Therapeutic effect of low molecular weight heparin on adjuvant treatment of Mycoplasma pneumoniae pneumonia with elevated D-dimer in children

Objective To investigate the therapeutic effect of low molecular weight heparin on adjuvant treatment 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 divided into the high dose group, the low dose group and the non-heparin group.All patients in 3 groups were given active anti-infection and other conventional treatment.High dose group was given subcutaneous injection of low molecular 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 normal; 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[(15 455.91±4 086.95) 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, (7 659.85±2 216.69) 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). 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 symptoms, 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 promote 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. Key words: D-dimer; Low molecular weight heparin; Mycoplasma pneumonia