| Objective: Analyze the clinical characteristics of bronchiolitis-type Mycoplasma pneumoniae pneumonia(MPP)and explore the risk factors for its formation to provide a basis for early clinical identification and treatment,thereby reducing the occurrence of sequelae.Methods:To retrospectively collect clinical data of 232 children diagnosed with MPP and high-resolution CT(HRCT)in the Second Department of Respiratory Medicine of Hebei Children’s Hospital from January 2019 to January 2020,According to the HRCT findings,the included children were divided into bronchiolitis group(86 cases)and non-bronchiolitis group(146cases),Carry out single factor analysis on the clinical data of the above two groups of children,and select suspicious risk factors for Logistic regression analysis to obtain independent risk factors for their occurrence,draw receiver operating characteristic(ROC)curves,and evaluate the accuracy of the regression model’s diagnosis degree.Results:1.General information,clinical features,laboratory tests: the age of onset of children in the bronchiolitis group(case group)of 5.0(2.0～7.0)years is significantly lower than that of the non-bronchiolitis group(control group)6.0(4.0～8.0)years old(P<0.05),and the incidence of wheezing,dyspnea,wet rales,and wheezing in the bronchiolitis group was significantly increased(P<0.05),and children with specific constitutions were also significantly higher More than the control group(P<0.05);in laboratory tests,the levels of CRP,LDH,Ig M and Ig G in the bronchiolitis group were lower than those in the control group,and the difference was statistically significant(P<0.05).2.Chest HRCT findings: Children in the bronchiolitis group have central lobular nodules and tree bud signs as the main manifestations.The lung lesions are mainly bilateral(67.4%),with an average of 3.0(2.0-4.0)lung lobes involved,The main manifestation of the lung lobes in the control group was consolidation.The lung lesions were mainly unilateral(56.8%),with an average of 2.0(1.0-2.0)lung lobes involved.The difference was statistically significant(P<0.05).3.Bronchoscopy: the bronchiolitis group showed mucosal nodules and granulation tissue hyperplasia as the main performances under bronchoscopy,while the control group had mucus plugs and plasticity as the main performances(P<0.05).4.Treatment: The above two groups of children were given azithromycin treatment,and some of the children were given methylprednisolone or intravenously.There was no significant statistical significance in the number of glucocorticoid applications and the duration of treatment in the two groups.5.Follow-up : There were 8 cases of BO in bronchiolitis group and none in control group,the difference was statistically significant(P < 0.05).Wet rales were found in all 8 cases of BO children during lung auscultation,wheezing and hypoxemia were found in 3 cases,dyspnea was found in 4 cases,and chest HRCT in 6 cases suggested diffuse lesions of both lungs.6.Logistic regression analysis results: wet rales(X1)and specific constitution(X2)are independent risk factors for the occurrence of bronchiolitis-type MPP,and the predictive probability regression equation Logit(P)=1.782X1+2.302X2(P<0.001).The area under the ROC curve is0.841(P<0.001).The model has a moderately high prediction accuracy,with sensitivity and specificity of 0.78 and 0.77,respectively.Conclusions:1.Children with bronchiolitis-type MPP are more common in infants and preschoolers.Most children have specific physiques.Some children may have clinical manifestations such as wheezing and dyspnea.The lungs have wet rales and wheezing.The main signs are other physical signs,and the chest HRCT is characterized by lobular center nodules or tree bud signs,and the child may progress to BO.2.When there are children with MPP with specific physical constitution in the clinic,when wet rales appear on the auscultation of the lungs,attention should be paid to the possibility of bronchiolitis lesions,and the chest HRCT examination should be perfected as soon as possible. |
PDF Full Text Request