Therapeutic effect of low molecular weight heparin on adjuvant treatment of Mycoplasma pneumoniae pneu- monia with elevated D-dimer in children
10.3760/cma.j.issn.2095-428X.2018.16.010
- VernacularTitle:低分子肝素辅助治疗D-二聚体升高的肺炎支原体肺炎患儿疗效
- Author:
Shanshan TAN
1
;
Ling CAO
Author Information
1. 100020,首都儿科研究所附属儿童医院呼吸内科
- Keywords:
D-dimer;
Low molecular weight heparin;
Mycoplasma pneumonia
- From:
Chinese Journal of Applied Clinical Pediatrics
2018;33(16):1242-1245
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the therapeutic effect of low molecular weight heparin on adjuvant treat-ment of Mycoplasma pneumoniae pneumonia (MPP)with elevated D-dimer in children,and to summarize the clinical features of MPP with elevated D-dimer in children. Methods Ninety-three cases of MPP with elevated D-dimer in the Affiliated Children′s Hospital of Capital Institute of Pediatrics from January 2015 to October 2016 were randomly di-vided into the high dose group,the low dose group and the non-heparin group. All patients in 3 groups were given ac-tive anti-infection and other conventional treatment. High dose group was given subcutaneous injection of low molecu-lar weight heparin 100 IU/ kg,q12h,treatment for 5 days or D-dimer returned to normal;Low dose group was given subcutaneous injection of low molecular weight heparin 50 IU/ kg,q12h for 5 days,and then D-dimer returned to nor-mal;non-heparin group was given anti-infection and other conventional treatment. Contrast observation was performed among 3 groups for clinical symptoms and chest imaging changes before and after treatment. Also,the hospitalization days and financial costs among 3 groups were compared and the adverse reactions were observed. Another 31 patients of MPP with normal D-dimer were randomly selected for comparison with non-heparin group,including C-reactive protein(CRP),erythrocyte sedimentation rate(ESR)and other inflammatory markers,clinical symptoms,chest imaging changes,hospitalization days and the costs. Results (1)The inflammatory indicators such as CRP [(33. 49 ± 31. 75)g/ L],ESR [(34. 59 ± 16. 25)mm/ 1h],cough improvement time [(7. 77 ± 2. 85)d],heat back time [(5. 87 ± 2. 88)d],hospitalization days[(10. 87 ± 3. 50)d],hospital costs[(15455. 91 ± 4086. 95)yuan],and chest imaging severity[the ratio of large-area shadowing to small-area shadowing in terms of chest image severity was (13 / 16 cases)]of MPP with elevated D-dimer group were higher than those of MPP with normal D-dimer group [(14. 83 ± 18. 97)g/ L,(25. 33 ± 20. 35)mm/ 1 h,(3. 90 ± 1. 08)d,(2. 81 ± 1. 99)d,(5. 26 ± 1. 84)d, (7659. 85 ± 2216. 69)yuan,5 / 23 cases],and the differences were statistically significant(Z =-2. 99,- 2. 06,- 5. 82,- 5. 21,- 6. 20,t = 12. 73,χ2 = 4. 80,all P < 0. 05). (2)The time of improvement of cough,chest imaging im-provement time and the hospitalization days in the heparin-treated group[those in the low dose heparin group were (5. 48 ± 1. 95)d,(13. 84 ± 9. 18)d,(9. 19 ± 5. 10)d,and those in the high dose heparin group were(5. 35 ± 1. 91)d,(12. 88 ± 10. 81)d,(8. 58 ± 2. 81)d]were lower than those in the non-heparin group[(7. 77 ± 2. 85)d, (18. 54 ± 10. 13)d,(10. 87 ± 3. 50)d],and the differences were statistically significant(all P < 0. 05),but no signi-ficant difference was found in different doses of heparin (all P > 0. 05). D-dimer and fibrinogen degradation product (FDP)after treatment in the high dose heparin-treated group [(258. 00 ± 516. 00)ng/ L,(2. 25 ± 7. 45)mg/ L] were significantly lower than those in the non-heparin group[(1. 00 ± 691. 00)ng/ L,(0. 70 ± 3. 10)mg/ L],and the diffe-rences were statistically significant(Z = 6. 41,6. 54,all P < 0. 05). Conclusions (1)Compared with the children with MPP with elevated D-dimer,MPP children with normal D-dimer in children have more severe clinical symp-toms,higher inflammatory indicators and more serious chest imaging performance. (2)Low molecular weight heparin on adjuvant treatment of elevated D-dimer children with MPP can significantly improve the clinical symptoms and pro-mote absorption of lung disease,shorten hospitalization days,reduce hospital costs. There is no adverse reaction with short-term application. It is worthy of further promotion.
