Analysis Of Relative Factors For Complicated Parapneumonic Effusion In Children

Objective: Community-acquired pneumonia(CAP)often occurs in children.As in Europe and North America,the prevalence of CAP in children under the age of five can reach 4%,of pneumonia in the proportion of hospitalized children because of CAP even reached 20% in some areas.More than 53% of CAP in the hospitalized children may be complicated with pulmonary complications such as pleural effusion,empyema,necrosis and lung abscess.It is defined as parapneumonic pleural effusion(PPE)caused by exudative pneumonia,lung abscess and atelectasis.In general,children with uncomplicated parapneumonic pleural effusion(UPPE)can be cured with regular and appropriate antibiotic treatment,while intervening measures,including pleural biopsy,pleural closed drainage or surgical intervention,are necessary for 10% of children with complicated parapneumonic pleural effusion(CPPE).The occurring of complicated parapneumonic pleural effusion not only result in the increasing of sick children’s pain,the rising of mortality rates,but also increasing the economic burden of sick children’s family.Therefore,early detection of complicated parapneumonic pleural effusion is important for taking timely and appropriate effective measures to solve those problems above.It’s our purpose to explore the relative factors of complicated parapneumonic effusion in children to get early diagnosis,guide clinical therapy,decrease the duration in hospital and improve the prognosis of the sick children,as well as the economic burden of sick children’s family.children.Method: The clinical data of 142 children with PPE were retrospectively reviewed from Jan.2013 to Jun.2015 in Children’s Hospital of Hebei Province.According to the effect of antibiotics and related articles,two groups were divided,including CPPE group and uncomplicated parapneumonic effusion(UPPE)group.The comparison was made between two groups in gender,age,course of the disease and fever before admitting in hospital,related information of the effusion detected by ultrasound(including the depth,loculation,thin and location),related information in blood(including white cell count,the percentage of neutrophils,platelet and C-reactive protein),related information in serum(lactate dehydrogenase,immunoglobulin(IgA,IgG,and IgM),mycoplasma,and fibrinogen),conventional and biochemical examination of the effusion,including white cell,the percentage of polymorphonuclear cell,lactate dehydrogenase,glucose,adenosine deaminase,lactic acid,C-reactive protein and total protein.The results of pathogen were also recorded.Comparison was made between the above groups.If the result of single factor regression showed P<0.05,the indicators were analyzed by the multifactor logistic regression.Draw the receiver operator characteristic(ROC)curve to evaluate the prediction ability of logistic regression model.Results:1 The results of single factor analysis showed that there was statistically significant difference in lactate dehydrogenase,adenosine deaminase,lactic acid of the effusion between CPPE group and UPPE group(P<0.05).The indicators,including the lactate dehydrogenase,adenosine deaminase,and lactic acid in effusion,were analyzed by the multifactor logistic regression.2 According to the ROC curve,the cut-point of the percentage of adenosine deaminase and lactic acid in effusion were 93.5U/L and 4.19mmol/L respectively.3 The results of the logistic regression analysis showed that the level of adenosine deaminase and lactic acid in effusion were the relative factors of CPPE(P<0.01).4 The area under the receiver operator characteristic curve of the regression model is 0.672,P=0.001,and the regression model has above average diagnostic accuracy.5 The cost in hospital of CPPE group was higher than that of UPPE group(Z=-4.59,P<0.001).6 In terms of germiculture positive rate and cure rate in hospital,there was no statistical difference between CPPE group and UPPE group(χ2=3.25,P=0.071;χ2=0.071,P=0.790).Conclusions:1 When the level of adenoine deaminase is more than 93.5U/L and lactic acid more than 4.19mmol/L in effusion of children with PPE,it may indicate the developing of CPPE.For the existence of the above factors in children with PPE,the occurrence of inflammation in the body may be stronger or cannot be easily controlled;2 According to the cooperation degree and disease severity in children with CPPE,clinicians should take appropriate interventions,such as the chest closed drainage,repeated pleural puncture;3 Fiberopic bronchoscopy alvage is an effective wat for children with PPE complicated with lung atelectasis or inflammation in lung absorbed slowly,by removing inflammatory factors and sticky secretions in the lower respiratory tract.By improving the degree of local inflammation at the same time,sick children with PPE may have a better prognosis.Meanwhile,we can learn more about the pathogen in children with PPE.