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.

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.

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.

Evaluating the role of interleukin-2 and interleukin-12 in pediatric patients with concurrent Mycoplasma pneumoniae and Epstein-Barr virus infections

BACKGROUND Mycoplasma pneumoniae(MP)frequently causes respiratory infections in children,whereas Epstein-Barr virus(EBV)typically presents subclinical manifestations in immunocompetent pediatric populations.The incidence of MP and EBV coinfections is often overlooked clinically,with the contributory role of EBV in pulmonary infections alongside MP remaining unclear.AIM To evaluate the serum concentrations of interleukin-2(IL-2)and interleukin-12(IL-12)in pediatric patients with MP pneumonia co-infected with EBV and assess their prognostic implications.METHODS We retrospectively analyzed clinical data from patients diagnosed with MP and EBV co-infection,isolated MP infection,and a control group of healthy children,spanning from January 1,2018 to December 31,2021.Serum IL-2 and IL-12 levels were quantified using enzyme-linked immunosorbent assay.Logistic regression was employed to identify factors influencing poor prognosis,while receiver operating characteristic(ROC)curves evaluated the prognostic utility of serum IL-2 and IL-12 levels in co-infected patients.RESULTS The co-infection group exhibited elevated serum IL-2 and C-reactive protein(CRP)levels compared to both the MP-only and control groups,with a reverse trend observed for IL-12(P<0.05).In the poor prognosis cohort,elevated CRP and IL-2 levels,alongside prolonged fever duration,contrasted with reduced IL-12 levels(P<0.05).Logistic regression identified elevated IL-2 as an independent risk factor and high IL-12 as a protective factor for adverse outcomes(P<0.05).ROC analysis indicated that the area under the curves for IL-2,IL-12,and their combination in predicting poor prognosis were 0.815,0.895,and 0.915,respectively.CONCLUSION Elevated serum IL-2 and diminished IL-12 levels in pediatric patients with MP and EBV co-infection correlate with poorer prognosis,with combined IL-2 and IL-12 levels offering enhanced predictive accuracy.

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.

Analysis of the Role of D-Dimer,Interleukin-6,and Interleukin-18 in Differential Diagnosis of Pediatric Refractory Mycoplasma pneumoniae Pneumonia

Objective:To analyze the value of D-dimer(D-D),interleukin-6(IL-6),and IL-18 in the differential diagnosis of children with refractory Mycoplasma pneumoniae pneumonia(RMPP).Methods:The medical records of 92 children with Mycoplasma pneumoniae pneumonia(MPP)treated in the hospital were selected for retrospective analysis from January 2023 to January 2024.After comprehensive examinations such as computed tomography examination of the chest,48 children with general Mycoplasma pneumoniae pneumonia(GMPP)were put in the GMPP group and 44 children with RMPP were grouped in the RMPP group.The IL-6,IL-18,and D-D levels were compared between the two groups,and the receiver operating characteristic(ROC)curves were plotted to analyze their value for differential diagnosis of RMPP.Results:The levels of IL-6,IL-18,and D-D in the RMPP group were higher than those in the GMPP group(P<0.05);the ROC curves showed that the specificity of the differential diagnosis of IL-6,IL-18,and D-D was higher,and their diagnostic value was significant.Conclusion:Determination of IL-6,IL-18,and D-D levels in children with MPP can further diagnose the children’s condition,which can help physicians formulate targeted treatment plans,and is of great significance to the improvement of the children’s condition,which is worthy of attention.

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.

