儿童结核病的流行状况及其诊断中的有关问题.ppt

J Infect Chemother. 2015 Mar;21(3):153-60. doi: 10.1016/j.jiac. Setting a standard for the initiation of steroid therapy in refractory or severe Mycoplasma pneumoniae pneumonia in adolescents and adults. we calculated serum LDH cut-off levels of 364 IU/L at initiation of steroid therapy and 302 IU/L at 1-3 days before the initiation of steroid therapy A serum LDH level of 302-364 IU/L seems to be an appropriate criterion for the initiation of steroid therapy Role of Prednisolone Treatment in Severe Mycoplasma pneumoniae Pneumonia in Children Pediatric Pulmonology 41:263–268 (2006) Methylprednisolone pulse therapy for refractory Mycoplasma pneumoniae pneumonia in children METHODS: Refractory patients were defined as cases showing clinical and radiological deterioration despite appropriate antibiotic therapy for 7 days or more. We initiated intravenous methylprednisolone at a dose of 30 mg/kg on 10.2+/-2.8 clinical days and administered it once daily for 3 consecutive days. Fever subsided 4-14 h after initiation of steroid pulse therapy in all patients. This dramatic effect was accompanied by rapid improvement of radiological abnormalities including infiltrates and pleural effusion, followed by improvement of laboratory abnormalities. 激 素 有以上指征 激 素 甲强：2mg/kg.d, 一般3天，减量, 视病情而定疗程。韩国和日本已应用,剂量不同。 剂量因病情而定 改善预后: 长期预后为主要指标 激素剂量参考 当CRP≥110mg/L，SF≥330ng/ml，LDH≥478IU/L， Neu%≥78%， 整叶高密度实变 提示2mg/kg.d甲强治疗可能无效 激素评价 短期效应无疑 减少支气管闭塞有一定疗效 避免坏死作用不肯定，对避免后遗症的评价待研究 支气管镜灌洗 肺高密度实变阴影并肺不张 肺间质病变,以气道损伤为主 7-10天进行，减少闭塞，减少肺不张 抗凝治疗 D-二聚体升高 肺部病变有栓塞征象 肝素抗凝治疗 病例 主诉 患儿，男，5岁。因“发热、咳嗽9天”入院。 查血常规：白细胞 10.75×109/L，中性 80.2％，CRP 200mg/L，血白蛋白 18.8g/L，ALT 229.2IU/L，CK-MB 96IU/L，胸片提示两肺广泛大片致密影，右上肺著，双肺胸腔积液（右侧著） 病例 甲泼尼龙（5-10mg/kg.d，实予6mg/kg.d连用3天，之后改为2mg/kg.d 并根据病情变化渐减量） MPP发热持续10d以上、CRP大于40 mg/L、肺部高密度均匀一致实变阴影(超过单侧肺叶2/3，CT值大于40HU，伴或不伴有胸腔积液)，可视为RMPP Young等发现MRMP其血清CRP水平及鼻咽吸出物中IL-18水平显著升高，并认为CRP可用于预测MRMP感染者对大环内酯类抗