| Objective1.To observe the clinical characteristics of refractory mycoplasma pneumoniae pneumonia(RMPP)in children,to explore the difference of RMPP and general mycoplasma pneumoniae pneumonia(GMPP),improved early recognition of RMPP.2.Comparing the differences between RMPP,GMPP and the general group,which in humoral immunity and cellular immunity.This part attempts to elucidate the RMPP is connected with pathogenesi,drug-resistant gene mutation and body immunity.Methods1.A total of 140 children diagnosed with mycoplasma pneumoniae pneumonia(MPP)in the respiratory department of xi’an children’s hospital of shaanxi province from April 1,2019 to December 31,2019 were selected as the study subjects.The healthy children receiving outpatient physical examination during the same period were collected as the control group.According to the diagnostic criteria of"expert consensus on the diagnosis and treatment of mycoplasma pneumoniae pneumonia in children(2015 edition)",140 children were divided into refractory group and general group.The clinical characteristics of RMPP were analyzed by comparing the two groups of data.2.In order to explore the role of immune response in the pathogenesis of RMPP,the differences of humoral immunity and T,B and N lymphocyte immunity among the control group,GMPP and RMPP were compared,and the immunological mechanism of RMPP was searched.Results1.The fever peak of disease in the refractory group were higher than in the general group,fever course,length of hospital stay and total course of disease in the refractory group were all longer than those in the general group,and RMPP showed more rashes,wheezing and dyspnea than those in the general group,with statistically significant differences(P<0.01).2.The white blood cell count,neutrophil count and percentage of neutrophils in the refractory group were all greater than those in the general group,while the percentage of lymphocytes in the refractory group was smaller than those in the general group,showing statistically significant differences(P<0.01).At the same time,CRP,ESR,PCT and LDH were all increased in the refractory group compared with the general group,with significant statistical differences(P<0.01).The liver function damage,hypoproteinemia,myocardial damage and MP nucleic acid in alveolar lavagein refractory group were significantly increased compared with the general group,showing a statistical difference(P<0.05).There was no statistically significant difference in 23S rRNA resistance gene mutation between the two groups(P>0.05).3.Compared with the general group,the incidence of pleural effusion in the refractory group was significantly increased(P<0.05).4.Logistic linear regression showed that Fever duration,CRP,ALB,LDH and CD8~+were all statistically significant(P<0.05).When Fever duration>11.5days,or serum CRP>28.66mg/L,or serum LDH>370.50 U/L,it suggested that MPP might become RMPP.5.IgG,IgM and IgA were increased in the refractory group compared with the control group,and IgG,IgM and IgA were increased in the general group compared with the control group,showing a statistical difference(P<0.05).However,there was no statistical difference between the general group and the refractory group(P>0.05).6.T,B and NK lymphocyte counts and CD4~+/CD8~+in the refractory group were significantly lower than those in the control group,with statistical significance(P<0.01),while T,B and NK lymphocyte immunity in the general group were significantly lower than those in the control group,with statistical significance(P<0.01).The T lymphocytes and B lymphocytes in the refractory group were lower than those in the general group,with statistical significance(P<0.05).There was no significant difference in NK cells and CD4~+/CD8~+levels between the general group and the refractory group(P>0.05).Conclusions1.RMPP mainly starts from fever,with high fever peak and longer fever duration.It is more prone to asthma,dyspnea and pleural effusion,and may be associated with extrapulmonary manifestations,such as rash,abnormal liver function,hypoproteinemia and myocardial damage.Fever duration,CRP,ALB,LDH and CD8~+were risk factors for RMPP.And when the fever duration>11.50 days,or serum CRP>28.66mg/L,or serum LDH>370.50u/L,is the early identification index of RMPP.2.The occurrence of RMPP is related to immune dysfunction.When MP is infected,children have it,which is mainly manifested as increased IgG,IgM and IgA,and decreased cellular immunity.In RMPP,the number of T and B cells decreased significantly. |