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。

不同时期RMPP患儿支气管肺泡灌洗液SPA表达及与肺功能的关系

目的探讨不同时期难治性支原体肺炎(refractory mycoplasma pneumoniae pneumonia,RMPP)患儿支气管肺泡灌洗液中表面活性物质相关蛋白-A(surfactant protein A,SPA)的表达水平及与肺功能的关系。方法选取2021年1月—2023年1月南通市第一人民医院收治的62例RMPP患儿为对象,以同期行支气管镜异物取出术且无肺部感染的50例患儿为对照组。RMPP患儿于急性期、恢复期行支气管肺泡灌洗液中SPA检测以及肺功能指标检测[第1秒用力呼气容积(forced expiratory volume in one second,FEV_(1))、用力肺活量(forced vital capacity,FVC)、FEV_(1)/FVC],对照组同样如此。比较三者检测结果差异,使用Pearson分析RMPP患儿支气管肺泡灌洗液中SPA水平与肺功能指标的相关性。结果RMPP患儿肺泡灌洗液中的SPA急性期(59.82±12.64)μg/L、恢复期(129.91±24.86)μg/L高于对照组,差异有统计学意义(P<0.05)。RMPP急性期、RMPP恢复期的FEV_(1)、FVC、FEV_(1)/FVC(80.95±6.88)%、(88.41±5.75)%较对照组低,差异有统计学意义(P<0.05);RMPP患儿于急性期时肺泡灌洗液中的SPA较恢复期低,FEV_(1)、FVC、FEV_(1)/FVC较恢复期低,差异有统计学意义(P<0.05);RMPP患儿肺泡灌洗液中SPA水平与FEV_(1)、FVC、FEV_(1)/FVC呈正相关(P<0.05)。结论RMPP患儿病情处于急性发展阶段的情况下其支气管肺泡灌洗液中的SPA表达相较病情恢复阶段更低,同时RMPP患儿支气管肺泡灌洗液中SPA水平与其肺功能指标呈正相关性。

Comparative Analysis for the Detection and Monitoring of Mycoplasma hyopneumoniae Infection by Nested PCR(n-PCR) and Real time PCR(q-PCR) from Field Swine Herds

[Objective] 303 nasal swabs samples were collected from pigs in farms located in Taizhou city, Jiangsu Province, China from March to December 2012 for the purpose of detecting the presence of Mycoplasma hyopneumoniae, the primary agent of Enzootic porcine pneumonia （EPP） in pig herds using the nested PCR and Real time PCR techniques. [Method] Nasal swabs were collected from pigs of different ages＇ i.e. 7, 14, 21, 28, 30 and 35 days old, soaked in sterile 1 xPBS overnight at 4 ℃ and DNA extracted using the TIANamp（R） bacterial DNA kit. The DNA samples underwent amplification under the Mhyo 183 q-PCR and P36 primer Nested PCR systems. [Result] With the Nested PCR assay, 38 （12.5%） out of 303 samples tested positive for the presence of M. hyopneumoniae; with the real time PCR assay 152 （50.2%） tested positive for M. hyopneumoniae. The two assays matched to positively detect Mhyo in 22 （7.3%） samples and again matched in 127 （41.9%） samples negative for Mhyo infection. The pattern of infection in both assays was similar where 7- and 35-day-old piglets in both assays had the highest rates of infection i.e. 15.6% and 18.4% for n-PCR and 53.1% and 56.6% for q-PCR for 7- and 35-day-old piglets respectively. [Conclusion] The results highlight the suitability of both PCR assays in establishing the herd infection status of pigs in field conditions.

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.

MP感染合并哮喘患儿血清miR-424-5p、MCP-1、TLR4水平联合检测预测预后的效能

目的探讨肺炎支原体(MP)感染合并哮喘患儿血清miR-424-5p、单核细胞趋化蛋白-1(MCP-1)、Toll样受体4(TLR4)水平联合检测预测预后的效能。方法回顾性选取2021年8月至2023年8月濮阳市人民医院收治的107例MP感染合并哮喘患儿作为研究对象,所有患儿均给予对症治疗,根据6个月预后分为预后良好组86例和预后不良组21例。比较两组患儿的基线资料和血清miR-424-5p、MCP-1、TLR4水平,采用Logistic回归分析各血清指标对预后的影响,绘制受试者工作特征(ROC)曲线及曲线下面积(AUC)分析血清miR-424-5p、MCP-1、TLR4对预后的预测效能。结果两组患儿的病程、发热天数、呼吸道感染史比较差异均有统计学意义(P<0.05);预后不良组患儿的血清miR-424-5p、MCP-1、TLR4水平分别为1.56±0.41、(84.29±15.19)μg/L、(95.21±13.52)ng/mL,明显高于预后良好组的1.23±0.33、(70.38±11.36)μg/L、(83.10±10.17)ng/mL,差异均有统计学意义(P<0.05);校正前Logistic回归分析结果显示,病程、发热天数、呼吸道感染史、血清miR-424-5p、MCP-1、TLR4均是MP感染合并哮喘患儿预后的独立影响因素(P<0.05),校正后Logistic回归分析结果显示,血清miR-424-5p、MCP-1、TLR4仍是MP感染合并哮喘患儿预后的独立影响因素(P<0.05);ROC曲线结果显示,血清miR-424-5p、MCP-1、TLR4联合检测预测MP感染合并哮喘患儿预后的AUC为0.900,优于各血清指标单独预测。结论MP感染合并哮喘患儿血清mi R-424-5p、MCP-1、TLR4与预后密切相关,三者联合检测预测MP感染合并哮喘患儿预后具有良好的参考价值。

