| Study objective:A drastically increasing number of severe cases caused by Mycoplasma pneumoniae(MP)infection with long-lasting fever has been reported repeatedly by the clinical studies over the recent years.In addition to pulmonary complications including pulmonary consolidation,pleural effusion,atelectasis and bronchiectasis,MP also plays a major role in extrapulmonary complications with concomitant multiple system and organ damage.It can also result in necrotizing pneumonia,lung related sequelae,even cause death in few severe cases.Therefore early diagnosis of severe Mycoplasma pneumoniae pneumonia(SMPP)and reducing the occurrence of the pulmonary and extrapulmonary complications has become a trending topicin the realm of MPclinical research.The aim of this paper is to investigate the clinical features and main factors of severe Mycoplasma pneumoniae pneumonia(MPP),and to serve as an clinical evidence for early diagnosis of the disease and proper medical treatment.Method:A total of 130 children were randomly selected for the study from all hospitalized MPP cases between September 2015 and April 2016,62 of which were diagnosed with SMPP and 68 of them with mild MPP.Both case and control groups have received blood routine,biochemical and etiology tests at admission,along with the electrocardiogram,ultrasound test,chest X-Ray and chest CT scan.In addition,the levels of serum interleukin 18(IL-18),interleukin 6(IL-6),lactate dehydrogenase(LDH),interferon γ(IFN-γ),tumor necrosis factor α(TNF-α)were measured for all the subjects.Results:There were 86.7% and 100% of the children have fever in the mild MPP group and SMPP group,respectively;and the extents of fever were significantly different between two groups(p<0.01).In terms of clinical laboratory tests,there were significant differences in blood routine,C-reactive protein(CRP),LDH,Tlymphocyte subsets and immune globulin between mild MPP group and SMPP group as well(p<0.01).We have observed 8(14.7%)cases having concurrent infections causing by other pathogenic bacteria in the mild MPP group,and 22(35.5%)cases in the SMPP group(p<0.01).The chest diagnostic imaging tests have also suggested statistical significant difference in lung lesions between two groups(p<0.01);where 76.8% in the mild MPP group had lobular lesion and 90.3% in the SMPP group had large pulmonary consolidation,mostly coming along with thepulmonary and extrapulmonary complications.The average serum IL-18 level of the 130 participants in the case group(256.56±18.26 pg/ml)was significantly(p<0.01)higher than it in the control group(78.82±14.26 pg/ml);as to serum IL-18,the serum IL-6 level of case group(59.35±14.26 pg/ml)was higher than it of control group(38.60±5.35 pg/ml)as well(p<0.01).Similar difference can be observed for LDH level between case and control group(559.38±187.15 U/L v.s.278.46±59.29 U/L with p<0.01).The sample also suggested the existence of postive correlation between serum IL-18 and IL-6(r=0.62,p<0.05).Although the IFN-γ level of the case group(2.72±0.68pg/ml)was higher than it of the control group(2.34±0.44 pg/ml),the difference was not significant.The level of TNF-α in the case group(13.92±3.91 pg/ml)was significantly(p<0.01)higher compare to the control group(7.5±2.04 pg/ml).The subjects with SMPP had significantly(p<0.05)higher levels of serum IL-18,IL-6 and LDH compare to the ones with mild MPP in general.The IFN-γ level is lower in the SMPP group,but the difference was not significant.The level of serum IL-18 was positively related to lung infiltrates(r=0.61,p<0.05).Conclusions:1.The children with SMPP have greater age than those with mild MPP in average,and the clinical manifestation were more severe.There were obvious abnormalities in the laboratory indexes among the children with SMPP.The chest diagnostic image have often shown substantial pulmonary consolidation in the SMPP group.The children with SMPP were more likely to suffer from the pulmonary and extrapulmonary complications,along with greater chance of having mixed infection.Hence the children with SMPP needed bronchoalveolar lavage(BAL)more than others.2.The serum IL-18 and IL-6 level markedly elevated during the acute MP infection stage,and played major roles in the development of MP infection.The serum IL-18 and IL-6 can stimulate the immune response of the mediators of Type 1 T helper(Th1);the abnormal behavior of IFN-γ suggested that the serum IL-18 may function not only through TH-1 cytokine pathway.The level of LDH rose noticeably when the children infected with SMPP,it also positively associated with the level of serum IL-18.It provides guidance for adjusting therapeutic regimen and improving prognosis. |
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