Okumura Toshihiko, Kawada Jun-Ichi, Tanaka Masaharu, Narita Kotaro, Ishiguro Tomonori, Hirayama Yuji, Narahara Sho, Tsuji Genki, Sugiyama Yuichiro, Suzuki Michio, Tsuji Takeshi, Hoshino Shin, Nakatochi Masahiro, Muramatsu Hideki, Kidokoro Hiroyuki, Takahashi Yoshiyuki, Sato Yoshiaki
Department of Pediatrics, Nagoya University Graduate School of Medicine, Japan.
Department of Pediatrics, Nagoya University Graduate School of Medicine, Japan.
J Infect Chemother. 2019 May;25(5):346-350. doi: 10.1016/j.jiac.2019.01.003. Epub 2019 Feb 2.
Mycoplasma pneumoniae pneumonia (MPP) is generally a self-limiting disease, but it may become refractory. It is thought that refractory MPP is linked to the excessive immunologic responses of the host. Consequently, the use of adjunctive systemic corticosteroids may have beneficial effects. In this study, we compared the effects of high- and low-dose corticosteroid therapy in a pediatric population with refractory MPP.
We retrospectively collected data from 91 pediatric MPP patients treated with adjunctive systemic corticosteroids between April 2014 and October 2016. The patients were divided into the following two groups: high-dose corticosteroid group (2 mg/kg/day or more of prednisolone equivalents; n = 38) and low-dose corticosteroid group (<2 mg/kg/day; n = 53). Additionally, we compared the number of febrile days post-corticosteroid administration. We used 25 paired patients in a propensity score matching analysis to correct for confounding factors both by age and by days (from onset till corticosteroid therapy initiation).
We observed that in the high-dose corticosteroid group defervescence following corticosteroid therapy initiation was achieved significantly earlier and length of hospitalization was significantly shorter (0.8 ± 1.0 vs. 1.5 ± 1.4 days and 8.2 ± 2.4 vs. 10.7 ± 2.7 days, respectively). In the propensity score matching, we observed that significant differences in the length of fever following corticosteroid therapy initiation and hospitalization were still present. Further, neither of the groups developed corticosteroid-related adverse events.
Our results suggest that patients with refractory MPP treated with high-dose corticosteroid could achieve defervescence earlier and have a shorter hospitalization.
肺炎支原体肺炎（MPP）通常是一种自限性疾病，但可能会变得难治。据认为，难治性MPP与宿主的过度免疫反应有关。因此，使用辅助性全身皮质类固醇可能会产生有益效果。在本研究中，我们比较了高剂量和低剂量皮质类固醇疗法对难治性MPP儿科患者的影响。
我们回顾性收集了2014年4月至2016年10月期间接受辅助性全身皮质类固醇治疗的91例儿科MPP患者的数据。患者分为以下两组：高剂量皮质类固醇组（泼尼松龙等效剂量为2mg/kg/天或更高；n = 38）和低剂量皮质类固醇组（<2mg/kg/天；n = 53）。此外，我们比较了皮质类固醇给药后的发热天数。我们在倾向评分匹配分析中使用了25对患者，以校正年龄和天数（从发病到开始皮质类固醇治疗）的混杂因素。
我们观察到，高剂量皮质类固醇组在开始皮质类固醇治疗后退热明显更早，住院时间明显更短（分别为0.8±1.0天对1.5±1.4天和8.2±2.4天对10.7±2.7天）。在倾向评分匹配中，我们观察到开始皮质类固醇治疗后的发热时间和住院时间仍存在显著差异。此外，两组均未发生与皮质类固醇相关的不良事件。
我们的结果表明，高剂量皮质类固醇治疗的难治性MPP患者可以更早退热，住院时间更短。