Lymph-node-first presentation of Kawasaki disease in a 12-year-old girl with cervical lymphadenitis caused by Mycoplasma pneumoniae:A case report

BACKGROUND To the best of our knowledge,cases of Kawasaki disease(KD)occurring at the age of 12 are rare,even in Asia where the incidence of KD is high.We report a case of lymph-node-first presentation of KD(NFKD)in a 12-year-old girl with Mycoplasma pneumoniae(M.pneumoniae)infection who presented with prolonged fever and lymphadenitis refractory to macrolide antibiotics.CASE SUMMARY A previously healthy 12-year-old girl presented with fever,myalgia,sore throat,swelling,and tenderness on the right side of the neck.She was initially diagnosed with lymphadenitis caused by M.pneumoniae refractory to macrolide antibiotics.She had elevated brain natriuretic peptide(BNP)levels.Finally,the patient was diagnosed with KD.After receiving intravenous immunoglobulin,the fever resolved,and her symptoms improved.CONCLUSION NFKD should be differentiated from adolescent lymphadenitis presenting with prolonged fever by checking the BNP level early.

干扰素γFM及MP-Ab检测在小儿支原体肺炎诊断及评估中的临床意义

目的:分析干扰素γ(Interferon-γ,IFN-γ)、纤维蛋白单体(Fibrin monomer,FM)及肺炎支原体抗体(Mycoplasma pneumoniae antibody,MP-Ab)检测在小儿支原体肺炎感染中的临床意义。方法:选取2020年11月至2023年11月本院收治的103例支原体肺炎患儿作为研究对象,设定为观察组,另选取同期在本院行体检各项正常者60例健康体检儿童作为对照组,对比两组血清IFN-γ、FM水平以及MP-Ab含量;对比观察组不同病情程度患儿血清IFN-γ、FM水平以及MP-Ab含量;以病原学检查为金标准,分析血清IFN-γ、FM及MP-Ab检测对支原体肺炎病情的评估价值。结果:103例支原体肺炎患儿中,其中72例属于急性期,31例属于恢复期;72例急性期患儿中18例为重症支原体肺炎,54例为轻症支原体肺炎。观察组中急性期、恢复期患儿血清IFN-γ、FM水平与MP-Ab含量及各指标阳性检出率均显著高于对照组,而急性期显著高于恢复期(P<0.05)。观察组急性期中重症患儿血清IFN-γ、FM水平与MP-Ab含量及各指标阳性检出率均显著高于轻症患儿,比较差异具有统计学意义(P<0.05)。结论:干扰素γ、FM水平及MP-Ab含量在支原体肺炎患儿中呈现高表达,且随着病情的加重而呈逐渐升高趋势,对患儿疾病的早期诊断及病情评估有潜在的应用价值。

MP合并hMPV和SP感染的重症肺炎患儿1例药学监护

临床药师全程参与1例肺炎支原体(MP)合并偏肺病毒(hMPV)和肺炎链球菌(SP)感染的重症肺炎患儿药学监护,在患儿病情复杂、医师忽略MP感染、超说明书用药和违反传统理论联合用药的情况下,查阅资料,结合病情深入剖析,及时提供安全有效的治疗方案分析和建议,监测疗效和不良反应,进行用药指导;较好地保障了患儿用药的安全性和有效性,提供了有效的药学服务,同时为此类患儿的药物治疗和监护提供参考。

