| Objective:To invest the predictors of severe mycoplasma pneumonia,and to summarize the clinical characteristics of children with severe mycoplasma pneumonia with elevated D-Dimer and the efficacy of low molecular weight heparin(LMWH)adjuvant therapy.Methods:1.A retrospective analysis was performed on 901 children with mycoplasma pneumoniae pneumonia(MPP)who were hospitalized in the respiratory department of children's hospital affiliated to the capital institute of pediatrics from January 1,2016 to December 31,2018.Based on the standard of the severe pneumonia in the 2013 version community-acquired pneumonia in children,all children with MPP were divided into severe and non-severe groups.The general data,clinical symptoms and laboratory examination data of the two groups were analyzed by single factor analysis,and then the indexes with statistical differences between the two groups were taken as independent variables and the severity of the disease was grouped into dependent variables,Logistic regression model was used to analyze the related risk factors of severe MPP(SMPP),and ROC curve was drawn to analyze the predictive value of each risk factor.2.The SMPP group was divided into D-dimer elevation group and normal group.The clinical manifestations of the two groups were compared,and the clinical characteristics of children with D-dimer elevation were summarized.3.In this study,333 children with SMPP and D-dimer elevation were enrolled.Azithromycin and routine treatment were given after admission.In addition to above treatment,148 children were given LMWH 40-100 IU/kg,IH,ql2h for 3-7 days or until D-dimer returned to normal.Sixty-five children with LMWH and 65 children without LMWH were divided into heparin group and non-heparin group by matching method.The clinical symptoms of children with LMWH were compared and the adverse reactions of heparin group were observed.With the method of ratio,65 cases were selected from the children who received heparin and those who did not receive heparin,and they were divided into the heparin group and the non-heparin group.The clinical symptom remission of the children was compared and the adverse reactions in the heparin treatment group were observed.Results:There was no significant difference in sex,course of disease before treatment,age,fibrinogen(FIB),activated partial prothrombin time(APTT),prothrombin time(PT)and lotting time(TT)between severe and non-severe groups,while the course of illness before admission in severe group was longer(P<0.05),and the incidence of extrapulmonary complications,platelet(PLT),c-reactive protein(CRP),D-dimer and lactate dehydrogenase(LDH)were significantly higher than those in non-severe group(P<0.05).The incidence of extrapulmonary complications,PLT,CRP,D-dimer and LDH were then taken as independent variables into Logistic regression model,the results showed that were all predictors of severe MPP.The cut-off values of PLT,CRP,D-dimer and LDH were 361×109/L,291ug/L,307U/L,21.75mg/L,AUC were 0.631,0.721,0.695 and 0.638,the sensitivity was 0.691,0.691,and 0.638,and the specificity was 0.523,0.749,0.607 and 0.615,respectively.2.The incidence of intrapulmonary and extrapulmonary complications in SMPP with D-dimer elevation was higher than that in the d-dimer normal group,and the time of fever regression,cough and signs improvement was longer(P<0.05).3.There was no statistically significant difference in the fever regression time between the heparin group and the non-heparin group(P>0.05),but the cough and signs improvement time of the heparin group was shorter(P<0.05).Conclusion:PLT,CRP,D-dimer,LDH and extrapulmonary complications were predictors of SMPP.2.Children with severe mycoplasma pneumonia with elevated D-dimer have more severe clinical symptoms than those with normal D-dimer.Low molecular weight heparin can significantly improve their clinical symptoms,shorten the course of disease,and no adverse reactions are observed in short-term use. |
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