Serum inflammatory markers in children with Mycoplasma pneumoniae pneumonia and their predictive value for mycoplasma severity

BACKGROUND Mycoplasma pneumoniae pneumonia(MPP)significantly impacts pediatric health,necessitating markers for early severe disease identification.AIM To investigate the correlation between serum inflammatory marker and the severity of MPP in children.METHODS A prospective study was carried out from January 2023 to November 2023.A total of 160 children with MPP who underwent treatment were selected:80 had severe MPP and 80 had mild MPP.Clinical and laboratory data were collected at the time of hospital admission and during hospitalization.Receiver operating characteristic curves were utilized to assess the diagnostic and prognostic for severe MPP.RESULTS Fever duration and length of hospitalization in pediatric patients with severe MPP exceeded those with mild MPP.The incidence of pleural effusion,lung consolidation,and bronchopneumonia on imaging was markedly elevated in the severe MPP cohort compared to the mild MPP cohort.In contrast to the mild cohort,there was a notable increase in C-reactive protein(CRP),procalcitonin(PCT),erythrocyte sedimentation rate,lactic dehydrogenase,D-dimer,and inflammatory cytokines[interleukin(IL)-6,IL-8,IL-10 and tumor necrosis factor(TNF)-α]in the severe MPP group were significantly higher.CONCLUSION Serum inflammatory markers(CRP,PCT,IL-6,D-dimer,IL-10 and TNF-α)were considered as predictors in children with severe MPP.

Chinese herbal medicine combined with Western medicine for Mycoplasma pneumoniae pneumonia in children:An overview of systematic reviews

Objective:To summarize the characteristics and evaluate the quality of the methodology and evidence within systematic reviews(SRs)of Chinese herbal medicine(CHM)for Mycoplasma pneumoniae pneumonia(MPP)inchildren.Methods:SRs of randomized controlled trials were searched using PubMed,the Cochrane Library,Embase,the Chinese National Knowledge Infrastructure Databases(CNKI),the Chinese Scientific Journals Database(VIP),Wanfang,and the SinoMed Database.SRs on the use of CHM alone or in combination with Western medications for MPP in children were included.The study compared the effects of Western medicine alone with those of CHM.The evidence quality using the A Measurement Tool to Assess Systematic Reviews(AMSTAR)2,the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)2020,and the Grading of Recommendations,Assessment,Development,and Evaluation(GRADE)criteria.The primary indicators were the total effective rate,fever subsidence time,and cough disappearance time.The secondary outcomes were pulmonary rale disappearance time,average hospitalization time,lung X-ray infiltrate disappearance time,immunological indices,and inflammatory cytokine levels.Results:Twelve relevant SRs were included;75%(9/12)were assessed as very low quality,and 25%(3/12)Were rated as low quality using the AMSTAR 2 criteria.According to the PRISMA 2020 checklist,the average SR score was 20.3 out of a 27 point maximum.In all SRs,CHM demonstrated improvement in symptoms and signs among children with MPP.The evidence quality using the GRADE criteria ranged from"very low"(>50%)to"moderate"(<5%).The most common downgrading factor was imprecision,followed by publication bias and inconsistency.Conclusion:This overview highlights the limited quality of the methodology and evidence of the included SRs.Although the included studies showed the beneficial effects of CHM on MPP in children,it was difficult to draw firm conclusions owing to methodological flaws.

Research Progress on Combined Chinese and Western Medicine Treatment of Mycoplasma pneumoniae Pneumonia in Children

With the continuous development of medical technology,combined treatment of Chinese and Western medicine has gradually become a research hotspot.As a common disease in pediatrics,the treatment of Mycoplasma pneumoniae pneumonia(MPP)in children is also being explored and improved.This article summarizes the research progress of combined Chinese and Western medicine treatment of MPP in children in recent years,aiming to provide a useful reference for the combined treatment of MPP in children.The article firstly introduces the etiology and pathogenesis of MPP in children,thereafter briefly introduces the Western anti-infective treatment and traditional Chinese medicine(TCM)diagnosis and treatment of MPP in children,and lastly introduces the methods of combined treatment of TCM and Western medicine in detail.The article points out that the combination of Chinese and Western medicine can give full play to the overall regulation of Chinese medicine and the precise treatment advantages of Western medicine,improve the therapeutic effect,reduce the use of antibiotics,and lower the recurrence rate of the disease,which is worthy of further research and promotion.