小儿MPP并发塑型性支气管炎的临床特点、胸部CT影像学特征及相关因素分析

目的分析小儿肺炎支原体肺炎(MPP)并发塑型性支气管炎(PB)的临床特点、胸部CT影像学特征及相关影响因素。方法选取2019年2月-2023年3月于我院住院治疗的MPP患儿206例作为研究对象,依据支气管镜检查结果分为PB组(n=48)和非PB组(n=158),对两组患儿临床资料、实验室指标、胸部CT、支气管镜检查报告进行回顾性分析,并采用多因素Logistic回归分析影响小儿MPP并发PB的重要相关因素。结果PB组患儿热峰、热程、住院时间、支气管镜次数,呼吸困难和肺部啰音的发生率均高于非PB组(P<0.05);PB组患儿C-反应蛋白(CRP)、降钙素原(PCT)、乳酸脱氢酶(LDH)、肌酸激酶同工酶(CK-MB)、红细胞沉降率(ESR)和D-二聚体(DD)水平均高于非PB组(P<0.05);PB组患儿胸部CT双肺实变、胸腔积液、节段性肺不张、支气管黏液嵌塞征和累及胸膜病变的发生率高于非PB组(P<0.05);PB组患儿支气管镜下可见痰栓堵塞呼吸道,堵塞部位以右下20.83%(10/48)和≥2个肺叶累积29.17%(14/48)最为多见,PB组患儿发生黏膜坏死的比例明显高于非PB组(P<0.05)。多因素Logistic回归分析结果显示,热程>11d、胸腔积液征、CRP>36.82mg/L和LDH>545.29U/L是MPP患儿并发PB的重要影响因素。结论MPP患儿并发PB热峰高、热程较长,有CRP、LDH、CK-MB、ESR明显升高的特征,胸部CT表现有胸腔积液,伴肺不张;热程>11d、胸腔积液征、CRP>36.82mg/L和LDH>545.29U/L是MPP患儿并发PB的重要危险因素。

Kawasaki disease, <i>Mycoplasma pneumoniae</i>infection and anaplastic large cell lymphoma: An uncommon association

Kawasaki disease (KD) is an acute febrile systemic vasculitis occurring predominantly in young children less than 5 years of age. Although imperfectly known, the aetiopathogenesis of KD would be secondary to immunological abnormalities that could constitute a favourable terrain for neoplasms. We report on a case in a 2-year-old girl who presented clinical manifestations compatible with Kawasaki disease complicated by coronary aneurysm. Aetiopathological investigations revealed M. pneumoniae infection as specific IgM were present in the serum (Elisa). The patient was initially treated by intravenous immunoglobulins (IVIG) and aspirin to anti-inflammatory dose. Following a few days of desquamation, resolution of the symptomatology occurred. Four weeks later she developed disseminated tumorous syndrome. Lymph node biopsy revealed massive infiltration by large cells lymphomatous proliferation. Histologic and immunophenotypic findings were characteristic of ALK-1+ anaplastic large cell lymphoma. Four weeks later, the patient died from a severe nosocomial infection complicated by septic shock. Our observation is the first cases describing the association between anaplastic large cell lymphoma, KD and M. pneumoniae. Immunologic disorder due to KD and M. pneumoniae infection may play probably a central role for malignancy.

