肺炎,支原体%糖皮质激素%儿童
肺炎,支原體%糖皮質激素%兒童
폐염,지원체%당피질격소%인동
Pneumoniae,mycoplasma%Glucocorticoid%Child
目的 总结对静脉给予2 mg/(kg·d)甲泼尼龙治疗3d无效的难治性肺炎支原体肺炎(RMPP)患儿的临床特征.方法 回顾性分析110例RMPP患儿临床资料,根据对初始采用2 mg/(kg·d)甲泼尼龙治疗3d的反应,分为“有效组”和“无效组”,对比患儿的临床表现、实验室检查、影像学特征及支气管镜表现,并且以激素疗效分组作为标准,将两组间差异有统计学意义的实验室指标作ROC曲线,寻找提示2 mg/(kg·d)甲泼尼龙治疗无效的参考指标.结果 (1)有效组86例(86/110,78.2％),无效组24例(24/110,21.8％).(2)治疗无效组患儿主要表现:①高热8例,超高热16例,与有效组相比,无效组超高热比例明显增高(66.7％比37.3％,P＜0.01);②比较两组白细胞计数(×109/L) [12.1 (5.6 ～ 19.5)比8.1(3.6～18.6),P＜0.05]、白细胞分类中性粒细胞(0.82±0.05)比(0.70±0.10)、C反应蛋白(mg/L)[160.0(78.9 ～285.0)比68.3(40～ 125.0),P＜0.01]、铁蛋白(μg/L)[388.3(337.1 ～975.8)比229.4(110.6 ～ 618.6),P＜0.01]、乳酸脱氢酶(IU/L)[(596.1±185.9)比(397.1±160.4),P＜0.01]、肌酸激酶同工酶(IU/L)[15.0(8.0 ～28.0)比12.0(6.0 ～27.0),P＜0.01]、纤维蛋白原(g/L)[(5.74±1.04)比(4.81 +0.95),P＜0.01]等指标,治疗无效组均明显高于有效组,淋巴细胞比明显下降[(0.12±0.04)比(0.19±0.06),P＜0.01];③混合感染比例高于有效组(33.3％比4.7％);④影像学表现:多为整叶以上均一致密高实变影,甚至多个肺叶受累,发生肺坏死比例高(41.7％比0％);⑤支气管镜下分泌物堵塞(45.0％比16.9％)、黏膜坏死(37.5％比8.1％)、支气管闭塞比例高(20.8％比0％);⑥经ROC曲线下面积计算得出C反应蛋白、血清铁蛋白、乳酸脱氢酶、白细胞分类中性粒细胞、淋巴细胞5个独立相关因素可作为2 mg/(kg·d)甲泼尼龙治疗无效的有价值的预测指标,界值分别为C反应蛋白110 mg/L,血清铁蛋白328 μg/L,乳酸脱氢酶478 IU/L,白细胞分类中性粒细胞0.78,淋巴细胞0.13.结论 甲泼尼龙2 mg/(kg·d)对于大多数RMPP患儿,能迅速改善临床症状及影像学表现,但当RMPP患者出现持续高热＞7d,初诊时C反应蛋白≥110 mg/L,白细胞分类中性粒细胞≥0.78,淋巴细胞≤0.13,血清乳酸脱氢酶≥478 IU/L,血清铁蛋白≥328 μg/L,肺CT提示整叶以上均一致密实变影,应注意2 mg/(kg·d)甲泼尼龙治疗可能无效.
