儿童中糖皮质激素耐药性难治性肺炎支原体肺炎的临床特征。
The clinical characteristics of corticosteroid-resistant refractory Mycoplasma Pneumoniae pneumonia in children.
机构信息
Department of Respiratory Medicine, Children's Hospital of Soochow University, Soochow University, Suzhou, China.
Department of Pediatrics, XuZhou Children's Hospital, Xuzhou, China.
出版信息
Sci Rep. 2016 Dec 23;6:39929. doi: 10.1038/srep39929.
To analyze the clinical characteristics of corticosteroid-resistant refractory Mycoplasma pneumoniae pneumonia (RMPP) and explore the related factors that predict corticosteroid-resistant RMPP. Retrospective analysis of 183 children with RMPP in our hospital admitted between January 1, 2012, and December 31, 2014 was performed. Of the 183 RMPP cases, 36 (19.7%) were corticosteroid-resistant RMPP cases. Corticosteroid-resistant RMPP cases had a longer duration of fever and hospitalization compared with corticosteroid-sensitive RMPP cases (P < 0.05). The radiographic findings of 123 (83.7%) cases of corticosteroid-sensitive RMPP apparently resolved after one week of corticosteroid treatment compared with 4 (11.1%) corticosteroid-resistant RMPP cases that had apparently resolution (P < 0.01). Twenty-four (75%) corticosteroid-resistant RMPP patients who received bronchoscopy had mucus plug formation while none of the corticosteroid-sensitive RMPP patients had mucus plug formation (P < 0.05). Multiple logistic regression analysis showed that duration of fever ≥11 days, percentage of lymphocytes ≤32%, CRP ≥48.73 mg/L and LDH ≥ 545.7 U/L were significant predictors of corticosteroid-resistant RMPP. Patients with corticosteroid-resistant RMPP had more severe presentations and more serious radiological findings. Clinicians might use the parameters of duration of fever, CRP, LDH and proportion of lymphocytes to identify children at higher risk of corticosteroid-resistant RMPP.
分析糖皮质激素抵抗性难治性肺炎支原体肺炎（RMPP）的临床特征，并探讨预测糖皮质激素抵抗性 RMPP 的相关因素。对 2012 年 1 月 1 日至 2014 年 12 月 31 日期间我院收治的 183 例 RMPP 患儿进行回顾性分析。183 例 RMPP 患儿中，36 例（19.7%）为糖皮质激素抵抗性 RMPP 病例。与糖皮质激素敏感性 RMPP 病例相比，糖皮质激素抵抗性 RMPP 病例的发热和住院时间更长（P < 0.05）。123 例（83.7%）糖皮质激素敏感性 RMPP 病例在糖皮质激素治疗一周后影像学表现明显缓解，而 4 例（11.1%）糖皮质激素抵抗性 RMPP 病例影像学表现明显缓解（P < 0.01）。24 例（75%）接受支气管镜检查的糖皮质激素抵抗性 RMPP 患者有黏液栓形成，而无糖皮质激素敏感性 RMPP 患者有黏液栓形成（P < 0.05）。多因素 logistic 回归分析显示，发热持续时间≥11 天、淋巴细胞百分比≤32%、CRP≥48.73 mg/L 和 LDH≥545.7 U/L 是糖皮质激素抵抗性 RMPP 的显著预测因素。糖皮质激素抵抗性 RMPP 患者表现更严重，影像学表现更严重。临床医生可能会使用发热持续时间、CRP、LDH 和淋巴细胞比例等参数来识别糖皮质激素抵抗性 RMPP 风险较高的儿童。
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