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。

CRP、LDH、ESR与MPP恢复期患儿发生气道高反应性的关系分析

目的探究C-反应蛋白(CRP)、乳酸脱氢酶(LDH)、红细胞沉降率(ESR)与肺炎支原体肺炎(MPP)恢复期患儿发生气道高反应性(AHR)的关系分析。方法回顾性选择2019年8月至2022年8月于西部战区总医院住院的MPP恢复期患儿102例,根据患儿是否发生AHR,分为AHR组(n=48)及非AHR组(n=54)。比较两组的CRP、LDH、ESR水平、肺功能指标[用力肺活量(FVC)、第1 s用力呼气容积(FEV1)、峰值呼气流速(PEF)与最大呼气中段流速(MEF25-75)]、气道反应性指标[基础呼吸传导率(Grs cont)、基础呼吸阻力(Rrs cont)、传导率下降斜率(SGrs)、特异性气道传导下降第35百分位(PD35)、最小诱发累积剂量(Dmin)],分析CRP、LDH、ESR水平与气道反应性指标的相关性,并采用受试者工作特征(ROC)曲线评估CRP、LDH、ESR对MPP恢复期患儿发生AHR的预测价值。结果AHR组的CRP、LDH、ESR水平分别为(47.34±7.65)mg/L、(315.26±68.32)U/L、(45.71±6.25)mm/h,均高于非AHR组[(26.21±6.28)mg/L、(284.53±61.09)U/L、(31.46±5.13)mm/h],差异均有统计学意义(P<0.05)。AHR组的FVC、FEV1、PEF、MEF25-75水平分别为(83.01±10.43)%、(74.35±9.27)%、(70.29±7.63)%、(75.54±9.25)%,均低于非AHR组[(87.82±12.06)%、(83.49±12.38)%、(78.11±9.54)%、(80.02±10.37)%],差异均有统计学意义(P<0.05)。AHR组的Grs cont、SGrs、PD35、Dmin水平分别为(0.13±0.03)L/(s·cmH_(2)O)、(0.03±0.01)L/(s·cmH_(2)O·min)、1.59±0.42、1.24±0.33,均低于非AHR组[(0.17±0.05)L/(s·cmH_(2)O)、(0.05±0.02)L/(s·cmH_(2)O·min)、4.06±1.15、3.97±0.82],Rrs cont水平为(8.75±1.63)cmH_(2)O/(L·s),高于非AHR组[(8.12±1.31)cmH_(2)O/(L·s)],差异均有统计学意义(P<0.05)。CRP、LDH、ESR与患儿的Grs cont、SGrs、PD35、Dmin水平均呈负相关(P<0.05),CRP、LDH、ESR与患儿Rrs cont水平均呈正相关(P<0.05)。ROC曲线分析结果显示,3项指标联合预测MPP儿童恢复期发生AHR的曲线下面积为0.878,均高于单一的CRP、LDH、ESR的0.804、0.674、0.760。结论CRP、LDH、ESR可作为MPP恢复期患儿发生AHR的重要标志物,可为临床评估患儿病情及用药提供参考。

肺炎支原体肺炎患儿外周血PCT、IL-6水平与MP抗体滴度、MP-DNA的相关性分析

目的探究肺炎支原体肺炎(MPP)患儿外周血降钙素原(PCT)和白细胞介素-6(IL-6)水平与肺炎支原体(MP)抗体滴度、肺炎支原体DNA(MP-DNA)的相关性。方法选取2023年3月至2024年3月武汉市第三医院收治的97例MPP患儿为研究对象,根据病情严重程度将其分为轻症组(n=63)和重症组(n=34),根据血清MP抗体滴度不同分为1∶160亚组(n=19)、1∶320亚组(n=56)和≥1∶640亚组(n=22)。比较轻症组和重症组患儿临床肺部感染评分(CPIS)、外周血PCT和IL-6水平、血清MP抗体滴度及MP-DNA阳性率,分析外周血PCT和IL-6水平与血清MP抗体滴度、MP-DNA阳性率的相关性。结果重症组患儿CPIS评分、外周血PCT水平、IL-6水平和MP-DNA阳性率均高于轻症组(P<0.05);两组患儿血清MP抗体滴度分布比较,差异有统计学意义(P<0.05);不同血清MP抗体滴度亚组患儿外周血PCT、IL-6水平及MP-DNA阳性率比较,差异有统计学意义(P<0.05),外周血PCT、IL-6水平随血清MP抗体滴度增加而升高(P<0.05),血清MP抗体滴度1∶160亚组的MP-DNA阳性率低于MP抗体滴度1∶320亚组和≥1∶640亚组(P<0.05);Spearman分析结果显示,MPP患儿外周血PCT和IL-6水平、MPP重症、CPIS评分与血清MP抗体滴度、MP-DNA阳性结果均呈正相关(P<0.05)。结论MPP患儿外周血PCT和IL-6水平随病情严重程度而升高,与血清MP抗体滴度和MP-DNA阳性结果呈正相关,二者对MPP患儿病情评估具有一定参考价值。