关键词: 难治性肺炎支原体肺炎, 甲泼尼龙, 肺泡灌洗, sB7-H3, IL-1β, IL-2

Abstract:

AIM: To explore the efficacy and safety of fiberoptic bronchoscopy combined with methylprednisolone in children with refractory mycoplasma pneumoniae pneumonia (RMPP) and the role of sB7-H3 in RMPP.  METHODS: Seventy cases of RMPP (from July 2015 to October 2017) in our hospital were divided into bronchoscope group (n=35) and combined treatment group (n=35) according to random number table method. The bronchoscope group accepted the conventional treatment for three days, and then accepted the treatment of fiberoptic bronchoscopy for alveolar lavage. The combined treatment group accepted the conventional treatment and methylprednisolone for three days, and then accepted the fiberoptic bronchoscopy for alveolar lavage. And 35 patients with bronchoscopy due to foreign bodies in the same period were chosen as normal control group. After the treatment for 4 weeks, the total effective rates, disappearance time of cough, disappearance of fever, disappearance of rales, normal time of chest radiograph, complications and adverse reactions were observed. And the levels of sB7-H3 and other inflammatory factors in bronchoalveolar lavage fluid of two groups and normal control were observed. The relationship between sB7-H3 and inflammatory factors in RMPP patients were analyzed. RESULTS:After the treatment for four weeks, the total effective rate of combined treatment group (97.1%) was much higher than that of bronchoscope group (82.9%), which was significantly different (P<0.05). The disappearance time of cough, fever, rales, normal time of chest radiograph in combined treatment group were much shorter than these in bronchoscope group (P<0.05). The levels of sB7-H3, IL-1β, IL-2, IL-6 and INF-γ in RMPP patients were much higher than those of normal control group (P<0.05). And the levels of sB7-H3, IL-1β and IL-2 in combined treatment group were much lower than those in bronchoscope group (P<0.05). Among the RMPP patients, there were positive correlations between sB7-H3 with IL-1β (r=0.815, P<0.001) and IL-2 (r=0.629, P<0.001), while there were no correlations between sB7-H3 with IL-6 (r=0.295, P=0.165) and INF-γ (r=0.189, P=0.148). There were no serious complications and adverse drug reactions in both groups. CONCLUSION: The effect of fiberoptic bronchoscopy combined with methylprednisolone in RMPP children is significant; it can significantly shorten the course of the disease. Furthermore, the levels of sB7-H3, IL-1β, IL-2, IL-6 and INF-γ in RMPP children were significantly increased, and the combined treatment may reduce the levels of sB7-H3, IL-1β and IL-2. In addition, sB7-H3 may be involved in the release of IL-1β and IL-2, thereby promoting the occurrence of RMPP.

Key words: refractory mycoplasma pneumoniae pneumonia, methylprednisolone, alveolar lavage, sB7-H3, IL-1β, IL-2