Clinical Features And Small Airway Function In Children With Mycoplasma Pneumoniae Pneumonia

Objective:To study and summarize the features of clinic,laboratory,chest imaging,and complications in children with different severity of acute phase MPP,to investigate the characteristics of different stages of severity and different clinical manifestations of pulmonary function in children with MPP,to further investigate the characteristics of pulmonary function of MPP in children with acute phase and convalescent,especially small airway function,the purpose is to provide a theoretical basis for clinical diagnosis and treatment of children with MPP in the acute and convalescent stages.Methods:A retrospective analysis was used to select 88 children with MPP who were admitted to the Respiratory Unit of Dalian Children’s Hospital from October 2016 to October 2017.According to the severity of illness,the patients were divided into severe MPP group and mild MPP group.According to the period of illness,it is divided into acute phase and recovery phase.According to the clinical manifestations of the disease,it is divided into wheezing group and non-wheezing group.The clinical manifestations,laboratory indicators,chest imaging findings,complications,and lung function indicators,especially small airway function indexes were statistically analyzed and compared.Results:1.Among 88 MPP children,33 were severe MPP and 55 were mild MPP.Compared with mild MPP group,the duration of fever,duration of cough,hospital stay,serum C-reactive protein(CRP)and procalcitonin(PCT)in severe MPP group weresignificantly higher than those in mild MPP group,and the difference was statistically significant(P <0.05).2.Among 88 children MPP,chest imaging findings in the acute stage was mainly lobar pneumonia,accounting for 57.96%,followed by lobular pneumonia,accounting for 39.77%.Among the severe MPP groups,lobar pneumonia was the most common,accounting for 100%.In the acute phase,MPP lesions were mainly located in single lobes,accounting for 75%,of which the most common was the lower lobe.Severe MPP group lesions involved in multiple lobes more than a single lobe,right lung more than left lung,lower lobe more than the upper lobe,mainly in the right lower lobe.3.The most common of intrapulmonary complications in 88 MPP children were pleural effusions,accounting for 31.82%.Intrapulmonary complications of the severe MPP group included atelectasis,emphysema,necrotizing pneumonia,and pleural effusion,of which the most common was pleural effusion,accounting for 75.76%,and followed by atelectasis,accounting for 9.09%.The most common extrapulmonary complications in 88 children with MPP were acute rash(13.63%),followed by abnormal electrocardiogram(ECG)and abnormal liver function.Extrapulmonary complications in the severe MPP group included rash,abnormal ECG,abnormal liver function,pericardial effusion,of which the most common was rash,accounting for21.2%.4.Eighty-eight MPP patients underwent pulmonary function tests,of which 75(85.23%)had pulmonary ventilation dysfunction and 7(7.95%)had small airway ventilation dysfunction.Of the 75 patients with MPP,the most common types of pulmonary dysfunction were mixed ventilation dysfunction,accounting for 92.0%;those with restrictive ventilation dysfunction were the second,accounting for 5.33%;and those with Obstructive ventilation dysfunction is the least,accounting for 2.67%.Compared with pulmonary dysfunction rate between severe MPP group and mild MPP group in 88 MPP children,there was no statistically significant difference between the two groups(P> 0.05).Compared with pulmonary dysfunction degree between severe MPP group and mild MPP group,there was statistically significant difference betweenthe two groups(P <0.05).Compared with FEV1,PEF,FEF25%,FEF50%,FEF75%,MMEF between severe MPP group and mild MPP group,there was no statistically significant difference between the two groups(P> 0.05).Among 88 acute MPP children,there were 16 cases in wheezing group,accounting for 18.18%;there were 72 cases in non-wheezing group,accounting for 81.82%.Compared with non-wheezing group,the FEF50% and MMEF of wheezing group were significantly lower than of non-wheezing group,and the difference was statistically significant(P <0.05).5.Totally 27 out of 75 acute MPP patients with pulmonary dysfunction underwent reexamination of lung function after 4 weeks.Among these 27 cases of convalescent MPP children,22 cases had normal pulmonary ventilation function,accounting for81.49%;the case of abnormal pulmonary ventilation function was o;5 cases had small airway dysfunction,accounting for 18.51%.Compared with FVC 、 FEV1 、 PEF 、FEF25%、FEF50%、FEF75%、MMEF between acute phase and convalescent in these 27 MPP children,all indexes of convalescent were obviously increased,and the difference between the two phases was statistically significant(P <0.05).Conclusion:1.In the acute phase of Mycoplasma pneumoniae pneumonia,compared with mild MPP,the clinical features of children with severe MPP were as follows: duration of fever and duration of cough were significantly prolonged;serum CRP,PCT and other indicators of infection was significantly increased;their hospital stay was also significantly increased;chest imaging showed mostly lobar pneumonia,mainly involving multiple lobes,of which the right lower lobe was more common;the main pulmonary complications were pleural effusion and atelectasis;the main extrapulmonary complication was the rash.2.About 4/5 of children of acute phase MPP had different levels of pulmonary ventilation dysfunction,mainly to mixed ventilation dysfunction.The severity of severe MPP was the most important,suggesting the application of bronchodilators in the acute phase of MPP.3.In the acute phase of MPP,about one-fifth of MPP patients had clinicalwheezing symptoms.Compared with non-wheezing group of MPP,FEF50% and MMEF were significantly decreased in the wheezing group,suggesting that we should focus on small airway dysfunction in children with wheezing symptoms in the acute phase of MPP.4.Children with pulmonary dysfunction in the acute phase of MPP experienced an improvement in their lung function.Most of the children with MPP returned to normal lung function gradually after 4 weeks of clinical recovery.However,there is still one-fifth of MPP patients with small airway dysfunction.