目的 總結對靜脈給予2 mg/(kg·d)甲潑尼龍治療3d無效的難治性肺炎支原體肺炎(RMPP)患兒的臨床特徵.方法 迴顧性分析110例RMPP患兒臨床資料,根據對初始採用2 mg/(kg·d)甲潑尼龍治療3d的反應,分為“有效組”和“無效組”,對比患兒的臨床錶現、實驗室檢查、影像學特徵及支氣管鏡錶現,併且以激素療效分組作為標準,將兩組間差異有統計學意義的實驗室指標作ROC麯線,尋找提示2 mg/(kg·d)甲潑尼龍治療無效的參攷指標.結果 (1)有效組86例(86/110,78.2％),無效組24例(24/110,21.8％).(2)治療無效組患兒主要錶現:①高熱8例,超高熱16例,與有效組相比,無效組超高熱比例明顯增高(66.7％比37.3％,P＜0.01);②比較兩組白細胞計數(×109/L) [12.1 (5.6 ～ 19.5)比8.1(3.6～18.6),P＜0.05]、白細胞分類中性粒細胞(0.82±0.05)比(0.70±0.10)、C反應蛋白(mg/L)[160.0(78.9 ～285.0)比68.3(40～ 125.0),P＜0.01]、鐵蛋白(μg/L)[388.3(337.1 ～975.8)比229.4(110.6 ～ 618.6),P＜0.01]、乳痠脫氫酶(IU/L)[(596.1±185.9)比(397.1±160.4),P＜0.01]、肌痠激酶同工酶(IU/L)[15.0(8.0 ～28.0)比12.0(6.0 ～27.0),P＜0.01]、纖維蛋白原(g/L)[(5.74±1.04)比(4.81 +0.95),P＜0.01]等指標,治療無效組均明顯高于有效組,淋巴細胞比明顯下降[(0.12±0.04)比(0.19±0.06),P＜0.01];③混閤感染比例高于有效組(33.3％比4.7％);④影像學錶現:多為整葉以上均一緻密高實變影,甚至多箇肺葉受纍,髮生肺壞死比例高(41.7％比0％);⑤支氣管鏡下分泌物堵塞(45.0％比16.9％)、黏膜壞死(37.5％比8.1％)、支氣管閉塞比例高(20.8％比0％);⑥經ROC麯線下麵積計算得齣C反應蛋白、血清鐵蛋白、乳痠脫氫酶、白細胞分類中性粒細胞、淋巴細胞5箇獨立相關因素可作為2 mg/(kg·d)甲潑尼龍治療無效的有價值的預測指標,界值分彆為C反應蛋白110 mg/L,血清鐵蛋白328 μg/L,乳痠脫氫酶478 IU/L,白細胞分類中性粒細胞0.78,淋巴細胞0.13.結論 甲潑尼龍2 mg/(kg·d)對于大多數RMPP患兒,能迅速改善臨床癥狀及影像學錶現,但噹RMPP患者齣現持續高熱＞7d,初診時C反應蛋白≥110 mg/L,白細胞分類中性粒細胞≥0.78,淋巴細胞≤0.13,血清乳痠脫氫酶≥478 IU/L,血清鐵蛋白≥328 μg/L,肺CT提示整葉以上均一緻密實變影,應註意2 mg/(kg·d)甲潑尼龍治療可能無效.
목적 총결대정맥급여2 mg/(kg·d)갑발니룡치료3d무효적난치성폐염지원체폐염(RMPP)환인적림상특정.방법 회고성분석110례RMPP환인림상자료,근거대초시채용2 mg/(kg·d)갑발니룡치료3d적반응,분위“유효조”화“무효조”,대비환인적림상표현、실험실검사、영상학특정급지기관경표현,병차이격소료효분조작위표준,장량조간차이유통계학의의적실험실지표작ROC곡선,심조제시2 mg/(kg·d)갑발니룡치료무효적삼고지표.결과 (1)유효조86례(86/110,78.2％),무효조24례(24/110,21.8％).(2)치료무효조환인주요표현:①고열8례,초고열16례,여유효조상비,무효조초고열비례명현증고(66.7％비37.3％,P＜0.01);②비교량조백세포계수(×109/L) [12.1 (5.6 ～ 19.5)비8.1(3.6～18.6),P＜0.05]、백세포분류중성립세포(0.82±0.05)비(0.70±0.10)、C반응단백(mg/L)[160.0(78.9 ～285.0)비68.3(40～ 125.0),P＜0.01]、철단백(μg/L)[388.3(337.1 ～975.8)비229.4(110.6 ～ 618.6),P＜0.01]、유산탈경매(IU/L)[(596.1±185.9)비(397.1±160.4),P＜0.01]、기산격매동공매(IU/L)[15.0(8.0 ～28.0)비12.0(6.0 ～27.0),P＜0.01]、섬유단백원(g/L)[(5.74±1.04)비(4.81 +0.95),P＜0.01]등지표,치료무효조균명현고우유효조,림파세포비명현하강[(0.12±0.04)비(0.19±0.06),P＜0.01];③혼합감염비례고우유효조(33.3％비4.7％);④영상학표현:다위정협이상균일치밀고실변영,심지다개폐협수루,발생폐배사비례고(41.7％비0％);⑤지기관경하분비물도새(45.0％비16.9％)、점막배사(37.5％비8.1％)、지기관폐새비례고(20.8％비0％);⑥경ROC곡선하면적계산득출C반응단백、혈청철단백、유산탈경매、백세포분류중성립세포、림파세포5개독립상관인소가작위2 mg/(kg·d)갑발니룡치료무효적유개치적예측지표,계치분별위C반응단백110 mg/L,혈청철단백328 μg/L,유산탈경매478 IU/L,백세포분류중성립세포0.78,림파세포0.13.결론 갑발니룡2 mg/(kg·d)대우대다수RMPP환인,능신속개선림상증상급영상학표현,단당RMPP환자출현지속고열＞7d,초진시C반응단백≥110 mg/L,백세포분류중성립세포≥0.78,림파세포≤0.13,혈청유산탈경매≥478 IU/L,혈청철단백≥328 μg/L,폐CT제시정협이상균일치밀실변영,응주의2 mg/(kg·d)갑발니룡치료가능무효.