Understanding serum inflammatory markers in pediatric Mycoplasma pneumoniae pneumonia

This editorial reflects on the research,which investigates the potential of serum markers to predict the severity of Mycoplasma pneumoniae infections.Mycoplasma pneumoniae pneumonia(MPP)is a prevalent cause of respiratory infections in children,often leading to significant morbidity.Predicting the severity of MPP can significantly enhance patient management and outcomes.This editorial reviews the role of specific laboratory markers:(1)Lactate dehydrogenase;(2)Interleukin(IL)-6;(3)IL-10;(4)Tumor necrosis factor-α;and(5)D-dimer in predicting the severity of MPP in pediatric patients.Elevated levels of these markers are strongly associated with severe cases of MPP,providing clinicians with valuable tools for early diagnosis and targeted intervention.

Clinical characteristics of community-acquired pneumonia in children caused by mycoplasma pneumoniae with or without myocardial damage:A single-center retrospective study

BACKGROUND Mycoplasma pneumoniae(MP)is a prevalent pathogen that causes respiratory infections in children and adolescents.AIM To assess the differences in the clinical features of MP-associated communityacquired pneumonia(CAP)in children who presented with mild or severe mycoplasma pneumoniae pneumonia(MPP);to identify the incidence of myocardial damage between the two groups.METHODS This work is a retrospective study.We identified children between 2 mo and 16 years of age with clinical and radiological findings consistent with CAP.We admitted patients to the inpatient department of the Second Hospital of Jilin University,Changchun,China,from January 2019 to December 2019.RESULTS A total of 409 hospitalized patients were diagnosed with MPP.Among them were 214(52.3%)males and 195(47.7%)females.The duration of fever and cough was the longest in severe MPP cases.Similarly,plasma levels of highly sensitive Creactive protein(t=-2.834,P<0.05),alanine transaminase(t=-2.511,P<0.05),aspartate aminotransferase(t=-2.939,P<0.05),and lactate dehydrogenase(LDH)(t=-2.939,P<0.05)were all elevated in severe MPP cases compared with mild MPP cases,and these elevations were statistically significant(P<0.05).Conversely,the neutrophil percentage was significantly lower in severe MPP cases than in mild MPP cases.The incidence of myocardial damage was significantly higher in severe MPP cases than in mild MPP cases(χ^(2)=157.078,P<0.05).CONCLUSION Mycoplasma pneumoniae is the main cause of CAP.The incidence of myocardial damage was higher and statistically significant in severe MPP cases than in mild MPP cases.

The Predictive Value of NLR, IL-6, CRP, and PCT in Mycoplasmal Pneumonia with Complicated Myocardial Injury

Objective:To evaluate the dynamic changes in neutrophil-to-lymphocyte ratio(NLR),interleukin-6(IL-6),C-reactive protein(CRP),and procalcitonin(PCT)levels in children with Mycoplasma pneumoniae pneumonia(MPP)complicated by myocardial injury and to determine their predictive value both individually and in combination.Methods:150 children diagnosed with MPP at Jiujiang Maternal and Child Health Hospital between June 2023 and June 2024 were selected.Patients were divided into the myocardial damage group(MD group,n=65)and the non-myocardial damage group(non-MD group,n=85),based on the presence of myocardial injury.Ninety hospitalized children without MPP served as the control group(Con group).Myocardial enzyme profile indicators,including lactate dehydrogenase(LDH),α-hydroxybutyrate dehydrogenase(α-HBDH),aspartate aminotransferase(AST),high-sensitivity cardiac troponin I(hs-cTnI),creatine kinase(CK),and creatine kinase-MB(CK-MB),were measured using a chemiluminescent immunoassay analyzer.Serum NLR,IL-6,CRP,and PCT levels were determined using appropriate analyzers.The correlation between these markers and myocardial enzyme indicators was analyzed using Spearman correlation analysis.Multivariate logistic regression was applied to identify risk factors for myocardial injury in MPP patients.Results:Serum levels of NLR,IL-6,CRP,and PCT in the MD and non-MD groups were significantly higher than in the Con group(P<0.05),with the MD group showing higher levels than the non-MD group(P<0.05).These markers were positively correlated with myocardial enzyme indicators.Logistic regression identified elevated NLR,IL-6,CRP,PCT,LDH,α-HBDH,AST,hs-cTnI,CK,and CK-MB as risk factors for myocardial injury in MPP patients(P<0.05).Conclusion:Elevated levels of NLR,IL-6,CRP,PCT,and myocardial enzymes are significant risk factors for myocardial injury in children with MPP,offering valuable insights for prevention and prognosis.

