| Background and objective:Recently an increasing number of severe or refractory Mycoplasma pneumoniae (MP) pneumonia has been reported. Despite of reasonable application of macrolide antibiotics, some cases become exacerbation and usually complicated with complications such as massive pleural effusion, occasionally resulting in death. In China, MP is considered the main cause of parapneumonic pleural effusion in children. Pleural effusion occured in approximately20%of MP pneumonia patients, leading to protracted hospital stay and increased morbidity. This study aimed to investigate the clinical features of MP pneumonia with pleural effusion and the changes of cytokines level in children.Methods:1. Retrospective analysis was conducted according to the clinical data of cases with pneumonia complicated by pleural effusion between July2009and Jun2014. These patients were divided into two groups based on etiologic agent:simple MP group (n=90) and bacterial group (n=29). Then we compared the clinical manifestations, laboratory examination and treatment between the two groups. In order to seek the reference indexes which indicate a discriminatory value for distinguishing MP pneumonia with pleural effusion cases from bacterial pneumonia, ROC curve was made.2. Prospective study was conducted based on20children diagnosed as MP pneumonia withpleural effusion between March2013and Jun2014. They were divided into two group s:MP-DN A positive in pleural effusion (n=11) and negative (n=9). At the same time, the patient’s blood, bronchoalveolar lavage fluid and pleural effusion samples were collected. Cytometric bead array (CBA) was used to detect IL-1β, IL-6, IL-10, TNF, IL-12p70, CXCL10, CCL2, CXCL9, CCL5and IL-8in blood, bronchoalvealar lavage fluid (BALF) and pleuraleffusion.Result:1. A total of530patients with pneumonia and pleural effusion between July2009and Jun2014were enrolled. MP infection was confirmed in185cases (34.9%), bacterial infection in29cases (5.5%), and tuberculosis infection in25cases (4.7%); MP MP mixed other pathogens were95cases (51.4%), including Chlamydia pneumoniae in51cases (53.7%), virus in27cases (28.4%), bacterial in15cases (15.8%) and parasite in2cases (2.1%).2. Compared with bacterial group, the mean age of simple MP group was much older (p=0.001). In the clinical manifestations, bacterial group exhibited a significantly longer time of hospital stay and fever, higher frequency of tachypnea (p<0.05). In the laboratory examination data, decreased levels of WBC, CRP, PCT and macrophages percentage in BALF, and increased levels of LDH, IL-4, IFN-y, neutrophil percentage in BALF and GLU in pleural effusion were observed in simple MP group compared with bacterial group (p<0.05). In treatment, simple MP group was less likely to undergo thoracocentesis (33.3%) and closed chest tube drainage (3.3%) than bacterial group (79.3%and24.1%, respectively). When compared with bacterial pleural effusion, the critical values of the four independent correlation factors were indicative for MP pneumonia including age≥45month, serum LDH≥479.5IU/L, IFN-γ>7.35pg/ml and pleural effusion GLU≥4.71mmol/L.3. The level of N%, CRP and blood LDH in pleural effusion MP-DNA positive group was higher than the negative group (p=0.047,p=0.001and p=0.049, respectively). Increased levels of IL-6, CCL2and IL-8in pleural effusion were observed in positive group compared with negative group (p=0.009,p=0.044and p=0.04, respectively). There were no statistically significant differences in terms of cytokine levels in blood and BALF between the two groups (p>0.05).Conclusion:1. Mycoplasma pneumonia is the most important etiology of infected pleural effusion in children, followed by bacterium and mycobacterium tuberculosis.2. Some factors might be indicative for MP pneumonia such as age≥45month, serum LDH≥479.5IU/L, FN-γ≥7.35pg/ml and pleural effusion GLU≥4.71mmol/L, when compared with bacterial pleural effusion.3. The increased levels of IL-6, CCL2and IL-8in pleural effusion may be associated with MP direct invasion of pleura. |
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