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.

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. [ABSTRACT FROM AUTHOR]