The Effect of Azithromycin in Treating Mycoplasma Pneumonia in Children

Objective:To discuss and analyze the effect of azithromycin in the treatment of mycoplasma pneumonia in children.Methods:A total of 120 children with mycoplasma pneumonia who were admitted to the Department of Pediatrics of our hospital from January 2022 to December 2022 were selected as the research subjects.They were divided into an azithromycin group and a reference group according to the random number drawing method,with 60 cases in each group.The azithromycin group was treated with azithromycin,and the reference group was treated with conventional treatment.The efficacy of treatment,laboratory indicators,platelet count and D-dimer,and adverse reactions of both groups were compared.Results:The efficacy of the azithromycin group was significantly higher than that of the reference group(P<0.05).Before treatment,there were no significant differences in the laboratory indicators like ferritin,procalcitonin(PCT),and erythrocyte sedimentation rate(ESR)between the two groups(P>0.05);after treatment,the laboratory indicators of the azithromycin group were significantly better than those of the reference group(P<0.05).Before treatment,there was no statistically significant difference in platelet count and D-dimer between the groups(P>0.05);after medication,the platelet count,and D-dimer in the azithromycin group were significantly better than those in the reference group(P<0.05).The total incidence of adverse reactions in the azithromycin group was significantly lower than that in the reference group(P<0.05).Conclusion:Azithromycin is more effective in treating mycoplasma pneumonia in children,and has certain clinical value.

Status of <i>Mycoplasma pneumoniae</i>Pneumonia in Chinese Children: A Systematic Review

Mycoplasma pneumoniae pneumonia (MPP) becomes one of the most important health problems in China recently. Date for MPP inChinais scarce. Although macrolides and/or cortical steroids had been reported to be effective treatment for MPP, the long-term outcome remained uncertain. A study on status of MPP in China was conducted via a systematic review of published studies which have the Chinese data and collected from published PubMed and core journals of China Knowledge Resource Integrated Database (CNKI). The analysis was based on epidemiology, clinical characteristics, treatment, drug resistance and prognosis. Twenty five articles concerned about MPP in Chinese children and adolescent were enrolled, including 11 studies on epidemiology/etiology, 11 studies on clinical characteristics, 7 studies on drug resistance, 5 studies on treatment from China's Mainland respectively. The overall incidence of MPP ranged from 7.1% to 54.4%. Fever and cough were most frequently identified in manifestations. Drug resistance to macrolides ranged from 18.9% to 90%. The outcome of treatment in patients who received combined treatment of macrolides, cephalosporin antibiotics and/or cortical steroid seems to be better than those who received macrolides only. Macrolide combined with cephalosporin or cortical steroid both may decrease the severity of MPP in the past decade. There was not enough evidence to suggest that cortical steroid can decrease the mortality of MPP in children. And a multi-center, randomized double blind research on the effect of cortical steroid was encouraged.

支气管镜介入治疗对RMPP患儿的疗效及其对外周血CRP、SF、IL-8水平及CD4^(+)/CD8^(+)比值的影响

目的探讨支气管镜介入治疗对难治性肺炎支原体肺炎(RMPP)患儿的疗效及其对外周血C反应蛋白(CRP)、铁蛋白(SF)、白细胞介素(IL)-8水平及CD4^(+)/CD8^(+)比值的影响。方法选取2020年12月至2022年12月河北省儿童医院收治的195例确诊为RMPP患儿作为研究对象,采用随机数字表法分为对照组和介入组(病程≥14 d归为晚期介入组、病程<14 d归为早期介入组)。根据临床疗效将130例接受支气管镜介入治疗的患儿分为有效组和无效组。对照组进行常规治疗,晚期介入组和早期介入组在对照组的基础上实施支气管镜介入治疗。比较对照组、晚期介入组和早期介入组临床疗效、临床症状与体征改善情况;检测并比较对照组、晚期介入组和早期介入组外周血CRP、SF、IL-8水平及CD4^(+)/CD8^(+)比值;比较对照组、晚期介入组和早期介入组不良反应发生率;比较有效组和无效组外周血CRP、SF、IL-8水平及CD4^(+)/CD8^(+)比值。采用受试者工作特征(ROC)曲线分析外周血CRP、SF、IL-8、CD4^(+)/CD8^(+)比值对支气管镜介入治疗RMPP疗效的预测价值。结果早期介入组总有效率高于对照组和晚期介入组,差异均有统计学意义(P<0.05);对照组和晚期介入组总有效率比较,差异无统计学意义(P>0.05)。早期介入组咳嗽持续时间、发热持续时间、住院时间均短于对照组和晚期介入组,差异均有统计学意义(P<0.05)。对照组、晚期介入组和早期介入组治疗后外周血CD4^(+)/CD8^(+)比值均高于治疗前,CRP、SF、IL-8水平均低于治疗前,差异均有统计学意义(P<0.05);早期介入组治疗后外周血CD4^(+)/CD8^(+)比值均高于对照组和晚期介入组,CRP、SF、IL-8水平均低于对照组和晚期介入组,差异均有统计学意义(P<0.05)。早期介入组出现不良反应8例,晚期介入组出现不良反应10例,均暂停灌洗操作后很快恢复。对照组未出现上述不良反应。无效组外周血CRP、SF、IL-8水平均高于有效组,CD4^(+)/CD8^(+)比值低于有效组,差异均有统计学意义(P<0.05)。ROC曲线分析结果显示,CRP、SF、IL-8、CD4^(+)/CD8^(+)比值联合检测预测支气管镜介入治疗RMPP无效的曲线下面积、灵敏度、特异度分别为0.871、81.81%、83.80%。结论早期应用支气管镜介入治疗对RMPP的疗效较好,可改善患儿外周血CRP、SF、IL-8水平及CD4^(+)/CD8^(+)比值,且外周血CRP、SF、IL-8、CD4^(+)/CD8^(+)比值联合检测有助于预测支气管镜介入治疗RMPP的疗效。

