Tamura Akihiro, Matsubara Kousaku, Tanaka Takayuki, Nigami Hiroyuki, Yura Kazuo, Fukaya Takashi
Department of Pediatrics, Nishi-Kobe Medical Center, 5-7-1 Kojidai, Nishi-ku, Kobe, 651-2273, Japan.
J Infect. 2008 Sep;57(3):223-8. doi: 10.1016/j.jinf.2008.06.012. Epub 2008 Jul 25.
To determine the efficacy of methylprednisolone pulse therapy for children with Mycoplasma pneumoniae pneumonia (MP) that is refractory to antibiotic treatment.
Refractory patients were defined as cases showing clinical and radiological deterioration despite appropriate antibiotic therapy for 7 days or more. We identified 6 such children (male/female: 3/3) aged 3-9 years who were treated between 1998 and 2006. During the same period, 190 children with MP were admitted to our institution.
Common laboratory findings of the patients included cytopenia, elevated serum lactate dehydrogenase and ferritin levels, and elevated urine beta(2)-microglobulin levels, suggesting complication of hypercytokinemic condition. We initiated intravenous methylprednisolone at a dose of 30 mg/kg on 10.2+/-2.8 clinical days and administered it once daily for 3 consecutive days. Fever subsided 4-14 h after initiation of steroid pulse therapy in all patients. This dramatic effect was accompanied by rapid improvement of radiological abnormalities including infiltrates and pleural effusion, followed by improvement of laboratory abnormalities. There were no adverse events of steroid therapy.
This is the first case-series study showing an effect of 3-day methylprednisolone pulse therapy on refractory MP in children. This therapy is apparently an efficacious and well-tolerated treatment for refractory MP.
确定甲泼尼龙冲击疗法对经抗生素治疗无效的支原体肺炎（MP）患儿的疗效。
难治性患者定义为尽管接受了7天或更长时间的适当抗生素治疗，但仍出现临床和影像学恶化的病例。我们确定了1998年至2006年间接受治疗的6名此类3至9岁儿童（男/女：3/3）。同期，190例MP患儿入住我院。
患者的常见实验室检查结果包括血细胞减少、血清乳酸脱氢酶和铁蛋白水平升高以及尿β2微球蛋白水平升高，提示存在高细胞因子血症并发症。我们在临床第10.2±2.8天开始静脉注射甲泼尼龙，剂量为30mg/kg，每日给药1次，连续给药3天。所有患者在开始类固醇冲击治疗后4至14小时体温下降。这种显著效果伴随着包括浸润和胸腔积液在内的影像学异常迅速改善，随后实验室异常也得到改善。类固醇治疗未出现不良事件。
这是第一项显示3天甲泼尼龙冲击疗法对儿童难治性MP有效的病例系列研究。该疗法显然是一种治疗难治性MP的有效且耐受性良好的治疗方法。
