关键词: 难治性肺炎支原体肺炎, 甲泼尼龙, 疗效, 儿童

Abstract: Objective To analyze the clinical characteristics of refractory Mycoplasma pneumoniae pneumonia(RMPP),in different effect response to treatment by observing the 35d effects in the initial treatment with conventional dose of methylprednisolone Methods Retrospective analysis was performed on the clinical data of 127 cases of RMPP patients treated in Dalian Municipal Women and Children′s Medical Center from January 2015 to December 2018 According to initial 35d effects of 2 mg/(kg·d) methylprednisolone,the dose was further adjusted,and patients were divided into 3 groups,“conventional” group,“highdose” group and “longcourse” group The clinical features,radiological features,laboratory examination and prognosis of the cases were compared Results （1）The rates of respiratory failure,extrapulmonary complications,cloudy opacity,lobar lung consolidation and necrotizing pneumonia in the three groups were statistically different(P<0.05);the incidence of extrapulmonary complications in “highdose” group was higher than the other two groups(P<0.017),and severe extrapulmonary manifestations were predominant in “highdose” group(26/31),but extrapulmonary manifestations of the other two groups were mainly mild(6/9,41/55) There was no significant difference in rates of wheezing,allergic diseases,family allergic diseases,mixed infection,diffused interstitial changes,acute pulmonary effusion,atelectasis among the three groups(P>0.05)（2）The levels of lactic dehydrogenase and serum ferritin in the three groups were statistically different(P<0.01),and they were higher in the “highdose” group than in the other two groups(P<0.01) The level of fibrinogen in the three groups was statistically different(P<0.05),and it was higher in the “highdose” group than in “conventional” group(P<0.05) Comparing the Creactive protein of the three groups,the level of Creactive protein in “highdose” group was higher than that in “conventional” group(P<0.05)There was no significant difference in levels of white blood cell count,percentage of neutrophils,eosinophil count,creatine kinase isoenzyme or DDimer among the three groups(P>0.05) （3）In 6 months of followup after treatment,the rates of lung consolidation and interstitial changes in the three groups were statistically different(P<0.05),and they were higher in the “highdose” group than in the “conventional” group(P<0.017) There were no significant differences in rates of atelectasis or wheezing among the three groups in the 6month followup (P>0.05) Conclusion Conventional dose of methylprednisolone may be ineffective in RMPP cases with respiratory failure,severe extrapulmonary complications,lobar lung consolidation,and necrotizing pneumonia significant increase of lactic dehydrogenase,serum ferritin,fibrinogen and Creactive protein,and these cases may have high risk of lung sequelae It is recommended to give highdose methylprednisolone,immunoglobulin,anticoagulation combined with bronchoscopic treatment,and to make regular reexamination.

Key words: Refractory Mycoplasma pneumoniae pneumonia, Methylprednisolone, Curative effect, Child