Objective To analyze the clinical manifestations of refractory Myeoplasma pneumoniae pneumonia (RMPP) which unresponded to methylprednisolone in the dosage of 2 mg/(kg · d) for 3 days.Method Retrospective analysis was performed on the clinical data of 110 children (64 boys and 46 girls) with RMPP.The patients were divided into "effective group" and "ineffective group" according to initial effect of 2 mg/(kg · d) methylprednisolone.The clinical manifestations,laboratory examination,radiological features and bronchofibroscopic findings of the children were compared.In order to seek the reference indexes which indicate nonresponsive to 2 mg/(kg · d) methylprednisolone,an ROC curve was made,of which the diagnostic cut-off was five independent correlation factors while grouping was made according to patients' different response to glucocorticosteroid.Result The effective group had 86 (86/110,78.2％) children while ineffective group had 24 (24/110,21.8％).The ineffective group children had the following performance:16 children (16/24,66.7％) in ineffective group had ultrahyperpyrexia (T ≥40 C),which was significantly more severe compared to those in effective group (32/86,37.3％,P ＜0.01) ; the levels of white blood cell (WBC) count,percentage of neutrophils count (N),C-reactive protein (CRP),serum ferritin (SF),alanine transaminase (ALT),lactic dehydrogenase (LDH),creatine kinase isoenzyme (CK-MB) and fibrinogen (Fib) in ineffective group were significantly higher than those in effective group(P ＜0.01) ; while percentage of lymphocyte count (L) was lower than that in effective group (P ＜ 0.01).Proportion of mixed infection in ineffective group was higher than that in effective group (33.3％ vs.4.7％).Radiological manifestations:It was more frequently seen in ineffective group that chest CT scan indicated high density consolidation in no less than a whole pulmonary lobe and pulmonary necrosis (41.7％ vs.0％).Abundant secretions blockage (45.0％ vs.16.9％) and mucosal necrosis (37.5％ vs.8.1％) on bronchofibroscopy were more frequently seen in ineffective group.The critical values of the five independent correlation factors were CRP 110 mg/L,SF 328 mg/L,LDH 478 IU/L,N 0.78,L 0.13.Conclusion Treatment with 2 mg/(kg · d) methylprednisolone can improve clinical symptoms and radiological manifestations of most children with RMPP quickly,but it may be ineffective in some situations such as lasting high fever or ultrahyperpyrexia for more than 7 days,CRP≥ 110 mg/L,N ≥ 0.78,L ≤ 0.13,serum LDH ≥ 478 IU/L,SF ≥ 328 μg/L,chest CT scan indicating high density consolidation in more than a whole pulmonary lobe involved and moderate-abundant pleural effusion.
