Analysis Of Clinical Characteristics And Risk Factors Of Refractory Mycoplasma Pneumoniae Pneumonia And Necrotizing Pneumonia In Children In Suzhou

Objective:To explore the clinical characteristics of Refractory Mycoplasma Pneumoniae Pneumonia(RMPP)in children with refractory mycoplasma pneumoniae pneumonia in Suzhou and analyze its related risk factors so as to provide guidance for early clinical diagnosis of RMPP.Methods:From January 2018 to December 2018,466 children with mycoplasma pneumoniae pneumonia,(MPP)were admitted to the Respiratory Department of the affiliated Children’s Hospital of Suzhou University,of which 76 were RMPP,as the observation group and the other 390 as the control group,namely the General Mycoplasma Pneumoniae Pneumonia(GMPP)group of common mycoplasma pneumoniae pneumonia.The epidemiological characteristics,clinical features,laboratory examination,imaging findings,bronchoscopy results,MP-DNA load in bronchoalveolar lavage fluid and extrapulmonary complications were compared and analyzed between the two groups.The above clinical data were analyzed by SPSS21.0 statistical software.Results:1.General data show that there is no significant difference in gender between refractory mycoplasma pneumoniae pneumonia and common mycoplasma pneumoniae pneumonia.The age of onset of RMPP was more common in children over 3 years old in both groups,and it was significantly higher than that of GMPP group(P<0.05).2.The main clinical manifestations of MPP were fever and cough,as well as shortness of breath,stuffy nose,chest pain,wheezing and so on.The proportion of clinical shortness of breath in RMPP group was higher than that in the GMPP group,and the fever course was longer than that in the GMPP group,which was statistically significant.The incidences of extrapulmonary and extrapulmonary complications such as atelectasis,pleural effusion,liver function injury,myocardial damage and rash in RMPP group were significantly higher than those in the GMPP group(P<0.05).3.The imaging data showed that the main type of RMPP lesion was massive consolidation shadow of the lung,and the proportion of pleural effusion and atelectasis in the GMPP group was significantly higher than that in the control group(P<0.05).4.There was no significant difference in serum WBC and N%between the RMPP group and the GMPP group,but the load levels of CRP,LDH and MP-DNA were significantly higher than those in the control group(P<0.05).5.The proportion of bronchoscopic bronchoalveolar lavage and two or more times of bronchoscopic bronchoalveolar lavage in RMPP group was significantly higher than that in GMPP group,and the proportion of sputum thrombus and plastic bronchitis in RMPP group was also higher than that in RMPP group(P<0.05).6.6.Univariate analysis and multivariate Logistic regression analysis showed that fever duration ≥ 7 days,shortness of breath,large consolidation of lung,pleural effusion,atelectasis and CRP>22mg/Lwere clinically related risk factors of refractory mycoplasma pneumoniae pneumonia in children.They have certain guiding significance in early diagnosis and identification of RMPP(P<0.05).Conclusion:1.Children with RMPP in Suzhou are not uncommon,especially in school-age children.The clinical symptoms of children with RMPP are more severe,the duration of fever(usually≥ 7 days)and hospital stay are longer,the imaging findings are more severe,and the incidence of intrapulmonary and extrapulmonary complications and the proportion of bronchoscopic lavage are higher.2.The levels of serum CRP,LDH and MP-DNA load in RMPP group were significantly higher than those in GMPP group.3.When the fever course≥ 7 days,obvious shortness of breath,large consolidation shadow,pleural effusion,atelectasis and CRP>22mg/L in children with MPP,we should pay attention to the possibility of RMPP.Objective:To compare and analyze the clinical characteristics and prognosis of Mycoplasma Pneumoniae Necrotizing Pneumonia(MPNP)and non-Mycoplasma Pneumoniae Necrotizing Pneumonia(N-MPNP),and to identify the possible pathogens of NP in order to standardize the treatment in time,reduce complications and improve the prognosis.Methods:The clinical characteristics and prognosis of 31 children with NP diagnosed in the affiliated Children’s Hospital of Suzhou University from January 1,2013 to January 3 1,2020 were retrospectively analyzed.11 cases of MPNP were included in the observation group,and the other 20 cases were taken as the control group.The general data,clinical features,laboratory examination,etiological results,imaging findings,bronchoscopy,lavage fluid etiological examination,closed thoracic drainage,drug treatment and outcome of the two groups