The Clinical Characteristics And Risk Factors Of Refractory Mycoplasma Pneumoniae Pneumonia In School-aged Children

Objective:MP infection was traditionally thought to be a self-limited process,but in recent years,there were more and more severe cases even fatal cases of MP infections reported,which especially happened in school-aged children.It may sometimes cause not only pulmonary but also extra-pulmonary complications,such as pulmonary consolidation,pulmonary atelectasis,pleural effusion,and even progress to a severe life-threatening pneumonia.Therefore it is significant for physicians to recognize refractory Mycoplasma Pneumoniae pneumonia(RMPP)in school-aged children earlier and suggest proper therapy.The object of this study was to elucidate the clinical characteristics and associations between cytokines and the prediction of RMPP in school-aged patients.Methods:Retrospective analyses were performed on school-aged children with Mycoplasma pneumoniae pneumonia(MPP)hospitalized in our hospital between January 1,2011 and December 31,2015.The clinical characteristics,including the cytokines in serum between the RMPP group and the general Mycoplasma pneumoniae pneumonia(GMPP)group were compared and the predictive values of RMPP were explored.Results:1.Of total 180 patients,115 patients were in the GMPP group,65 were in the RMPP group.There were no significant differences between the two groups with respect to age,gender distribution.2.For signs and symptoms,we found that the incidence of tachypnea,decrease in breath sound and extra-pulmonary complications were significantly higher in RMPP group than those in GMPP group(P<0.001,P<0.05 and P<0.001,respectively).3.The median duration of fever before admission was 8(5～10)days,the median duration of fever was 9(6～11)days,and the median length of stay was 5(3～7)days in GMPP group,while which respectively was 10(8～11)days,14(12～17)days,and 8(7-10)days in RMPP group(P<0.001).4.The levels of the percentage of neutrophils,C-reactive protein(CRP),procalcitonin(PCT)and lactate dehydrogenase(LDH)in RMPP group were much higher than those in GMPP group(P<0.01);but there were no significant difference in the count of white blood cells(WBC),tilter of MP-IgM,subgroup of immunoglobulin and subtypes of T lymphocytes between two groups.Furthermore,we found the levels of cytokines,including interleukin(IL)-6,IL-10,interferon gamma(IFN-γ)in RMPP group were significantly higher than those in GMPP group(P<0.01).5.As to radiological manifestations,large lesions,pleural effusion and atelectasis were more frequently happened in RMPP group than those in GMPP group(83.1%vs 53.9%,53.8%vs 22.6%,24.6%vs 7.8%,respectively)(P<0.01).6.For treatment,oxygen,BAL and methylprednisolone therapy were more frequently used in RMPP group than those in GMPP group(P<0.001).7.In ROC curve analysis,IL-10 and IFN-γ were useful for differentiating patients with RMPP from those with GMPP.Logistic regression analysis showed that the IL-10 ≥3.7 pg/ml and IFN-γ ≥29.1 pg/ml were significant predictors regarding to RMPP.Conclusion:1.RMPP may lead to severe clinical features,more complications,more serious radiological manifestations and need more oxygen,BAL and methylprednisolone therapy.2.The levels of the percentage of neutrophils,C-reactive protein(CRP),lactate dehydrogenase(LDH),procalcitonin(PCT)and interleukin(IL)-6,IL-10,IFN-y in RMPP group were significantly higher than those in GMPP group.3.IL-10 ≥ 3.7pg/ml and IFN-γ ≥ 29.1pg/ml could be used as the good predictors to differentiate RMPP from GMPP in school-aged children.