Risk Factors Analysis And Follow-up Study On Prolonged Recovery Of Imaging In Children With Lobar Pneumonia Caused By Mycoplasma Pneumoniae

Objective: To explore the relevant risk factors of prolonged imaging recovery in children with lobar pneumonia caused by Mycoplasma pneumoniae,providing clinical basis for early treatment of Mycoplasma pneumoniae pneumonia.Methods: 339 children with lobar pneumonia caused by Mycoplasma pneumoniae were collected from the pediatrics department of Fuyang People’s Hospital from January 1,2021 to June 30,2022.After discharge,they were regularly followed up in the outpatient department and We Chat platform for more than 8 weeks.According to whether the pulmonary imaging examination(chest radiograph or chest CT plain scan)returned to normal within 8 weeks,they were divided into the delayed recovery group(observation group)of 69 cases and the general recovery group(control group)of 270 cases.The clinical characteristics of the two groups of children were analyzed retrospectively.The general data included age,sex,onset season,heat duration,heat peak,hospital stay,and the time of bronchoscopic alveolar lavage;Laboratory tests included white blood cell count,percentage of neutrophils,percentage of lymphocytes,lactate dehydrogenase,alkaline phosphatase,C-reactive protein,D-dimer,immunoglobulin A,immunoglobulin M,and immunoglobulin G;Other conditions include whether there is a large amount of pleural effusion,whether there is atelectasis,whether there are multiple lung lobes,the time of glucocorticoid use,and whether there is a mucous plug.The children in the observation group and control group were all treated with macrolide antibiotics,glucocorticoids and bronchoscopic alveolar lavage.The discharge criteria were unified as clinical symptoms relieved,lung rales disappeared and body temperature was normal for at least 3 consecutive days after regular treatment.The possible influencing factors of delayed recovery of imaging of lobar pneumonia caused by Mycoplasma pneumoniae were first analyzed by single factor analysis to obtain the risk factors of delayed recovery,and the factors with statistical significance were analyzed by multifactor logistic regression analysis to summarize the high-risk factors of lobar pneumonia caused by Mycoplasma pneumoniae in children,and then the best cutoff value was obtained by analyzing the relevant factors with the ROC curve,Summarize the early prediction indexes of its imaging delayed recovery.Results: Univariate analysis between the observation group and the control group showed that there was no significant difference in sex,age,heat peak,onset season,white blood cell count,percentage of neutrophils,percentage of lymphocytes,alkaline phosphatase,immunoglobulin A,immunoglobulin M,and immunoglobulin G(P>0.05).The children in the observation group were involved in ≥ 2 pulmonary lobes during the heat course,hospital stay,CRP,LDH,D-dimer,pulmonary lesions,and a large amount of pleural effusion The bronchoscopic alveolar lavage time and the formation of mucus thrombus were higher than those in the control group,which was statistically significant(P<0.05).Further multivariate logistic regression analysis showed that the hospitalization time,CRP,LDH,pulmonary imaging manifestations of ≥ 2 pulmonary lobes involved in pulmonary lesions,and the combination of a large amount of pleural effusion were independent risk factors for delayed imaging recovery of lobar pneumonia caused by Mycoplasma pneumoniae.The critical values of ROC curve were hospitalization time ≥ 10.5 days [AUC=0.835,95%CI 0.773～0.898],CRP ≥ 25.92 mg/L[AUC=0.944,95%CI 0.872～0.963],LDH ≥ 378 U/L [AUC=0.917,95%CI0.912～0.976].Conclusion:1.Hospitalization time,CRP,LDH,involvement of lung lesions in ≥ 2 lobes,and concomitant large amounts of pleural effusion are risk factors for prolonged imaging recovery of childhood lobar pneumonia caused by Mycoplasma pneumoniae.The ROC curve analysis showed the highest predictive efficiency of CRP,with an optimal cutoff value of 25.92 mg/L.2.Based on the results of this study,it is recommended that in the diagnosis and treatment of children with lobar pneumonia caused by Mycoplasma pneumoniae,if the above risk factors exist,it is highly suggestive that the imaging recovery of the child is slow.It is necessary to closely follow up such children,strengthen patient management after discharge,and avoid irreversible sequelae such as bronchiectasis,necrotizing pneumonia,and occlusive bronchiolitis.