44.45 mg/L, lactate dehydrogenase (LDH) ≥ 590 IU/L, FER ≥ 411 ng/L, neutrophil≥73.75%, lung consolidation, and pleural effusion may be predictors that guide the treatment of RMPP with pulse dose of GC
It has been found that some children may progress to refractory Mycoplasma pneumoniae pneumonia (RMPP) after being treated with sufficient and long-term macrolide antibiotics in timely [2], which often leads to pulmonary necrosis and pleural effusion, which may be difficult to treat and costing, and leave sequelae such as bronchiectasis, necrotizing pneumonia, bronchiolitis obliteransa and so on [3,4,5,6,7], affect the quality of life
Summary
To observe the effect of corticosteroids in the treatment of children with refractory Mycoplasma pneumoniae pneumonia (RMPP) under different doses, to summarize the clinical features of children treated with glucocorticoid pulse therapy. Studies have confirmed the effectiveness of glucocorticoid (GC) in the treatment of RMPP [2, 10, 11]. GC are effective in the treatment of severe RMPP by downregulating the cell-mediated immune response associated with lung injury during infection [12,13,14,15]. It is vital for clinicians to identify severe RMPP as early as possible and give pulse dose of hormone therapy. The purpose of this study was to compare the differences of clinical manifestations, laboratory data and imaging findings between two groups and to explore the predictive values of pulse therapy of RMPP
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