Miyashita Naoyuki, Kawai Yasuhiro, Inamura Norikazu, Tanaka Takaaki, Akaike Hiroto, Teranishi Hideto, Wakabayashi Tokio, Nakano Takashi, Ouchi Kazunobu, Okimoto Niro
Department of Internal Medicine 1, Kawasaki Medical School, Okayama, Japan.
Department of Internal Medicine 1, Kawasaki Medical School, Okayama, Japan.
J Infect Chemother. 2015 Mar;21(3):153-60. doi: 10.1016/j.jiac.2014.10.008. Epub 2014 Dec 19.
Serum interleukin (IL)-18 level was thought to be a useful as a predictor of refractory or severe Mycoplasma pneumoniae pneumonia, and steroid administration is reported to be effective in this situation. The serum levels of IL-18 correlated significantly with those of lactate dehydrogenase (LDH). The purpose of this study was to set a standard for the initiation of steroid therapy in M. pneumoniae pneumonia using a simple serum marker. We analyzed 41 adolescent and adult patients with refractory or severe M. pneumoniae pneumonia who received steroid therapy, and compared them with 108 patients with M. pneumoniae pneumonia who responded to treatment promptly (control group). Serum LDH levels were significantly higher in the refractory and severe group than in the control group at the initiation of steroid therapy (723 vs 210 IU/L, respectively; p < 0.0001). From receiver operating characteristic curve analysis, we calculated serum LDH cut-off levels of 364 IU/L at initiation of steroid therapy and 302 IU/L at 1-3 days before the initiation of steroid therapy. The administration of steroids to patients in the refractory and severe group resulted in the rapid improvement of symptoms and a decrease in serum LDH levels in all patients. Serum LDH level can be used as a useful parameter to determine the initiation of steroid therapy in refractory or severe M. pneumoniae pneumonia. A serum LDH level of 302-364 IU/L seems to be an appropriate criterion for the initiation of steroid therapy.
血清白细胞介素（IL）-18水平被认为可作为难治性或重症肺炎支原体肺炎的预测指标，据报道在这种情况下使用类固醇治疗是有效的。血清IL-18水平与乳酸脱氢酶（LDH）水平显著相关。本研究的目的是使用一种简单的血清标志物为肺炎支原体肺炎的类固醇治疗起始设定标准。我们分析了41例接受类固醇治疗的难治性或重症肺炎支原体肺炎的青少年和成年患者，并将他们与108例对治疗迅速有反应的肺炎支原体肺炎患者（对照组）进行比较。在开始类固醇治疗时，难治性和重症组的血清LDH水平显著高于对照组（分别为723和210 IU/L；p < 0.0001）。通过受试者工作特征曲线分析，我们计算出在开始类固醇治疗时血清LDH的截断水平为364 IU/L，在开始类固醇治疗前1 - 3天为302 IU/L。对难治性和重症组患者给予类固醇治疗后，所有患者的症状迅速改善，血清LDH水平下降。血清LDH水平可作为确定难治性或重症肺炎支原体肺炎类固醇治疗起始的有用参数。血清LDH水平为302 - 364 IU/L似乎是开始类固醇治疗的合适标准。
