Risk Factors Analysis And Prognosis Of Childhood Mycoplasma Pneumoniae Pneumonia Blocked With Secretions From Respiratory Tract

Objective:Objective to investigate the clinical risk factors and prognosis of Mycoplasma pneumoniae pneumonia in children blocked with secretions from respiratory tract.Methods:Retrospective analysis was executed on the clinical data of 130 children,who diagnosed mycoplasma pneumoniae pneumonia and treated with fiberoptic bronchoscopy in our hospital pediatric department between September 2016 to January 2017.The patients were divided into the airway blocked group and the control group according the performance of flexible bronchoscopy.The clinical manifestations,laboratory examination,radiological features,bronchofibroscopic findings and the outcome were compared between the two groups.The multiple logistic regression analysis and ROC curve were used to identify the critical value of independent risk factors of the MPP blocked with glutinosity secretions from airway.Results:1.Gender and age:There was no significant difference in gender and age between the two groups(P>0.05),Most children were over 6 years old.2.Clinical symptoms and signs:Compared with the control group,the fever peak[39.8(39.5,40.0)vs 39.5(39.0,39.8),P<0.05],the febrile time(11.3±3.1 vs 7.8±2.4,P<0.05),the proportion of diminished breath sounds(80.0% vs 41.4%,P<0.05),the proportion of percussion dullness or solid sound(56.7% vs 14.3%,P<0.05)were higher in the blocked group.3.Laboratory examination:The white blood cells count(WBC,109/L),the percentage of neutrophils(NE%),C-reactive protein(CRP,mg/L),lactic dehydrogenase(LDH,U/L),D-dimer levels in the blocked group were significantly higher than those in the control group [WBC(9.4 ± 3.7 vs 8.2 ± 2.9,P<0.05),NE%(69.8 ± 11.2 vs 62.3 ± 11.9,P<0.05),CRP(mg/L)[48.2(19.8,91.0)vs12.4(7.1,25.4),P<0.05],LDH(U/L)[466.5(371.5,639.0)vs323.0(273.2,376.8),P<0.05],D-dimer(ug/L)[1002.0(577.50,2042.0)vs 352.5(198.5,573.8),P<0.05].4.Imaging features:It was seen that chest X-ray scan indicated high density.The blocked group which combined with pleural effusion and atelectasis,involved lobes more than 2 were higher than the control group.there were 10% patients with pulmonary necrosis in the blocked group.however the control group had no patients with pulmonary necrosis.5.Characteristics of fiberoptic bronchoscopy and Sputum embolism pathology:It was seen that bronchiole secretions blocked the respiratory tract in the blocked group.The right upper lung and lower left lung were the main blocked sites.There were 3 cases of them with dendritic sputum embolism,5 cases of them with bronchial obliterans.It was seen flocculent secretions in the control group,no patients with bronchial obliterans.The pathology of sputum embolism were inflammatory necrosis tissue,and it can be found that there were infiltration of cellulose,neutrophils and lymphocytes.6.Treatment and outcome:Compared with the control group,the hospitalization time(13.5±3.8 vs 8.5±3.2,P<0.05)were higher in the blocked group.The temperature of 44 cases(33.8%)returned to normal of all patients after the first bronchoalveolar lavage,22 cases in the blocked group,22 cases in the control group.All children were discharged.120 patients were followed up effectively one months after discharged.Compaired with the control group,the rate of inflammation absorption completely were lower in the blocked group(84.4% vs 53.6%,P<0.05).7.All children were refractory Mycoplasma pneumoniae pneumonia(RMPP)in the blocked group,There were 67.1% children were RMPP in the control group.The multiple logistic regression analysis showed that,the febrile time,CRP,and LDH were independent predictors of the MPP blocked with glutinosity secretions from bronchioles.The receiver operating characteristic curve analysis showed that the cut-off values of the 3 predictors were 9.5d,30.35mg/L,343.5U/L,respectively.Conclusion:1.Compared with the control group,the fever peak,febrile time,hospitalization time,percentage of WBC,neutrophils,CRP,LDH,D-dimer level,the proportion of complicated with diminished breath sounds,percussion dullness or solid sound,pleural effusion and atelectasis,involved with two or more than two lobes significantly higher in the blocked group.And All patients were refractory Mycoplasma pneumoniae pneumonia in the blocked group.2.The febrile time≥9.5d,CRP≥30.35mg/L,LDH≥343.5U/L were independent predictors of the MPP blocked with secretions from airway,which can be used as indicators of prediction.3.Mycoplasma pneumoniae pneumonia in children blocked with secretions from airway had severe lung inflammation and lower inflammation absorption rate.Compared with the control group,The possibility of pulmonary necrosis and bronchial obliterans were higher in the blocked group.These patients should be treated with fiberoptic bronchoscopy timely.