Comparison The Different Outcomes And Exploration The Adjunctive Treatment Of Methylprednisolone In Children With Lobar Mycoplasma Pneumoniae Pneumonia

Part I:The Comparison of different outcomes of children with lobar Mycoplasma pneumoniae pneumoniaObjective:To compare the clinical differences on admission of two groups of children with lobar Mycoplasma pneumoniae pneumonia in different outcomes after 7 days of treatment with macrolide antibiotics,and to explore the relevant indicators for the early identification of refractory Mycoplasma pneumoniae pneumonia.Method:A retrospective analysis of the clinical data of children aged 1～14 years old with lobar Mycoplasma pneumoniae pneumonia hospitalized at the Children’s Medical Center of the First Affiliated Hospital of Hunan Normal University(Hunan Provincial People’s Hospital)on January 2017-January 2018 was performed.A total of 26 patients who became ineffective after 7 days of treatment with macrolide antibiotics were classified into refractory Mycoplasma pneumoniae pneumonia(RMPP)group,a total of 30 patients who became effective after 7 days of treatment with macrolide antibiotics were classified into non-refractory Mycoplasma pneumoniae pneumonia(NRMPP)group.To compare the differences between the two groups in general condition,clinical features,pulmonary imaging characteristics,fiberoptic bronchoscopy,laboratory examination results and co-infections.Result:1.General condition:There was no difference between the two groups in the median age,age distribution and gender(P>0.05).2.Clinical features:There was no difference in the course of disease and the fever time before admission between the two groups;but the total fever time in the RMPP group was longer than that in the NRMPP group(P<0.05),and the RMPP group was more likely to have extra-pulmonary complications than the NRMPP group(P<0.05).3.Pulmonary imaging characteristics:There was no difference in the main pathological changes of pulmonary imaging between the two groups(P>0.05).But the RMPP group were more likely to have pleural effusion than the NRMPP group(P<0.05).4.Fiberoptic bronchoscopy:The incidence of plastic bronchitis through the Fiberoptic bronchoscopy microscope was higher in the RMPP group than in the NRMPP group(P<0.05);The copies of MP-DNA in the bronchoalveolar lavage fluid in the RMPP group were higher than those in NRMPP group(P<0.05).5.Laboratory examination results:There was no difference between the two groups in peripheral white blood cells(WBC)(P>0.05),but the percentage of neutrophils(N%),C-reactive protein(CRP),and procalcitonin(PCT),lactate dehydrogenase(LDH),D-dimer(DDI)were higher than NRMPP group(P<0.05).6.Co-infection:There was no significant difference in the co-infection rate between the two groups(P>0.05).Conclusion:When the child with lobar Mycoplasma pneumoniae pneumonia performances as long-term fever,with pleural effusion,with extra-pulmonary complications,as plastic bronchitis through the Fiberoptic bronchoscopy microscope,with high MP-DNA load in the bronchoalveolar lavage fluid,and N%,CRP,LDH,DDI is higher,it maybe develop to RMPP.Part II:Exploring the treatment of methylprednisolone in children with lobar Mycoplasma pneumoniae pneumoniaObjective:To compare the different stages in the early or advanced using the treatment of methylprednisolone adjuvant therapy for children with lobar Mycoplasma pneumoniae pneumonia,and to explore the better time to use glucocorticoid adjuvant treatment for lobar Mycoplasma pneumoniae pneumonia in children.Method:A retrospective analysis of the clinical data of children aged 1～14 years old with lobar Mycoplasma pneumoniae pneumonia hospitalized at the Children’s Medical Center of the First Affiliated Hospital of Hunan Normal University(Hunan Provincial People’s Hospital)on January 2017～January 2018 was performed.A total of 37 patients,who combined with methylprednisolone during the treatment period of macrolide antibiotics less than 7 days,were classified into the early treatment group,A total of 26 patients,who combined with methylprednisolone during the treatment period of macrolide antibiotics for 7 days or more,were classified into the advanced treatment group.Comparing the general condition,clinical features,pulmonary imaging characteristics,fiberoptic bronchoscopy,laboratory examination results on admission and the dose,course of methylprednisolone treatment between the two groups.And then,comparing the differences in the overall treatment time,total fever time,pulmonary imaging changes,and adverse reactions between the two groups after methylprednisolone therapy.Result:There was no difference in the general conditions,clinical features,pulmonary imaging,fiberoptic bronchoscopy,laboratory examination results and the dose,course of methylprednisolone treatment between the two groups(P>0.05);At the same time,in the early treatment group,the rate of obvious absorption of pulmonary imaging was higher than that of the advanced treatment group after methylprednisolone treatment(P>0.05).Conclusion:It is better efficacy for children with lobar Mycoplasma pneumoniae pneumonia to use of early glucocorticoid adjuvant therapy,and does not increase the incidence of recent adverse reactions.