Zhai Ying-Ying, Wu Shang-Zhi, Yang Yi, Yang Li-Ying, Xu Jia-Xing, Huang Zhan-Hang, He Zhen-Tao, Lin Yu-Neng, Chen De-Hui
Department of Pediatrics, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Ann Palliat Med. 2020 Sep;9(5):2592-2599. doi: 10.21037/apm-19-497. Epub 2020 Sep 7.
Refractory mycoplasma pneumonia (RMPP) is one of the important pathogens of community-acquired pneumonia (CAP) in children. Its treatment is difficult. The aims of this study were to analyze the clinical manifestations, diagnosis, and treatment of 20 cases of RMPP in children in order to provide a reference for the diagnosis and treatment of RMPP.
The clinical data of 20 patients with RMPP admitted to the Pediatrics Department of the First Affiliated Hospital of Guangzhou Medical University in the recent three years were retrospectively analyzed. The clinical data of 36 patients with common mycoplasma pneumonia in the same period were compared. The clinical manifestations, laboratory examinations, and imaging characteristics of RMPP were discussed. Intrapulmonary and extrapulmonary complications and treatment were also analyzed in order to provide assistance in the diagnosis and treatment of RMPP.
There were significant differences between the refractory group and the general group in terms of heat duration, hospitalization time, hypoxemia, lung rales, CRP, ESR, PCT, LDH, ALT, PLT, WBC, D dimer and other laboratory examinations, intrapulmonary and extrapulmonary complications, and treatment (all P<0.05). There was no significant difference in the age, sex, and wheezing between the two groups (P>0.05).
Long duration of fever, tachycardia, and lung rale protrusion may be the clinical characteristics of RMPP. Unilateral pulmonary shadow and atelectasis should be paid more attention, which may be a high-risk factor for the development of RMPP. The inflammation index of RMPP cases increased and there were many complications inside and outside the patients' lungs. It was necessary to give enough macrolides to fight the infection by using Glucocorticoid and Intravenous immunoglobulin reasonably while liver, heart, and fiberoptic bronchoscopy was completed to improve the effectiveness of the diagnosis and treatment.
难治性支原体肺炎（RMPP）是儿童社区获得性肺炎（CAP）的重要病原体之一，其治疗困难。本研究旨在分析20例儿童RMPP的临床表现、诊断及治疗情况，为RMPP的诊治提供参考。
回顾性分析广州医科大学附属第一医院儿科近三年收治的20例RMPP患者的临床资料，并与同期36例普通支原体肺炎患者的临床资料进行比较，探讨RMPP的临床表现、实验室检查及影像学特征，分析其肺内及肺外并发症及治疗情况，为RMPP的诊治提供帮助。
难治组与普通组在发热持续时间、住院时间、低氧血症、肺部啰音、CRP、ESR、PCT、LDH、ALT、PLT、WBC、D-二聚体等实验室检查、肺内及肺外并发症及治疗方面差异均有统计学意义（均P<0.05）。两组在年龄、性别及喘息方面差异无统计学意义（P>0.05）。
发热时间长、心率快及肺部啰音突出可能是RMPP的临床特点。单侧肺部阴影及肺不张应予以更多关注，可能是RMPP发生发展的高危因素。RMPP病例炎症指标升高，肺内外并发症多，需给予足量大环内酯类抗感染，合理使用糖皮质激素及静脉注射免疫球蛋白，同时完善肝脏、心脏及纤维支气管镜检查，以提高诊治效果。
