Bronchoalveolar Lavage Cytokine Levels In Children With Refractory Mycoplasma Pneumoniae Pneumonia And Effectiveness Analysis Of Steroid Therapy

Objectives:To investigate cytokine level in bronchoalveolar lavage fluid (BALF) in children with refractory mycoplasma pneumoniae pneumonia (RMPP) and the effectiveness of short-term intravenous routine doses of methylprednisolonein on RMPP.Methods:In this study,60cases of RMPP patients and20cases of bronchial foreign body with no respiratory tract infection hospitalized in children’s hospital affiliated to Zhejiang university medical school from February2012to February2013were enrolled. The cytokines in BALF were detected, and the clinical data were analyzed.1. Grouping:RMPP patients were divided into two groups randomly (each30cases), group A were given methylprednisolone2mg/kg/d intravenously, Qd for3days. Patients whose fever disappeared in3days were placed in group A1, those still have persistent fever were plased to group A2. Then all of them had bronchoscopy and bronchoalveolar lavage. Group B who did not given steroid therapy had bronchoscopy and bronchoalveolar lavage3days after admission. At the same time, group C(20cases) as the control group, whose history and chest film or CT showed bronchial foreign body and without any signs of infection, had bronchoscopy and bronchoalveolar lavage within2days after admission.2. Collection of BALF:Patients in group A and B had bronchoscopy and bronchoalveolar lavage3days after admission, and patients in group C within2days after admission. BALF were tested immediately or preserved at-80℃refrigerator until tested.3. Detection of cytokines:Double antibody sandwich enzyme linked immunosorbent assay (ELISA) was used to detect IL-1β IL-2、IL-4、IL-6、IL-8、 IL-10、IL-12、IFN-y and TNF-a levels in BALF.4. Data collecting:Clinical data including age, sex, clinical manifestations (including the duration of fever, cough before admission, fever and cough relief time after treatment, the total fever disappearing time and cough relief time, chest lesion absorption time etc) and laboratory examination, special examination, adverse reactions, complications, prognosis were collected. The judge of effect is according to the proportion of patients whose fever disappeared within3days after steroid therapy and the recovery situation of comprehensive index in2weeks.5. Statistical procession:All data used SPSS18software to analyse. Results of P<0.05means statistical significance.Results:1. In group A, the proportion of patients whose fever disappeared within3days after steroid therapy was9/30cases (30%), and in group B no one responded within3days after medication, showing statistically significant difference(P=0.002). The total fever time of group A was14.5±2days, group B was16.1±1.2days, with no significant difference (p=0.506). The fever time of group A after steroid therapy was4.7±1days, and group B was6.7±1days, with no significant difference (p=0.134). The total cough relief time of group A was14.4±2days, and group B was15.8±0.9days, showing no significant difference (p=0.511). The cough relief time of group A after steroid treatment was5.1±0.6days and group B was7.1±0.6days, and the difference was statistically significant (p=0.027).2. Cytokine levels in BALF:IL-1β,IL-4, IL-6, IL-8, IL-10, IL-12, IFN-γ in BALF of group A and group B were both higher than group C, with significant difference (P<0.05). The same comparison between group A and group B had no significant difference (p>0.05). Comparison of IL-2in BALF between AB, AC and BC showed no significant difference (p>0.05). TNF-a in BALF of group A and group B were both higher than group C, and comparison between group A and group C showed significant difference (P<0.05), but no significant difference was found between group B and group C (p>0.05).3. Comparison of BALF cytokine levels in A1and A2:IL-2and IL-8in BALF of group Al were significantly lower than that in group A2, showing statistically significant difference (p=0.010,0.049), but no significant difference was found between the two groups in BALF IL-1β,IL-4, IL-6, IL-10, IL-12, IFN-γ,TNF-a levels(P>0.05).Conclusions:1. Short-term intravenous rountine dose of methylprednisolone therapy is partially effective in children with RMPP.2. Incresed BALF IL-1p, IL-4, IL-6, IL-8, IL-10, IL-12, IFN-y levels were observed in RMPP.3. There might be relevance between high level of BALF IL-8and persistent fever of RMPP in children.