基于NLRP3炎性体信号通路在肺泡灌洗联合布地奈德局部喷洒对SMPP的疗效

目的探讨纤维支气管肺泡灌洗、布地奈德联合治疗重症肺炎支原体肺炎(SMPP)的临床疗效,分析可能作用机制。方法选取2019年1月至2022年1月收治的96例SMPP患儿为研究对象,采用奇偶数分组法分为研究组和对照组,每组48例。对照组予以纤维支气管肺泡灌洗治疗,研究组在对照组基础上予以布地奈德局部喷洒治疗。对比2组治疗7 d后临床疗效及临床症状改善时间。分析2组治疗前后肺功能指标(FEV1%pred、PEF、FEV1/FVC)、淋巴细胞亚群(CD19^(+))水平。对比2组治疗前后NOD样受体热蛋白结构域相关蛋白3(NLRP3)炎性体信号通路相关因子[白细胞介素-1β(IL-1β)、白细胞介素-18(IL-18)]及其相关蛋白[NLRP3、凋亡相关的斑点样蛋白(ASC)、含半胱氨酸的天冬氨酸蛋白水解酶-1(Caspase-1)]表达水平。结果研究组总有效率高于对照组,临床症状改善时间短于对照组(P<0.05);治疗后,研究组FEV1%pred、FEV1/FVC、PEF高于对照组(P<0.05);治疗后,研究组CD19+绝对计数及比例低于对照组(P<0.05);治疗后,研究组IL-1β、IL-18水平及NLRP3、ASC、Caspase-1 mRNA表达水平低于对照组(P<0.05)。结论纤维支气管肺泡灌洗联合布地奈德局部喷洒治疗SMPP患儿疗效确切,可改善肺功能、免疫功能病理状态,减轻炎性反应,这可能与抑制NLRP3炎性体信号通路有关。

Comparison of acute pneumonia caused by SARS-CoV-2 and other respiratory viruses in children:a retrospective multi-center cohort study during COVID-19 outbreak

Background:Until January 18,2021,coronavirus disease-2019(COVID-19)has infected more than 93 million individuals and has caused a certain degree of panic.Viral pneumonia caused by common viruses such as respiratory syncytial virus,rhinovirus,human metapneumovirus,human bocavirus,and parainfluenza viruses have been more common in children.However,the incidence of COVID-19 in children was significantly lower than that in adults.The purpose of this study was to describe the clinical manifestations,treatment and outcomes of COVID-19 in children compared with those of other sources of viral pneumonia diagnosed during the COVID-19 outbreak.Methods:Children with COVID-19 and viral pneumonia admitted to 20 hospitals were enrolled in this retrospective multi-center cohort study.A total of 64 children with COVID-19 were defined as the COVID-19 cohort,of which 40 children who developed pneumonia were defined as the COVID-19 pneumonia cohort.Another 284 children with pneumonia caused by other viruses were defined as the viral pneumonia cohort.The epidemiologic,clinical,and laboratory findings were compared by Kolmogorov-Smirnov test,t-test,Mann-Whitney U test and Contingency table method.Drug usage,immunotherapy,blood transfusion,and need for oxygen support were collected as the treatment indexes.Mortality,intensive care needs and symptomatic duration were collected as the outcome indicators.Results:Compared with the viral pneumonia cohort,children in the COVID-19 cohort were mostly exposed to family members confirmed to have COVID-19(53/64 vs.23/284),were of older median age(6.3 years vs.3.2 years),and had a higher proportion of ground-glass opacity(GGO)on computed tomography(18/40 vs.0/38,P<0.001).Children in the COVID-19 pneumonia cohort had a lower proportion of severe cases(1/40 vs.38/284,P=0.048),and lower cases with high fever(3/40 vs.167/284,P<0.001),requiring intensive care(1/40 vs.32/284,P<0.047)and with shorter symptomatic duration(median 5d vs.8d,P<0.001).The proportion of cases with evaluated inflammatory indicators,biochemical indicators related to organ or tissue damage,D-dimer and secondary bacterial infection were lower in the COVID-19 pneumonia cohort than those in the viral pneumonia cohort(P<0.05).No statistical differences were found in the duration of positive PCR results from pharyngeal swabs in 25 children with COVID-19 who received antiviral drugs(lopinavir-ritonavir,ribavirin,and arbidol)as compared with duration in 39 children without antiviral therapy(median 10d vs.9d,P=0.885).Conclusions:The symptoms and severity of COVID-19 pneumonia in children were no more severe than those in children with other viral pneumonia.Lopinavir-ritonavir,ribavirin and arbidol do not shorten the duration of positive PCR results from pharyngeal swabs in children with COVID-19.During the COVID-19 outbreak,attention also must be given to children with infection by other pathogens infection.

