Analysis Of Clinical Data Of Severe Community-acquired Mycoplasma Pneumoniae Pneumonia In Children

BackgroundCommunity acquired pneumonia is a common infectious disease in children,of which 7%to 13%can develop into severe pneumonia,making it the first cause of death in children aged 1 month to 5 years.Because severe pneumonia are characterized by acute onset,critical condition and rapid progress and it is difficult to distinguish severe pneumonia in children in clinical manifestations,it brings severe challenges to clinical work,seriously threatens the life and health of children,and brings serious economic and mental burden to the society and family.Previous data have shown that bacteria are the primary pathogen of severe pneumonia in children in China.In recent years,the proportion of children with severe pneumonia caused by mycoplasma pneumoniae（MP）infection has increased.Severe pneumonia caused by MP infection is often accompanied with many sequelae and complications.It is worth discussing whether the occurrence of severe mycoplasma pneumoniae pneumonia（SMPP）caused by MP infection is different from the clinical signs,body immune status and clinical outcome of severe pneumonia caused by other etiological infections.ObjectivesThis study aimed to retrospectively analyze the clinical data of severe community-acquired mycoplasma pneumoniae pneumonia（MPP）in children,,The clinical features and immunoinflammation indexes of severe pneumonia caused by MP infection with other pathogens were compared,which provided a reference for clinical treatment and prognosis.MethodsRetrospective analysis of the clinical data of 92 children with severe CAP hospitalized in the pediatric PICU of the First Affiliated Hospital of Guangzhou Medical University from January 1,2019 to December 31,2020,According to whether accompanied with MP infection,pneumonia was classified as SMPP group（n=57）or SNMPP group（n=35）.Clinical data of the two groups including general information,clinical symptoms,laboratory and imaging results,treatment strategies,hospital stay and treatment costs and treatment outcome were collected and recorded to compare and analyse their difference.Results1.General data comparison between the two groups:There was no significant difference in gender and age（P>0.05）between SMPP group and SNMPP group.Meanwhile,the SMPP group of children and the SNMPP group of children showed no significant difference in premature birth history and previous endotracheal intubation and ventilator assisted ventilation（P>0.05）.There were 16 children（28.1%）of underlying diseases in the SMPP group,mainly 7 cases of chronic pulmonary infectious diseases,in the SNMPP group,there were 23 cases（65.7%）of underlying diseases,16 cases of chronic pulmonary infectious diseases.Compared with the children in the SNMPP group,the children in the SMPP group had a lower proportion of underlying diseases,and the proportion of chronic pulmonary infectious diseases in the underlying diseases of the respiratory system was lower（P<0.05）.2.Comparison of clinical signs in the two groups:Compared with SNMPP group,SMPP group had longer fever time（P<0.05）.However,there was no significant difference between the two groups in the duration of cough and the proportion of clinical manifestations such as wheezing,dyspnea,and rales of the lungs,and the value of systolic blood pressure and SO₂%（P>0.05）.3.Comparison of laboratory results between two groups:Compared with SNMPP group,the percentage of peripheral neutrophils ratio（N%）,serum D dimer（D-D）,lactic dehydrogenase（LDH）,C-reaction protein（CRP）,Procalcitonin（PCT）levels were significantly higher in SMPP group（P<0.05）.There was no significant difference in platelet count（PLT）,alanine aminotransferase（ALT）,and glutamic-oxaloacetic transaminase（AST）between the two groups（P>0.05）.4.Comparison of serum cytokine levels between two groups:Compared with SNMPP group,the serum levels of Interleukin-6（IL-6）and Interleukin-10（IL-10）were significantly higher in SMPP group（P<0.05）.There were no significant differences in the levels of IL-2,IL-4,Tumor necrosis factor-α（TNF-α）and Interferon-γ（IFN-γ）between the two groups（P>0.05）.5.Comparison of immune levels in peripheral blood between two groups:Compared with SNMPP group,the proportions of CD3⁺T lymphocytes and CD4⁺T helper cells in peripheral blood were significantly decreased in SMPP group,and serum Ig M levels were significantly increased（P<0.05）.There were no significant differences in the ratio of CD4⁺T helper cells to CD8⁺T suppressor cells,CD8⁺T suppressor cells,CD19⁺B lymphocytes and CD3^-CD16⁺CD56⁺NK cells and Ig A and Ig G levels between the two groups（P>0.05）.6.Comparison of intrapulmonary and external complications in the two groups:Compared with the SNMPP group,the incidence of extrapulmonary complications was higher in the SMPP group,and the difference was statistically significant（P<0.05）.Compared with the SNMPP group,the incidence of pleural effusion was higher in the SMPP group with a statistically significant difference（P<0.05）.7.Comparison of pathogen co-infection between two groups:Compared with the SNMPP group,the proportion of mixed infected persons in the SMPP group（≥2pathogens）was higher,and the proportion of co-infected adenovirus was the highest,and the difference was statistical significant（P<0.05）.8.Comparison of treatment strategies between two groups:Compared with SNMPP group,children in SMPP group had a higher proportion of nasal catheter or mask oxygen and intravenous blood products during hospitalization（P<0.05）,while there was no significant differences in the use of hormone,assisted ventilation,and bronchoscopic intervention,etc.between the two groups（P>0.05）.9.Comparison the length of hospital stay,treatment outcome and total treatment cost of children in two groups:Compared with SNMPP group,the SMPP group had longer hospital stay,higher treatment cost,and the difference was statistically significant（P<0.05）,there were no deaths in the SMPP group and 3 deaths in the SNMPP group,and the difference was statistically significant（P<0.05）.Conclusions1.In this study,there were no specific differences in clinical signs between children with SMPP and SNMPP.Compared with children with SNMPP,children with SMPP had higher levels of N%,D-D,LDH,CRP,PCT and inflammatory cytokines（IL-6,IL-10）,while CD3⁺T lymphocytes and CD4⁺T helper cells had lower proportions.The duration of fever is longer,the incidence of extrapulmonary complications is higher,and intrapulmonary complications are mainly pleural effusion,longer hospital stay,and higher treatment costs.2.Compared with children with SNMPP,children with SMPP have a lower incidence of underlying respiratory disease（chronic pulmonary infectious disease）and lower mortality.The inflammatory storm in children with SMPP was more obvious than that in children with SNMPP,and the treatment was difficult,but the overall prognosis was better than that of SNMPP.