Clinical Diagnosis And Treatment Of Refractory Mycoplasma Pneumoniae Pneumonia Resist To Regular Dose Methylprednisolone In Children

Objective:Investigateclinicalcharacteristicsofregulardose methylprednisolone-resistant Refractory Mycoplasma Pneumoniae pneumonia(RMPP)in children,then discuss the related predictor for diagnosis of regular dose methylprednisolone-resistant RMPP,probe the value of bronchoscopy BAL treatment in the RMPP cases,in order to early identificate regular dose methylprednisolone-resistant RMPP cases and improve treatment effect.Methods:Retrospectively analysis was performed on 26 cases who was clinically diagnosed RMPP with relevant guideline and hospitalized in first affiliated hospital of university of south China from October 2015 to November 2016.According to the effect of 3-days treatment of regular dosage(2mg/kg/d)methylprednisolone,children patients were divided into“regular dosage methylprednisolone-resistant group”and“regular dosage methylprednisolone-sensitive group”.Analyze enrollment children’sclinlicalmanifestation,includingdurationof fever,cough,tachypnea,rales,Collect and analyze laboratory datas of examinations of white blood cell(WBC)、proportion of neutrophils(N%)、C-reactiveprotein(CRP)、procalcitonin(PCT)、lactate dehydrogenase(LDH),MP-DNA of BALF,Discuss chest radiological findings,Observe morphologic features under bronchoscope,and clinical outcome after combined treatment.Simultaneously discuss the value of bronchoscopy BAL treatment methods in children RMPP cases,except other conventional methods as jointly using immunoglobulin G(IVIG),increasing dosage of corticosteroid hormone,non-macrolide antibiotics.Results:1.Of the 26 RMPP cases,5(19.2%)were regular dosage methylprednisolone-resistantRMPPcases(regulardosage methylprednisolone-resistant group),21(80.8%)were regular dosage methylprednisolone-sensitiveRMPPcases(regulardosage methylprednisolone-sensitive group).2.Theclinicalcharateristicsofregulardosage methylprednisolone-resistant RMPP cases in children:(1)a longer duration of hyperpyrexia≥11day(P<0.01),hospitalization≥13day(P<0.01),statistically significant difference compared with sensitive group.(2)laboratory datas:proportion of neutrophils(N%)≥71%(P<0.05),CRP≥89mg/L(P<0.01),PCT≥11.6ng/ml(P<0.01),LDH≥451.2U/L(P<0.01),BALF MP-DNA≥2.33×10~5copies/ml(P<0.01),statisticallysignificantdifferencecomparedwith corticosteroid-sensitive RMPP cases.(3)radiological findings:It was more frequently seen in corticosteroid-resistant group that indicated high density consolidation in no less than a whole pulmonary lobe and pulmonary necrosis(60%to 0%,P<0.01).(4)bronchoscopy:segmental bronchus opening swelling and straitness in 11 cases,mucosal small nodular process in 8 cases,mucosal erosion in 10 cases,4(80%)regular dosagemethylprednisolone-resistantcaseshadmucusplug formation,while none(0%)of the sensitive case had mucus plug(P<0.01).3.Receiver operator characteristic(ROC)curves method find that 5univariate parameters such as proportion of neutrophils(N%),CRP,PCT,LDH,BALF MP-DNA copies can be used as valuable predictive index in the diagnosis.4.In the treatment of children RMPP cases,conventional treatment methods as joint application of IVIG,increasing dosage of glucocorticoid,non-macrolide antibiotics will improve effect.except that,withtheapplicationofbronchoscopyBAL,1week later,defervescence in 4 cases(80%),recover of PCT in 3 cases(60%),chest radiological lesion dissapeared in 4 cases(80%),the effect improved tremendously.Conclusions:1.The clinical characteristics of children regular dose methylprednisolone-resistantRMPPincludenextfour features:A)Duration of hyperpyrexia≥11 days,B)Obviously abnormal laboratory datas:N%,CRP,PCT,LDH,MP-DNA;Parameters such as proportion of neutrophils(N%)≥71%(P<0.05),CRP≥89mg/L(P<0.01),PCT≥11.6ng/ml(P<0.01),LDH≥451.2U/L(P<0.01),BALF MP-DNA≥2.33×10~5copies/ml(P<0.01)can be used as predictors that cliniciancanmakeadiagnosisaboutregulardosage methylprednisolone-resistantRMPPcases;C)moreseverechest radiological findings:like Consolidation of pulmonary lobe;D)Find airway mucus plug formation under fiberal bronchoscope.2.In the treatment of children RMPP cases,except conventional treatment methods,bronchoscopy BAL will be a more useful and safe choise of comprehensive curations.