Objective To analyze the differences of clinical diagnosis and treatment of severe pneumonia in leukemia children and non - leukemia children,in order to improve the level of diagnosis and treatment of children with severe pneumonia and reduce mortality. Methods A retrospective study was made on the clinical data of 91 children with severe pneumonia who were admitted into the First Affiliated Hospital of Guangzhou Medical University from 2010 to 2013. According to whether leukemia existed,the children were divided into two groups:leukemia group( n = 30)and non - leukemia group( n = 61). General condition,high risk factors, clinical manifestations, complications, laboratory examination and treatment methods were observed. Results Children of leukemia group suffered from fever and shortness of breath as main symptoms,and most of the cases were absent of other symptoms and positive signs;complications were mainly stomatitis,intestinal infection,urinary tract infections,infectious shock,respiratory failure,heart failure and intracranial infection;pathogens were mainly pseudomonas aeruginosa,fungus and klebsiella pneumoniae;blood routine examination mostly revealed white blood cell count reduced,lack of granulocyte,CRP elevated;blood gas analysis and electrolyte analysis mostly revealed metabolic acidosis, respiratory acidosis,hypoxemia,hypokalemia,hyponatremia;there were 6 cases of type 1 respiratory failure and 6 cases of type 2 respiratory failure;chest imaging revealed multiple nodular high - density shadow. After treatment,20 cases were cured,and 8 cases had marked effect,with a total effective rate 93. 3% ;2 cases died,and the mortality rate was 6. 7% . Children of non -leukemia group suffered from cough, fever, shortness of breath, wheezing and had more positive signs and symptoms;complications were mainly pyothorax,septic shock,heart failure and respiratory failure;pathogens were mainly staphylococcus aureus,deputy flu bloodthirsty bacillus and mycoplasma pneumoniae;blood routine examination mostly revealed white blood cell count elevated and CRP elevated;blood gas analysis and electrolyte analysis mostly revealed metabolic acidosis,respiratory acidosis,hypoxemia,hypokalemia and hyponatremia;there were 8 cases of type 1 respiratory failure and 5 cases of type 2 respiratory failure;chest imaging revealed localized patchy consolidation shadows in single lung in most cases. After treatment, 56 cases cured,and 2 cases saw efficacy,with a total effective rate of 95. 1% ;3 cases died treatment with a mortality rate of 4. 9%. Conclusion Leukemia children and non - leukemia children are distinctly different in clinical manifestations,pathogen and treatment. Early recognition of high risk factors for the disease attack and correct treatment of infection during chemotherapy are important factors for the success of chemotherapy.%目的：分析白血病与非白血病患儿重症肺炎临床诊治差异，以提高儿童重症肺炎的诊治水平，降低病死率。方法回顾性分析2010—2013年于广州医科大学附属第一医院儿科住院的91例重症肺炎患儿的临床资料。按照是否患有白血病将患儿分为白血病组（30例）和非白血病组（61例）。观察患儿的一般情况、高危因素、临床表现、并发症、实验室检查、治疗方法。结果白血病组患儿以发热、气促为主要症状，大多缺乏其他症状及阳性体征；并发症以口腔炎、肠道感染、泌尿系感染、感染性休克、呼吸衰竭、心力衰竭、颅内感染为主；病原学以铜绿假单胞菌、真菌、肺炎克雷白菌为主；血常规检查大多数患儿白细胞计数降低，中性粒细胞减少，C 反应蛋白（CRP）水平升高；血气分析与电解质分析以代谢性酸中毒、呼吸性酸中毒、低氧血症、低钾血症、低钠血症为主，Ⅰ型呼吸衰竭及Ⅱ型呼吸衰竭各6例；胸部影像学表现为多发结节样高密度影；治愈20例，好转8例，总有效率为93.3%，死亡2例，病死率为6.7%。非白血病组患儿多有咳嗽、发热、气促、喘息表现，出现症状、阳性体征较多；并发症以脓胸、感染性休克、心力衰竭、呼吸衰竭为主；病原学以金黄色葡萄球菌、肺炎支原体、副流感嗜血杆菌为主；血常规检查大多数患儿白细胞计数升高，CRP 水平升高；血气分析与电解质分析以代谢性酸中毒、呼吸性酸中毒、低氧血症、低钾血症、低钠血症为主，Ⅰ型呼吸衰竭8例，Ⅱ型呼吸衰竭5例；胸部影像学多表现为单侧肺局部斑片状实变影；治愈56例，好转2例，总有效率为95.1%，死亡3例，病死率为4.9%。结论白血病与非白血病患儿重症肺炎临床表现、病原学、治疗有很大区别，早期认识发病的高危因素，正确处理白血病化疗时并发的感染，是化疗成功的重要因素。
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