糖皮质激素联合阿奇霉素对难治性支原体肺炎患儿的疗效及影响因素分析

Curative effect of glucocorticoid combined with azithromycin on children with refractory mycoplasma pneumonia and its influencing factors

目的研究糖皮质激素联合阿奇霉素对难治性支原体肺炎患儿的疗效及其影响因素。方法对2019年1月至2022年1月收治的难治性支原体肺炎患儿120例临床资料进行分析。患儿均采用糖皮质激素联合阿奇霉素进行治疗。观察治疗前后患儿白细胞计数(WBC)、乳酸脱氢酶(LDH)、超敏C-反应蛋白(hs-CRP)、中性粒细胞比例(Ne)水平。观察患儿治疗后临床预后,并根据预后分为预后良好组和预后不良组观察不同疗效患儿临床病理特征,分析影响预后的相关因素。结果治疗后患儿WBC、LDH、h-CRP、Ne指标明显低于治疗前(P<0.05)。120例患儿预后良好104例、预后不良16例,分析其病理特征显示:年龄、病程、发热持续时间、有无循环系统并发症、神经系统并发症、并发症数量≥3种及WBC、LDH、h-CRP、Ne表达水平是影响患儿预后的主要可疑因素(P<0.05);进一步分析显示:病程、发热持续时间、存在循环系统并发症、神经系统并发症、并发症≥3种及LDH、h-CRP、Ne表达水平是影响患儿预后的危险因素(P<0.05)。各因素的拟合数据对预后不良患儿的预测AUC 0.965;预测敏感度86.5%、特意度97.5%。结论糖皮质激素联合阿奇霉素治疗难治性支原体肺炎患儿具有较好疗效,患儿临床预后率较高。病程、发热持续时间、存在循环系统并发症、神经系统并发症、并发症3个或以上及LDH、h-CRP、Ne比例表达水平是影响患儿预后的主要危险因素。

Objective To analyze the curative effect of glucocorticoid combined with azithromycin on children with refractory mycoplasma pneumonia and its influencing factors.Methods The clinical data of 120 children with refractory mycoplasma pneumonia admitted in our hospital from January 2019 to January 2022 were analyzed.They were treated with glucocorticoid and azithromycin.White blood cell count(WBC),lactate dehydrogenase(LDH),high-sensitivity C-reactive protein(hs-CRP)and neutrophil ratio(Ne)were measured before and after treatment.The clinical prognosis of children after treatment was observed,and they were divided into good prognosis group and poor prognosis group.The clinicopathological characteristics of children with good and poor prognosis were compared,and its influencing factors were analyzed.Results WBC,LDH,hs-CRP and Ne in children after treatment were significantly lower than those before treatment(P<0.05).104/120 children had good prognosis and 16 had poor prognosis.Age,course of disease,duration of fever,presence or absence of circulatory system complications,nervous system complications,the number of complications≥3,WBC,LDH,hs-CRP,and Ne were significantly correlated with the prognosis of children with refractory mycoplasma pneumonia.Furthermore,it is found that the course of disease,duration of fever,presence of circulatory system complications,nervous system complications,three or more complications,LDH,hs-CRP,and Ne were risk factors for the prognosis of children with refractory mycoplasma pneumonia(all P<0.05).The area under the curve(AUC),sensitivity and specificity of their combination detection in diagnosing refractory mycoplasma pneumonia in children were 0.965,86.5%,and 97.5%,respectively.Conclusion Glucocorticoid combined with azithromycin has a good effect on children with refractory mycoplasma pneumonia,with a good prognosis.The course of disease,duration of fever,presence of circulatory system complications,nervous system complications,three or more complications,LDH,hs-CRP,and Ne are the main risk factors affecting the prognosis of children with refractory mycoplasma pneumonia.