儿童难治性肺炎支原体肺炎的危险因素及甲泼尼龙治疗的最佳剂量探讨

Risk Factors of Refractory Mycoplasma Pneumoniae Pneumonia in Children and Explore the Optimal Dose of Methylprednisolone Treatment

目的:分析儿童难治性肺炎支原体肺炎(RMPP)发生的危险因素,并探讨甲泼尼龙治疗的最佳剂量。方法:选择2018年7月~2021年8月期间我院收治的肺炎支原体肺炎(MPP)患儿183例。根据病情程度的不同将患儿分为普通肺炎支原体肺炎(GMPP)组(n=90)和RMPP组(n=93),构建多因素Logistic回归方程分析儿童RMPP发生的危险因素。RMPP患儿均在常规治疗基础上应用甲泼尼龙治疗,并按照给药剂量的不同分为低剂量组[2 mg/(kg·d)]、中剂量组[3 mg/(kg·d)]和高剂量组[4 mg/(kg·d)],每组各31例,对比三组的疗效、临床症状消失时间和不良反应发生情况。结果:单因素分析结果显示:RMPP组发热天数长于GMPP组,特异性体质、肺外并发症患儿比例以及中性粒细胞百分比、降钙素原(PCT)、C反应蛋白(CRP)、乳酸脱氢酶(LDH)、白细胞介素-6(IL-6)水平高于GMPP组,淋巴细胞百分比低于GMPP组(P<0.05)。多因素Logistic回归分析结果显示:发热天数≥10 d、特异性体质、有肺外并发症、CRP≥24 mg/L、LDH≥250 IU/L、IL-6≥17 pg/mL是RMPP发生的危险因素(P<0.05)。高剂量组的临床总有效率高于中剂量组、低剂量组(P<0.05),但中剂量组与低剂量组间临床总有效率无统计学差异(P>0.05)。高剂量组和中剂量组的咳嗽消失时间、体温恢复正常时间、肺部啰音消失时间和住院时间均短于低剂量组,且高剂量组上述时间均短于中剂量组(P<0.05)。低中高剂量三组间不良反应发生率比较无统计学差异(P>0.05)。结论:儿童RMPP的发生受到发热天数、特异性体质、肺外并发症以及CRP、LDH、IL-6水平等因素影响。应用4 mg/(kg·d)剂量甲泼尼龙治疗儿童RMPP疗效较好,可明显缩短患儿临床症状消失时间。

Objective:To analyze the risk factors of refractory mycoplasma pneumoniae pneumonia(RMPP)occurrence in children,and to explore the optimal dose of methylprednisolone treatment.Methods:183 children with mycoplasma pneumoniae pneumonia(MPP)who were treated in our hospital from July 2018 to August 2021 were selected.According to the degree of illness,the children were divided into general mycoplasma pneumoniae pneumonia(GMPP)group(n=90)and RMPP group(n=93),multivariate Logistic regression equation was constructed to analyze the risk factors of RMPP occurrence in children.All children with RMPP were treated with methylprednisolone on the basis of routine treatment,and they were divided into low-dose group[2 mg/(kg·d)],medium-dose Group[3 mg/(kg·d)]and high-dose group[4mg/(kg·d)]aaccording to the different dose,with 31 cases in each group.The curative effects,clinical symptoms disappearance time and occurrence of adverse reactions of the three groups were compared.Results:Univariate analysis showed that the fever days in RMPP group were longer than those in GMPP group,the specific constitution,the proportion of children with extrapulmonary complications,the percentage of neutrophils,procalcitonin(PCT),C-reactive protein(CRP),lactate dehydrogenase(LDH)and interleukin-6(IL-6)were higher than those in GMPP group,and the percentage of lymphocytes was lower than that in GMPP group(P<0.05).Multivariate Logistic regression analysis showed that fever days≥10 d,specific constitution,extrapulmonary complications,CRP≥24 m/L,LDH≥250 iu/L and IL-6≥17 pg/mL were the risk factors of RMPP occurrence(P<0.05).The total clinical effective rate of high-dose group was higher than that of medium-dose group and low-dose group(P<0.05),but there was no significant difference in the total clinical response rate between medium-dose group and low-dose group(P>0.05).The cough disappearance time,body temperature recovery normal time,the pulmonary rales disappearance time and the hospital stay in the high-dose group and the medium-dose group were shorter than those in the low-dose group,and the above-mentioned time in the high-dose group was shorter than that in the medium-dose group(P<0.05).There was no significant difference in the incidence of adverse reactions in the three groups(P>0.05).Conclusion:The RMPP occurrence in children is affected by fever days,specific constitution,extrapulmonary complications and the levels of CRP,LDH and other factors.Methylprednisolone 4 mg/(kg·d)is effective in the treatment of RMPP in children,and which can significantly shorten the time for clinical symptoms to disappear.