血小板参数及凝血功能指标对重症MPP的预测价值及与其预后的相关性分析

目的:探讨血小板参数及凝血功能指标对重症肺炎支原体肺炎(MPP)的预测价值及与其预后的相关性。方法:选取2022年6月-2023年5月台山市人民医院收治的110例MPP患儿,另外选取同期儿童保健科收治的50例健康体检儿童作为对照组。根据病情严重程度将MPP患儿分为重症组(52例)和轻症组(58例)。检测三组实验室指标,评估MPP患儿小儿危重病例评分法(PCIS)评分及重症组预后。比较三组实验室指标。分析重症MPP的影响因素。分析血小板计数(PLT)、D-二聚体(D-D)、纤维蛋白原降解产物(FDP)对重症MPP的预测价值。分析重症MPP患儿PLT、D-D、FDP与PCIS评分的相关性。比较预后良好组和预后不良组实验室指标。分析重症MPP患儿预后不良的影响因素。结果:轻症组和重症组PLT、活化部分凝血活酶时间(APTT)均低于对照组,血小板分布宽度(PDW)、PLT/淋巴细胞计数比值(PLR)、D-D、FDP、纤维蛋白原(FIB)均高于对照组,重症组PLT、APTT均低于轻症组,PDW、PLR、D-D、FDP均高于轻症组,差异有统计学意义(P<0.05)。多因素logistic回归分析提示,PLT、D-D、FDP均是重症MPP的独立预测因子(P<0.05)。ROC曲线分析结果显示,PLT、D-D、FDP及联合检测预测重症MMP的AUC分别为0.794、0.845、0.800和0.947。相关性分析发现,PLT与PCIS评分呈正相关(r=0.582,P<0.05),D-D(r=-0.646,P<0.05)、FDP(r=-0.727,P<0.05)与PCIS评分呈负相关。预后不良组PLT水平低于预后良好组,D-D、FDP、FIB均高于预后良好组,差异有统计学意义(P<0.05)。多因素分析结果提示,高D-D、FDP水平是影响重症MMP患儿预后不良的独立危险因素(P<0.05)。结论:MPP患儿普遍存在血小板参数及凝血功能指标异常情况,PLT、D-D、FDP联合检测对重症MPP具有较高的预测价值,其中D-D、FDP与重症MPP患儿预后有关。

Low-dose versus high-dose methylprednisolone for children with severe Mycoplasma pneumoniae pneumonia (MCMP): Study protocol for a randomized controlled trial

Background:Severe Mycoplasma pneumoniae pneumonia(MPP)may develop with long-term pulmonary outcomes despite treatment with macrolides.Combined treatment with glucocorticoids can improve this outcome,though the optimal dosage is unknown.The aim of this study was to investigate the effects of low-and high-dose methylprednisolone in reducing the percentage of long-term pulmonary outcomes for children with severe MPP.Methods:A randomized,single-blind,parallel-controlled,multicenter clinical trial,methylprednisolone for children with severe M.pneumoniae pneumonia(MCMP),is being conducted in China.Pediatric patients(≤18 years of age,expected number=402)admitted to the hospital with a clinical diagnosis of severe MPP and fulfilling inclusion and exclusion criteria are randomized(ratio of 1:1)to either a low-dose(2 mg/kg/d)or high-dose(10 mg/kg/d)methylprednisolone treatment group for 3 days followed by tapering of methylprednisolone over 12 days and combined with azithromycin.The primary composite outcome will be incidence of atelectasis,bronchiectasis,or bronchiolitis obliterans at 6-months after treatment.Secondary outcomes include recovery time of patient temperature,proportion of pulmonary lesions absorbed,changes of mucosa identified by bronchoscopy,length of hospital stay,pulmonary function and number of participant(s)needing intensive care.Assessments will be made at baseline,post-treatment and at 1-month,3-month and 6-month follow-ups.Discussion:This is the first randomized clinical trial designed to evaluate the safety and efficacy of low-versus high-dose methylprednisolone for reducing long-term pulmonary outcomes in pediatric patients with severe MPP.The results of this study will provide scientific evidence to guide clinical practice for the treatment of severe MPP.Trial registration:This study is registered at ClinicalTrials.gov(NCT02303587).

