| Objective:By analyzing the pathogen spectrum,local and systemic inflammatory cells of recent childhood lobar pneumonia,combined with clinical characteristics,the pathogenic trend,systemic and local immune status were revealed,and the basis for individualized immune regulation was provided.Methods:A retrospective study was conducted on the clinical manifestations,pulmonary alveolar lavage fluid and peripheral blood laboratory examinations and imaging characteristics of 153 children with lobar pneumonia aged 0～18 years who were admitted to Qilu Hospital of Shandong University from June 2021 to December 2021.According to the metagenomic next-generation sequencing(mNGS)test results of bronchoalveolar lavage fluid,the patients with pure Mycoplasma pneumoniae(MP)infection were determined as the simple infection group;the patients with mixed infection of Streptococcus pneumoniae(SP)and MP were determined as the mixed infection group.Results:The mean onset age of 153 children with lobar pneumonia was 6.48 years,and the main onset age was 3-14 years.MP was detected in the bronchoalveolar lavage fluid of 133 cases(86.9%),of which 52 cases(39.1%)were infected with MP alone,and 26 cases(19.5%)were infected with MP and SP.The clinical manifestations were mainly cough and fever,and a few children had wheezing.The difference of febrile peak between the two groups was statistically significant(t=-2.266,P=0.026),and the febrile peak in the mixed infection group was higher than that in the simple infection group.There was no significant difference in febrile duration(Z=-1.022,P=0.307).There were no significant differences in leukocytes,lymphocytes,C-reactive protein,lactate dehydrogenase,D-dimer,IgE and ESR between the two groups(Z=-1.272,P=0.203;Z=0.901,P=0.368;Z=1.230,P=0.219;Z=0.879,P=0.379;Z=0.431,P=0.666;Z=0.235,P=0.814;Z=-1.802,P=0.071),and there were statistically significant differences in neutrophils and neutrophil to lymphocyte ratio between the two groups(Z=-2.411,P=0.016;Z=-2.025,P=0.043),neutrophils and neutrophil to lymphocyte ratio in the simple infection group were higher than those in the mixed infection group.The leukocytes of the cases before the onset of 8 days in both groups were lower than that of the cases after 8 days,and the difference was statistically significant(Z=-2.399,P=0.016;Z=2.109,P=0.035).Imaging examinations showed that involvement of the right lung was common,and some had intrapulmonary complications such as pleural effusion.Bronchoscopy was mainly manifested as airway mucosal congestion and swelling,and thick secretions.Plastic secretions were mainly seen in cases where MP infection was detected.The bronchoalveolar lavage fluid was dominated by neutrophils,and the proportion of neutrophils and macrophages in the bronchoalveolar lavage fluid of the two groups was not statistically significant(t=-0.083,P=0.934;t=0.400,P=0.691).In the mixed infection group,the neutrophils before the onset of 8 days were higher than that of the cases after 8 days,and the macrophages were lower than those of the cases after 8 days(t=2.707,P=0.025;t=-6.087,P<0.001).There were 72 cases of all children with extrapulmonary manifestations,and there was no significant difference in extrapulmonary manifestations between the two groups(χ2=0.975,P=0.323).Conclusion:1.In the second half of 2021,the pathogen of lobar pneumonia in children in Shandong area was mainly MP,followed by SP;2.Co-infection of lobar pneumonia was more common,MP and SP are prone to co-infection;3.The application of mNGS detection in bronchoalveolar lavage fluid for patients with poor treatment effect can effectively detect mixed infection pathogens and provide a basis for treatment;4.Both simple MP infection and MP and SP mixed infection showed stronger systemic inflammatory response after 8 days,and the systemic inflammatory response of simple infection was stronger than that of mixed infection.5.The local inflammatory response was dominated by neutrophils with the participation of macrophages.The local neutrophils had the strongest inflammatory response within 8 days of mixed infection. |
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