were compared and analyzed.The above clinical data were analyzed by SPSS21.0 statistical software.Results:1.All the 31 children enrolled in the group were healthy in the past,including 5 boys and 6 girls in 11 cases of MPNP and 6 boys and 14 girls in 20 cases of non-MPNP.There was no significant difference in sex composition ratio between the two groups.In terms of age distribution,the median age of 5 years old in MPNP group was higher than that of non-MPNP median age 3.5 years,but there was no significant difference between the two groups(P>0.05).2.According to the clinical features,all the children with NP had fever,cough and poor spirit.The total days of fever in the MPNP group was 13(10-15)days,which was longer than that in the non-MPNP group 11.5(7.3-30)days,but there was no significant difference between the MPNP group and the non-MPNP group(Z=-0.166,P=0.868).However,there were 14 cases of shortness of breath in the non-MPNP group,which was significantly higher than that in the MPNP group(P=0.02).In addition,there was no significant difference in pulmonary rale and extrapulmonary manifestations between the two groups(P>0.05).3.Lactate dehydrogenase(LDH)in all the children with MPNP was higher than the normal value,and the median value was 805.0(423.7-1029.5)U/L,which was significantly higher than that in the non-MPNP group 414.0(299.9-540.6)U/L(Z=-2.518,P=0.012).In addition,the peripheral blood WBC count in the non-MPNP group was 17.8(11.1-21.7)×109/L,significantly higher than that in the MPNP group 10.2(6.3-14.1)×109/L(P=0.043),and the median of inflammatory indexes such as N%,CRP,PCT,Fib,DD and ESR were significantly higher than the normal value,but P>0.05.4.Chest imaging examination showed that the time of necrotic lesions in the MPNP group was significantly later than that in the non-MPNP group[20.9±6.9(d)vs.16.8±6.1(d),t=3.101,P=0.004].In addition,the incidence of pleural effusion in the non-MPNP group 19 cases of children(95%)was significantly higher than that in the MPNP group(54.55%).(P=0.013).5.All the children with NP were treated with antimicrobials.After treatment,except for 2 cases(non-MPNP)whose family members gave up treatment and died,the other 29 cases were improved and discharged from the hospital.25 cases of NP were treated with fiberoptic bronchoscopic bronchoalveolar lavage because of persistent non-absorption of pulmonary consolidation,and the proportion of bronchoalveolar lavage was similar between the two groups.However,the proportion of repeated bronchoalveolar lavage in the MPNP group(54.55%)was higher than that in the non-MPNP group(30%).Among them,2 cases were treated with bronchoscopic lavage at most 4 times,and plastic bronchitis was found in 3 cases in the MPNP group and 0 case in the non-MPNP group(P=0.037).However,the rate of oxygen inhalation in the non-MPNP group(55%)was higher than that in the MPNP group(18.18%),but there was no statistical difference.In addition,the hospital stay of 18(10-22)days in MPNP group was shorter than that in non-MPNP group(13.5-47)days(P>0.05).6.Among the 31 cases of NP,12 cases(41.38%)lost follow-up and 17 cases(58.62%)were followed up for a long time,including 9 cases in MPNP group and 8 cases in non-MPNP group.Among the follow-up children,there were 5 cases with complete imaging recovery within 1 month after discharge,including 4 cases in MPNP group and 1 case in non-MPNP group,3 cases in MPNP group and 2 cases in non-MPNP group within 3 months after discharge,2 cases in 3-6 months after discharge,1 case in each group.The other 7 cases were followed up for more than half a year and had sequelae,including 3 cases in MPNP group and 4 cases in non-MPNP group,the main sequelae were pleural thickening,pulmonary fibrosis and bronchiectasis,there was no difference between the two groups.In addition,no pneumonectomy was performed in all children with NP.Conclusion:1.MP infection was the most common in children with NP in Suzhou.There was no difference in sex and age between MPNP and non-MPNP,but bacterial infection was dominant in non-MPNP children.2.Non-MPNP children have more severe clinical symptoms,more prone to shortness of breath,longer hospital stay,and earlier necrotic manifestations in imaging,while children with MPNP are more likely to be associated with plastic bronchitis.The levels of WBC and LDH and the occurrence of pleural effusion can be used to distinguish MPNP from non-MPNP to some extent.The prognosis of children with 3.MPNP was better than that of non-MPNP,and there was no death.The most common sequelae were pleural thickening,pulmonary fibrosis and bronchiectasis.Compared with non-MPNP,the recovery time of MPNP lung imaging is shorter.