小儿肺炎支原体肺炎(MPP)应用X射线和CT检查的临床价值

目的:对比X射线与CT在小儿肺炎支原体肺炎(mycoplasma pneumonia,MPP)诊断中的临床价值。方法:选择MPP疑似病例为研究对象(病例71例,病例选取时间:2019年1月至2021年12月)。全部患儿均进行X射线检查、CT检查。比较两种方法的诊断效能和病灶影像学特征。结果:CT检查对研究中MPP疑似病例诊断符合率95.77%,显著高于X射线检查80.28%(P<0.05);CT对MPP诊断灵敏度95.35%,高于X射线检查81.40%(P<0.05);CT对MPP诊断特异度96.43%,高于X射线检查78.57%(P<0.05)。MPP影像学检查中,X射线影像学特征以明显增大的肺门影、斑片影肺纹增多为主;CT影像学特征主要是肺部可见斑片状或大片状实变、肺部实质阴影、胸腔积液。结论:MPP诊断使用X射线检查、CT检查均能够准确诊断,相比之下CT检查的整体效能更好,联合检查可以进一步提高诊断准确率。可以根据临床诊疗需求选择合适的检查方法。

支气管肺泡灌洗液中细胞分类及炎症因子水平与MPP合并气道黏液栓患儿预后的关联性分析

目的分析支气管肺泡灌洗液(BALF)中细胞分类及炎症因子水平与肺炎支原体肺炎(MPP)合并气道黏液栓患儿预后的关联性。方法选择2018年2月至2022年2月于佳木斯中心医院接受支气管肺泡灌洗术的168例MPP患儿的临床资料,根据支气管镜下查出气道黏液栓存在情况,将其分为MPP合并气道黏液栓组(78例)和单纯MPP组(90例)。根据病程2个月时影像学复查结果,将MPP合并气道黏液栓组患儿分为肺炎吸收缓慢组(35例)和肺炎完全吸收组(43例)。应用瑞氏-吉姆萨染色法测定BALF中各细胞分类水平。应用酶联免疫吸附试验检测BALF中白介素(IL)-2、IL-4、IL-8、IL-10水平。采用多因素logistic回归分析MPP合并气道黏液栓患儿肺炎吸收缓慢的影响因素。通过受试者工作特征(ROC)曲线分析各指标对MPP合并气道黏液栓患儿预后的预测价值。结果MPP合并气道黏液栓组BALF巨噬细胞百分比、IL-4、IL-10水平低于单纯MPP组,BALF中性粒细胞百分比、IL-2、IL-8水平高于单纯MPP组,差异有统计学意义(P<0.05)。多因素logistic回归分析结果显示,较长的发热时间、较高的BALF中性粒细胞百分比是促进MPP合并气道黏液栓患儿肺炎吸收缓慢的独立危险因素(P<0.05);较高的BALF巨噬细胞百分比是抑制肺炎吸收缓慢的保护因素(P<0.05)。ROC曲线分析结果显示,联合发热时间、BALF巨噬细胞百分比、BALF中性粒细胞百分比可有效预测MPP合并气道黏液栓患儿肺炎吸收缓慢的发生情况(P<0.05),其灵敏度和特异度分别为89.00%、75.00%。结论联合发热时间、BALF巨噬细胞百分比、BALF中性粒细胞百分比可有效预测MPP合并气道黏液栓患儿的预后,指导临床治疗。

