Abstract
Objective: To observe the effect of corticosteroids in the treatment of children with refractory Mycoplasma pneumoniae pneumonia(RMPP)under different doses, to summarize the clinical characteristics of children treated with glucocorticoid pulse therapy.Methods: The clinical data of 125 children with RMPP hospitalized in Tianjin Children's Hospital from September 2018 to October 2019 were retrospectively analyzed. They were divided into two groups according to the dose of hormone. Group I was given conventional dose methylprednisolone 2mg/kg/day (<200mg/day) (n=81), and group II was treated with methylprednisolone pulse therapy ≥200mg/day(n=44). Compare the clinical manifestations, laboratory findings, and imaging between the two groups of children, and use meaningful related indicators as ROC curves to find reference indicators for pulse therapy.Results: (1)The age and weight of the group II were greater than the group I(P<0.05). (2) The symptoms of group II were more serious than group I, with higher incidence of hypoxemia, longer fever, longer hospital stays, higher incidence of extrapulmonary complications, and more severe radiological findings (P<0.05). (3)The more severe the disease was, the higher hormone amount,use rate of gamma globulin,use rate of bronchoscopy , and incidence of plastic bronchitis (P<0.05)were.(4) WBC, CRP, LDH, FER, D-D dimer, APTT, TT, PCT, IL-6 and the percentage of neutrophils in peripheral blood in Group II were higher than those in Group I(P<0.05). Moreover, the lymphocyte percentage level in group II was lower than that in group I(P<0.05). (5) In ROC curve analysis, CRP, LDH, FER, and neutrophils of leukocyte classification were independent related factors that could be used as valuable predictors of methylprednisolone pulse therapy for RMPP in children. The cut-off values were CRP 44.45 mg/L, LDH 590 IU/L, FER 411 ng/L, and neutrophils in leukocyte classification were 73.75%, respectively.Conclusions: Conventional dose methylprednisolone can improve the clinical symptoms and imaging findings of most children with RMPP rapidly. However, CRP 44.45 mg/L, LDH 590 IU/L, FER 411 ng/L, neutrophil 73.75%, lung consolidation and pleural effusion were found in RMPP patients, which should be treated with pulse dose of methylprednisolone in time to reduce the incidence of severe RMPP and the occurrence of severe sequelae.