| Object: To study the clinical efficacy of children with lobar pneumonia after intervention with bronchoalveolar lavage and to analyze the high-risk factors affecting the duration of disease after lavage.Methods:(1)The clinical data of hospitalized children diagnosed with lobar pneumonia in the pediatric department of our hospital from January 2018 to January 2022 were retrospectively collected,and patients in the lavage group and control group were matched1:1 according to whether bronchoalveolar lavage was performed using the Propensityscorematching(PSM)method,and the clinical characteristics of children in both groups before and after treatment were analyzed by The clinical characteristics of children in the two groups were analyzed before and after treatment to compare the differences in treatment effects between the two groups.(2)Based on whether the duration of disease in the lavage group was >2 weeks,the groups were divided into a long duration group and a short duration group,and the general information,clinical characteristics,laboratory tests,alveolar lavage data,and imaging data of the children in the two groups were analyzed,and a binary logistic regression analysis was performed to investigate the risk factors for a disease duration of >2 weeks after alveolar lavage for lobar pneumonia.Regression equations were established.(3)Subjects’ working curves were plotted for the continuous variables in risk factors to determine the best predictive cut-off values.Results:(1)285 children with lobar pneumonia were included,and 88 cases in the lavage group and 88 cases in the control group were screened after PSM 1:1 matching.The children in the two groups before matching were statistically different in age and thermal peak(χ2=8.027,P=0.018;Z=-2.267,P=0.023),and the two groups were balanced and comparable after matching(χ2=1.031,P=0.597;Z=-1.475,P=0.140).(2)Before treatment,there were no statistically significant differences between the irrigation group and the control group in terms of age,gender,season,fever peak,pre-hospital fever days,and pre-hospital cough duration,(P>0.05).In terms of laboratory tests,there were no statistically significant differences in the levels of WBC,NLR,PLR,SII,CRP,ESR,PCT,and PA between the lavage and control groups(P>0.05).In terms of imaging,the differences between the two groups of children were statistically significant(P<0.05)in three aspects: the proportion of left,right and double lung infections,the proportion of one-lobed/multi-lobed infections,and the proportion of combined pleural effusions.(3)After treatment,the time to fever remission,time to cough relief,time to disappearance of lung rales,and time to lung imaging reduction in the lavage group were all smaller than those in the control group,Differences were statistically significant(P<0.05).Compared with the control group,the levels of white blood cell count,NLR,CRP,PCT,and ESR were lower in the lavage group after treatment(P<0.05).(4)Analysis of clinical characteristics between the lavage groups showed that the levels of heat peak,CRP,and lactate dehydrogenase(LDH)were significantly higher in the long-course group;the proportion of multiple lobar infections,combined pleural effusions,and mixed pathogenic infections was significantly higher than that in the short-course group,with statistically significant differences(P<0.05).(5)Dichotomous logistic showed that CRP [dominance ratio(Odds Ratio,OR)1.020;95%confidence inter-val(CI),1.005-1.035],LDH(OR,1.013;95% CI,1.002-1.024),mixed infection(OR 22.548;95% CI,2.624 to 193.762),and combined pleural effusion(OR,17.701;95% CI,3.579-87.538)were independent risk factors for disease duration >2 weeks in the lavage group(6)ROC curve analysis showed that the optimal cut-off values for LDH predicting the duration of disease >2 weeks in children with lobar pneumonia after alveolar lavage were 333U/L,The area under the ROC curve was 0.737,with a sensitivity of 0.840 and a specificity of0.619.The best cut value of 32.6 for CRP predicting severe lobar pneumonia in children with disease duration >2 weeks had an area under the curve of 0.843,with moderate diagnostic efficacy,and the best effect was suggested when the CRP level was 32.6 mg/L,at which time the sensitivity was 0.960 and the specificity was 0.683.Conclusion:(1)Bronchoalveolar lavage significantly improved the treatment time and accelerated the recovery of inflammation in patients with lobar pneumonia.(2)Mixed infection,multilobar infection,LDH,and CRP are independent risk factors for a disease duration greater than 2 weeks after alveolar lavage in children with lobar pneumonia.(3)LDH>333U/L,CRP>32.6mg/L can be used as a sensitive indicator to predict the duration of disease after alveolar lavage in lobar pneumonia greater than 2 weeks. |
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