儿童RMPP血清和支气管肺泡灌洗液中ATX水平的检测意义及其与免疫细胞、炎症因子的相关性

目的 探讨儿童难治性肺炎支原体肺炎(RMPP)血清和支气管肺泡灌洗液(BALF)中自分泌运动因子(ATX)的检测意义及其与免疫细胞、炎症因子的相关性。方法 将2019年6月至2022年10月吕梁市人民医院收治的80例RMPP患儿和80例普通肺炎支原体肺炎(GMPP)患儿纳入本次回顾性研究,分别作为RMPP组和GMPP组,RMPP组患儿在急性期接受支气管肺泡灌洗术(BAL)治疗,其中35例患儿在恢复期接受第2次BAL。比较2组血清和BALF中ATX、肺炎支原体(MP)载量、中性粒细胞比例、巨噬细胞比例及血清乳酸脱氢酶(LDH)、C-反应蛋白(CRP)、降钙素原、D-二聚体表达,分析RMPP患儿急性期血清和BALF中autotaxin与MP载量、中性粒细胞比例、巨噬细胞比例、血清LDH、CRP、降钙素原、D-二聚体的相关性。结果 RMPP组急性期血清和BALF中ATX、MP载量、中性粒细胞比例分别为(23.14±6.17)mg/L、(19.90±5.52)pg/mL、(8.54±0.59)copies/mL、(31.25±10.64)%,显著高于恢复期[(7.76±1.91)mg/L、(6.25±1.64) pg/mL、(5.21±0.48) copies/mL、(7.09±3.15)%]和GMPP组[(4.36±1.30) mg/L、(3.31±1.26) pg/mL、(4.09±0.36) copies/mL、(5.22±2.57)%],而巨噬细胞比例为(26.33±8.02)%,显著低于恢复期[(39.17±8.99)%]和GMPP组[(60.11±21.42)%],差异均有统计学意义(P<0.05)。RMPP组急性期血清LDH、CRP、降钙素原、D-二聚体分别为(512.81±108.54)U/L、(31.56±10.58)mg/L、(0.25±0.07)ng/L和(6.16±1.09)mg/L,均显著高于恢复期[(295.52±72.36)U/L、(17.63±7.24)mg/L、(0.18±0.05)ng/L和(5.27±0.92)mg/L]和GMPP组[(246.98±50.47)U/L、(12.69±5.60)mg/L、(0.13±0.03)ng/L和(4.20±0.74)mg/L],差异均有统计学意义(P<0.05)。RMPP组患儿血清ATX与MP载量、中性粒细胞比例、LDH、CRP、降钙素原、D-二聚体呈正相关(r=0.701、0.689、0.599、0.721、0.628和0.679,P<0.001),与巨噬细胞比例呈负相关(r=-0.607,P<0.001);RMPP组患儿BALF中ATX与MP载量、中性粒细胞比例、LDH、CRP、降钙素原、D-二聚体呈正相关(r=0.763、0.730、0.571、0.677、0.654、0.641,P<0.001),与巨噬细胞比例呈负相关(r=-0.672,P<0.001)。结论 RMPP患儿血清和BALF中ATX显著升高,其与MP载量、中性粒细胞比例、CRP、LDH、降钙素原、D-二聚体呈正相关,与巨噬细胞比例呈负相关,提示ATX参与了RMPP的发生、发展,且可促进机体炎症反应,诱导免疫细胞趋化,参与了凝血功能失调。

重症MPP患儿外周血Th1/Th2类细胞因子变化及对近期预后不良的预测分析

目的:探讨重症肺炎支原体肺炎(MPP)患儿外周血Th1/Th2类细胞因子变化情况及其对近期预后不良的预测价值。方法:选取2016年1月至2021年4月青海省妇女儿童医院收治的185例重症MPP患儿为观察组,另选取同期161例健康体检儿童为对照组,均行外周血Th1/Th2类细胞因子(IL-4、IL-6、IL-10、TNF-α、IFN-γ)水平检测。另根据观察组患儿入院1个月内预后情况将其分为预后良好组、预后不良组,对比两组血清各指标水平,并采用受试者工作特征(ROC)曲线分析各指标单项及联合检测对重症MPP患儿近期预后不良的预测价值。结果:观察组血清IL-4、IL-6、IL-10、TNF-α、IFN-γ水平均明显高于对照组(P<0.05);入院1个月内,185例重症MPP患儿预后不良率为28.65%(53/185),预后不良组血清IL-4、IL-6、IL-10、TNF-α、IFN-γ水平均明显高于预后良好组(P<0.05);经ROC曲线分析,血清IL-4、IL-6、IL-10、TNF-α、IFN-γ水平联合预测重症MPP患儿近期预后不良的灵敏度(96.23%)与曲线下面积(AUC=0.959)均高于各指标单独预测(均P<0.01),联合预测的特异度(80.30%)与各指标单独预测比较差异无统计学意义(P>0.05)。结论:重症MPP患儿外周血IL-4、IL-6、IL-10、TNF-α、IFN-γ水平均异常升高,且可能与重症MPP患儿近期预后不良存在一定的关系,各指标联合预测时对此类患儿近期预后不良具有良好的预测效能。

