Fang Chengchao, Mao Yueyan, Jiang Mingfen, Yin Wei
Department of Pediatrics, The First People's Hospital of Linping District, Hangzhou, China.
Hemodialysis center, The First People's Hospital of Linping District, Hangzhou, China.
Front Surg. 2022 May 25;9:897550. doi: 10.3389/fsurg.2022.897550. eCollection 2022.
To investigate the clinical characteristics of children with severe Mycoplasma pneumoniae pneumonia (SMPP) and the correlation with pediatric critical illness score (PICS), and to explore the effect of combined treatment with antibiotics and glucocorticoids.
The medical records of 120 children with SMPP admitted to our hospital from January 2020 to June 2021 were retrospectively analyzed. Children with a PICS score greater than 80 within 24 h of admission were included in the non-critical group, those with a score of 71-80 were included in the critical group, and those with a score of ≤70 were included in the extremely critical group. The relevant clinical data and examination indicators of the three groups of children were intercepted and compared. Univariate and multifactorial logistic regression analyses were performed to analyze the correlation between clinical characteristics of children with SMPP and PICS. According to the different treatment methods, the children were subdivided into the control group ( = 54) who received antibiotics alone and the comprehensive group ( = 66) who received antibiotics combined with glucocorticoid therapy. The erythrocyte sedimentation rate (ESR), inflammation and immune indexes, symptom relief or disappearance time, hospitalization days, and clinical efficacy were compared between the two groups before and after treatment.
Within 24 h of admission, among the 120 children with SMPP, 79 had PICS >80, 32 had PICS 71-80, and 9 had PICS ≤70. Before discharge, among the 120 children with SMPP, 99 had PICS >80, 17 had PICS 71-80, and 4 had PICS ≤70. Univariate analysis showed that there were no significant differences in gender ratio, ratio of fever duration >10 days, age and WBC among the three groups (> 0.05), the differences in the ratio of abnormal ECG, the ratio of ≥2 pathogenic infections, the ratio of ≥2 systemic damages, CRP levels, and D-dimer levels were statistically significant when compared among the three groups (< 0.05). Multivariate Logistic regression analysis showed that the number of Co-systemic damages and the level of D-dimer were negatively correlated with PICS classification (< 0.05). After medication, ESR, CRP, IL-6, and CD8+ levels decreased and CD4+ and CD4+/CD8+ levels increased in both the control and comprehensive groups, and all changes were significant in the comprehensive group compared with the control group (< 0.05). The antipyretic time, cough relief time, disappearance time of lung rales and hospitalization days in the comprehensive group were shorter than those in the control group (< 0.05). The total effective rate of the comprehensive group (95.45%) was better than that of the control group (83.33%) (< 0.05).
PICS can effectively reflect the clinical characteristics of children with SMPP. The comprehensive treatment effect of azithromycin combined with glucocorticoid is significantly better than that of azithromycin alone. It can effectively reduce the level of inflammation in children with SMPP, improve the immune function of children, and accelerate clinical recovery. It has promotion value.
探讨重症肺炎支原体肺炎（SMPP）患儿的临床特征及其与小儿危重病评分（PICS）的相关性，并探究抗生素联合糖皮质激素治疗的效果。
回顾性分析2020年1月至2021年6月我院收治的120例SMPP患儿的病历资料。入院24小时内PICS评分大于80分的患儿纳入非危重组，评分71 - 80分的患儿纳入危重组，评分≤70分的患儿纳入极危重组。截取并比较三组患儿的相关临床资料及检查指标。进行单因素和多因素logistic回归分析，以分析SMPP患儿临床特征与PICS的相关性。根据治疗方法不同，将患儿分为单纯接受抗生素治疗的对照组（n = 54）和接受抗生素联合糖皮质激素治疗的综合组（n = 66）。比较两组治疗前后的红细胞沉降率（ESR）、炎症及免疫指标、症状缓解或消失时间、住院天数及临床疗效。
入院24小时内，120例SMPP患儿中，PICS>80分的有79例，PICS 71 - 80分的有32例，PICS≤70分的有9例。出院前，120例SMPP患儿中，PICS>80分的有99例，PICS 71 - 80分的有17例，PICS≤70分的有4例。单因素分析显示，三组患儿的性别比例、发热持续时间>10天的比例、年龄及白细胞计数差异无统计学意义（>0.05），三组间心电图异常比例、≥2种病原感染比例、≥2种全身损害比例、CRP水平及D - 二聚体水平差异有统计学意义（<0.05）。多因素logistic回归分析显示，合并全身损害数量及D - 二聚体水平与PICS分级呈负相关（<0.05）。用药后，对照组和综合组的ESR、CRP、IL - 6及CD8+水平均下降，CD4+及CD4+/CD8+水平均升高，且综合组与对照组相比，所有变化均有统计学意义（<0.05）。综合组的退热时间、咳嗽缓解时间、肺部啰音消失时间及住院天数均短于对照组（<0.05）。综合组的总有效率（95.45%）优于对照组（83.33%）（<0.05）。
PICS能有效反映SMPP患儿的临床特征。阿奇霉素联合糖皮质激素的综合治疗效果明显优于单纯阿奇霉素治疗。可有效降低SMPP患儿的炎症水平，提高患儿免疫功能，加速临床康复。具有推广价值。
