| Objective:By retrospective analysis refractory Mycoplasma pneumoniae pneumonia in children with clinical data, collect relevant clinical and laboratory parameters, compare the difference between hormone-sensitive and non-sensitive to preliminary discussion the independent risk factors and Clinical features of hormone insensitivity.The study is aimed to provide a basis for RMPP.Methods:Subjects are patients who are in accordance with the diagnostic criteria RMPP and exclusion criteria of the study and received intravenous methylprednisolone in the dose of 2mg/Kg.d from January 2012 to December 2014.All of them are hospitalized in the Department of Respiratory in the Children’s Hospital of Suzhou University. According RMPP children react to 2mg / kg.d methylprednisolone therapy, the patients were grouped into ―sensitive group‖(With hormone after 72 hours decreased peak heat or fever interval extension)and ―insensitive group‖(With hormone after 72 hours no significant decline in the peak heat(<1 ℃), no interval prolonged fever). Clinical symptoms,signs,laboratory examination(including blood routine test,CRP, LDH,blood biochemistry, cellular and humoral immunity etc.),the number of bronchoscopy,radiological manifestations,treatment effect and prognosis of these patients were observed.Results:1.1Collected 183 cases of RMPP, including 147 cases of hormone-sensitive group, 78 males and 69 females; hormone-insensitive group of 36 patients, 17 males and 19 females.The sex ratio has no statistically significant of the two groups(χ2 = 0.40, P> 0.05). 2Hormone-sensitive group, the average age of 6.11 ± 2.59 years, hormone-insensitive group 6.58 ± 2.63 years, the age of the two groups showed no significant difference(t = 0.99,P>0.05). 3 Hormone-insensitive group hospitalized 13 days(6-24) days, significantly longer than the hormone-sensitive group 9(5-20) days, the two groups were statistically significant difference(Z =-6.68, P <0.01)2. 1 Patients in hormone-insensitive group had a significantly higher ratio of tachypnea(41.7%VS3.4%,χ2=39.65) and rales(83.3%VS53.7%,χ2=10.51) than those in hormone-sensitive group, there are significant differences between the two groups(P<0.01)2Total fever days of patients in hormone-insensitive group was 12(9~21)days,the hormone-sensitive group was 8(5~16)days,the hormone-insensitive group was longer than that in hormone-sensitive group, there are significant differences between the two groups(P<0.01,Z=‐7.84); 3hormone-sensitive groups mainly with high fever(55.8%), hormone-Insensitive groups mainly with excessive heat(72.2%), patients in hormone-Insensitive group had a significantly higher ratio of excessive heat than those in hormone-sensitive group, there are significant differences between the two groups(P<0.01,χ2=14.61).3. 1 WBC count(8.61±3.65×109/LVS7.44±2.76×109/L, t=-2.13), nertrophil(74.80±10.11% VS64.04±11.33%,t=-5.21),LDH(674.13±324.54 U/L VS423.59±135.05 U/L,t=-7.19),CRP(73.80±49.04mg/LVS25.30±28.33mg/L,t=-7.82) in hormone-insensitive group rised apparently compared to those in hormone-sensitive group,with statistical difference between the two groups(p<0.05).And the lymphocyte percentage(18.23±8.33% VS26.74±9.75%,t=4.83) decreased apparently.2 Hormone-insensitive group compared to the hormone-sensitive group, the CD3+(58.31±10.00VS65.17±8.94,t=-3.96), CD3+CD4+(31.23±9.74VS35.13±7.38,t=-2.62)was significantly lower,but CD3-CD19+(25.40±9.46 VS20.01±7.46,t=3.62)、CD19+CD23+(8.19±4.19 VS6.69±3.73,t=2.07) was significantly higher, with statistical difference between the two groups(p<0.01).4. 1Patients in hormone-insensitive group had a higher ratio of pleural effusion(47.2%vs 19.0%), especially medium to large pleural effusion(12.2%VS3.3%), than those in hormone-sensitive group, with statistical difference between the two groups(χ2=12.38,p<0.05). 2The proportion of skin lesions in hormone-insensitive group was higher than the hormone-sensitive group, with statistical difference between the two groups(χ2=16.82,p<0.01). 3The ratio of chest radiographs without significant absorption in hormone-insensitive group is higher than the hormone-sensitive group, there are significant statistical differences between the two groups(χ2=71.70,P<0.01).5. Patients who needed lavage under bronchofibroscope in hormone-insensitive group(2(1-5)) were significantly higher than hormone-sensitive group(1(1~3)), there are significant statistical differences between the two groups(Z=-6.41,P<0.01).6. Hormone-insensitive group compared to the hormone-sensitive group, Its combination with one non-macrolide antibiotics(II or III generation cephalosporins generations) treatment(11.33 ± 3.01 day VS8.37 ± 2.51 day, t = 6.02) long,Total hormone treatment(12.33±3.56VS7.25±1.78,t=12.20)long,there are statistical differences between the two groups(P<0.01).The hormone-Insensitive group, 21(58.3%) cases of patients’ body temperature decreased gradually in the first 4 to 5 days,15(41.7%) patients with 3 days to 4mg/kg.d, 7 cases in 24 ~ 48 h peak heat gradually decreases and progression-free, 7 cases within 48 h no downward trend, and gamma globulin(400mg/ kg.d, once every two days) after the body temperature within 24 ~ 48 h gradually stable, One case of 4mg/kg.d methylprednisolone treatment for 3 days to 6mg/kg.d, body temperature also within 24 h waning.7. Select indicators which were significantly different by univariate analysis(P <0.05), total fever days, fever type,pleural effusion, skin lesions, WBC、N%、L%、PLT、LDH、CRP、CD3+、CD3+CD4+、CD3-CD19+、CD19+CD23+,and than use multivariate logistic regression analysis, The results suggest that when the thermal process ≥11d, L% ≤32%, CRP≥48.73mg/L, LDH≥545.7U/L, suggesting that hormone-insensitive RMPP risk factors.Conclusions:1.The hormone-insensitivity group had more severe clinical manifestations than the hormone-sensitivity group.2. When RMPP patients with thermal process ≥11d, L% ≤32%, CRP≥48.73mg/L, LDH≥545.7U /L, prompt risk factors of hormone-insensitive RMPP.3. For children with hormone-insensitive RMPP, increase the steroid dose, prolonged therapy or in combination with gamma globulin treatment effective. |
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