肺炎支原体抗体效价对MPP的诊断价值及与气道炎症反应的关系

目的探究ROC曲线评价肺炎支原体(MP)抗体效价对肺炎支原体肺炎(MPP)患儿的诊断价值及其对气道炎症反应的影响。方法选取阜阳市阜南县中医院2020年1月至2022年8月疑似MP感染患儿272例作为研究对象,根据呼吸道多病原核酸检测结果确诊为MPP患儿(168例)与非MMP患儿(104例)。采用颗粒凝集法检测血清MP抗体效价,受试者工作特征(ROC)曲线评价MP抗体效价对MPP的诊断价值,对比不同MP抗体效价患儿气道炎症反应指标[嗜酸粒细胞(EOS)、白三烯B4(LTB4)、白介素-18(IL-18)、肿瘤坏死因子-α(TNF-α)、C-反应蛋白(CRP)]水平,分析气道炎症反应指标与MP抗体效价相关性,并进行多元线性回归分析。结果以咽拭子检测结果为金标准,确诊168例阳性。外周血EOS、LTB4、IL-18、TNF-α、CRP水平:MP抗体效价<1:160<1:160<1:320<1:640<+1:1280,差异有统计学意义(F=80.241、97.513、90.028、87.502、80.325,P<0.05);外周血EOS、LTB4、IL-18、TNF-α、CRP水平与MP抗体效价呈正相关(r=0.735、0.578、0.494、0.399、0.424,P<0.05);多元线性回归模型控制发热时间、病情程度、X线影像特点等混杂因素后,外周血EOS、LTB4、IL-18、TNF-α、CRP仍与MP抗体效价显著相关(P<0.05)。结论MP抗体效价与MPP患儿气道炎症反应关系密切,对疑似MP感染患儿进行MP抗体效价检测可提高诊断率,便于指导临床早期治疗。

儿童重症肺炎支气管肺泡灌洗液的病原菌及药敏试验分析

目的了解儿童重症肺炎支气管肺泡灌洗液(BALF)的病原菌及药敏试验情况。方法选取该院2021年1月至2023年4月收治的100例重症肺炎患儿作为研究对象,对所有患儿进行支气管镜肺泡灌洗,并分析其BALF病原菌及药敏试验情况。结果100例患儿BALF中共培养出病原菌131株,革兰阴性菌98株(74.81%),革兰阳性球菌33株(25.19%),其中流感嗜血杆菌(25.19%)、肺炎链球菌(21.37%)占比较高,卡他布兰汉菌(15.27%)、肺炎克雷伯菌(11.45%)其次。重症肺炎患儿BALF中前4位病原菌主要以<1岁(97.37%)、1~3岁(96.88%)占比较高,>3~7岁(94.12%)、>7~14岁(92.31%)相对较少。各年龄BALF中流感嗜血杆菌、卡他布兰汉菌、肺炎克雷伯菌分布情况比较,差异均无统计学意义(P>0.05);各年龄BALF中肺炎链球菌分布情况比较,差异有统计学意义(P<0.05)。20株流感嗜血杆菌对四环素、阿莫西林-克拉维酸、头孢噻肟、复方磺胺甲噁唑均较敏感,对氯霉素敏感性其次,对氨苄西林、头孢克洛、头孢呋辛耐药性均较高;15株卡他布兰汉菌对头孢噻肟较敏感,对氨苄西林耐药性最高;8株肺炎克雷伯菌对头孢噻肟较敏感,对氨苄西林、头孢呋辛、氯霉素耐药性均较高,对阿莫西林-克拉维酸、四环素耐药性其次;20株肺炎链球菌对万古霉素、氯霉素均较敏感,对青霉素G、泰利霉素敏感性其次,对复方磺胺甲噁唑耐药性较高,对四环素、头孢噻肟、克林霉素耐药性其次。结论儿童重症肺炎BALF中病原菌以流感嗜血杆菌、肺炎链球菌多见,且0~3岁患儿病原菌占比高于>3~14岁,临床应合理用药以预防耐药菌株产生。

血清PCT、CRP及IL-4水平预测小儿支原体肺炎病情严重程度的价值

目的:探讨血清降钙素原(PCT)、C反应蛋白(CRP)及白细胞介素-4(IL-4)水平预测支原体肺炎患儿病情严重程度的价值。方法:选取2019年1月—2023年1月淮安市第二人民医院儿科收治的102例支原体肺炎患儿作为研究对象,根据病情将患儿分为轻症组59例和重症组43例。比较两组临床资料及基质细胞衍生因子(CXCL12)、γ干扰素(IFN-γ)、硫化氢(H_(2)S)、超氧化物歧化酶(SOD)、基质金属蛋白酶-9(MMP-9)、PCT、CRP及IL-4水平,多因素分析采取非条件logistic逐步回归分析,采用ROC曲线分析PCT、CRP及IL-4水平对重症支原体肺炎的预测价值。结果:两组性别、年龄、病程及CXCL12、IFN-γ、H_(2)S、SOD、MMP-9水平比较,差异无统计学意义(P>0.05);重症组PCT、CRP、IL-4水平显著高于轻症组,差异有统计学意义(P<0.05)。logistic逐步回归分析结果显示,PCT、CRP及IL-4为重症支原体肺炎独立危险因素(P<0.05)。ROC分析显示,PCT、CRP及IL-4预测重症支原体肺炎的曲线下面积分别为0.896、0.851、0.787。结论:血清PCT、CRP及IL-4水平均参与支气管肺炎患儿的病情进展,且可作为重症支气管肺炎的诊断指标。