Study On Risk Factors Of Airway Mucus Thrombus Formation In Severe Pneumonia

Severe pneumonia is a common respiratory disease in children and adolescents.Bronchoscopy technology has gradually become an important means for the treatment of severe pneumonia.In bronchoscope operation,it can be seen that the formation of airway mucus plug obstructs the airway in some cases,which may even threaten life if it is not treated in time and effectively.At present,there is no clear consensus on the suitability of bronchoscopic intervention and the selection of the timing of interventional therapy in clinical practice,and no exact report can provide sufficient credible basis and operating guidelines for clinical application.Therefore,we hope to find some biomarkers that can be used as bronchoscopy for the formation of airway mucus thrombus.Research objectives: By analyzing the relationship between mucins,cytokines,D-dimer and other related factors and the formation of mucus thrombus,this study provides an experimental basis for further guidance on whether to select bronchoscopy for clinical intervention.Research Methods: Children with severe pneumonia who were hospitalized in Dalian Children’s Hospital from June 2019 to January 2021 and met the inclusion criteria and exclusion criteria were selected.30 children with bronchoscopic manifestations of mucus plug formation(mucus secretions visible in one or more segmental bronchial tubes were blocked in sticky strips and difficult to be aspirated)were selected as the case group.30 children with bronchoscopic manifestations of no mucus plug formation(only airway mucosal congestion,swelling,roughness,patchy changes,secretions sticking to the wall,canal crest widening,luminal secretions and other acute phase changes)were used as the control group.Through collecting the clinical data(age,gender,weight,length of hospital stay,heating time,heating peak,etc.)and related inspection and test results(blood routine,creactive protein,D-dimer,airway lavage fluid and the viscosity of sputum protein,serum interleukin,etc.)and use SPSS26.0 statistics software will collect data for statistical processing and analysis,To study the relationship between related indexes and the formation of airway mucinous thrombus.Results :(1)Comparison of gender differences between mucus embolism group and non-mucus embolism group: among the 60 patients data,there were 30 cases in the mucus embolism group,16 males and 14 females;30 cases in the control group of non-mucus embolism group,14 males and 16 females,obtaining a P value of 0.606,and the gender difference between the two groups was not statistically significant(P > 0.05);the age of the infant and toddler group,preschool,and school age The different subgroups were not statistically significant for airway mucus embolism formation(χ2 =1.867,P>0.05).(2)Relationship between mucin expression levels and mucus plug formation: MUC5 AC of lavage fluid and MUC5 B of lavage fluid were higher in the mucus plug group than in the non-mucus plug group and the difference was statistically significant(P < 0.05),and the difference between MUC5 AC of sputum and MUC5 B of sputum was statistically significant(P < 0.05)in the mucus plug group than in the non-mucus plug group.(3)Relationship between interleukin levels and mucus plug formation: the elevated serum IL-13 levels in the mucus plug group were statistically significant compared to the nonmucus plug group(P < 0.05),and the differences in elevated serum IL-4,IL-9,and IL-33 levels in the mucus plug group compared to the non-mucus plug group were not statistically significant(P > 0.05)(4)Relationship between other laboratory tests,clinical manifestations and mucus plug formation.The mucus plug group had longer fever,higher D-dimer,CRP,PCT,SAA,and neutrophil percentage and statistically significant lower lymphocyte percentage than the non-mucus plug group.Body weight,peak fever and ALT,AST,LD,white blood cell count,hemoglobin content,and platelet count were not statistically significant in the mucus plug group compared to the non-mucus plug group.(5)Multi-factor logistic regression analysis and ROC curve of mucus plug formationThe relevant risk factors were subjected to multi-factor logistic regression analysis,and we obtained that the lavage fluid MUC5 AC,sputum MUC5 B and sputum MUC5 AC were statistically significant with 85% accuracy.When the above factors were plotted on ROC curves,the area under the curve of lavage fluid MUC5 AC was 0.74,the area under the curve of sputum MUC5 B was 0.793,and the area under the curve of sputum MUC5 AC was 0.652,suggesting that lavage fluid MUC5 AC,sputum MUC5 B,and sputum MUC5 AC have some value in suggesting airway mucus plug formation,and the value of MUC5 B was higher.Conclusions.(1)Age group,sex,body weight,peak fever,ALT,AST,LD,white blood cell count,hemoglobin content,platelet count and infection with Mycoplasma pneumoniae had no predictive effect on the formation of airway mucus thromb;(2)Long heat span,serum IL-13,D-dimer,CRP,PCT,SAA,percentage of neutrophils,MUC5 AC and MUC5 B in the perfusion fluid,and MUC5 AC and MUC5 B in the sputum increased,suggesting a greater possibility of the formation of airway mucus thrombocytes.(3)The increased levels of MUC5 B and MUC5 AC in sputum of children with severe pneumonia,especially the increased level of MUC5 B in sputum,are of great value to indicate the formation of airway mucus thromb.The early detection of this indicator in sputum may have certain suggestive significance for bronchoscopic intervention.