西安市儿童医院92例难治性肺炎支原体肺炎临床特点分析

Clinical features of 92 cases of refractory mycoplasma pneumoniae pneumonia in Xi'an Children's Hospital

目的分析难治性肺炎支原体肺炎（RMPP）的临床特点,寻找提示常规糖皮质激素治疗效果不佳的指标。方法回顾性分析92例临床确诊的难治性肺炎支原体的临床特点。对比治疗中需要联合静脉使用丙种球蛋白的病例的临床资料。结果 RMPP多见于学龄前期及学龄期儿童,3~9岁占78.26%（72/92）;以反复发热、咳嗽为主要症状;血常规白细胞计数在正常范围为主的占73.91%（68/92）,超敏C反应蛋白明显升高。最常见肺外表现为胸腔积液,确诊后给予甲基强的松龙2mg·kg-1·d-1,75例（84.78%）患儿体温于使用次日即可正常。22例患儿给予常规剂量甲强龙2mg·kg-1·d-1治疗3天后仍有发热（包括停用甲强龙治疗后再次出现发热）,需要联合静脉使用丙种球蛋白治疗。对比仅甲强龙治疗和甲强龙＋丙种球蛋白治疗的两组患儿临床及实验室结果,降钙素原值具有显著性差异（t=-3.24,P〈0.05）。结论 RMPP患者,常规剂量的甲基强的松龙治疗可获得较好的临床效果,当降钙素原升高时,提示治疗中可能需要联合静脉使用丙种球蛋白。

Objective To analyze the clinical features of refractory mycoplasma pneumoniae pneumonia（ RMPP） and look for indictors revealing poor efficacy of conventional glucocorticoid therapy. Methods Retrospective analysis was conducted on the clinical features of 92 cases of RMPP. Comparison was made on the clinical data of cases requiring combination treatment with intravenous gamma globulin or not. Results RMPP was common in preschool and school-age children,and children aged 3-9 years occupied 78. 26%（ 72 /92） with main symptoms of recurrent fever and cough. Cases with blood leukocyte count in normal range occupied 73. 91%（ 68 /92）,and high-sensitivity C-reactive protein increased significantly. The most common extrapulmonary manifestation was pleural effusion. After confirmed diagnosis methylprednisolone（ 2mg / kg per day） was given. There were 75 cases（ 84. 78%） declining to normal body temperature next day after medication. Twenty-two cases still had fever 3 days after use of methylprednisolone（ 2mg / kg per day）（ fever again after drug stop）,and combination with intravenous gamma globulin was needed. Clinical and experimental results of cases only accepting methylprednisolone and those accepting methylprednisolone combined with gamma globulin were compared,and the difference in primary value of calcitionin was significant（ t =- 3. 24,P〈0. 05）. Conclusion Conventional doses of methylprednisolone can achieve better clinical results in treatment of RMPP patients. Procalcitonin increasing may require joint therapy with intravenous gamma globulin.