The Value Of Respiratory Multiple Detection Combined With Clinical Features In The Diagnosis And Treatment Of Community-acquired Pneumonia

Objective:To explore the internal relationship between different pathogenic infections and characteristic clinical manifestations in refractory community-acquired pneumonia(RCAP),and to provides clinical evidence to support clinical physicians in the diagnosis and early intervention of RCAP.To explore the clinical characteristic of children with Mycoplasma pneumoniae pneumonia(MPP)with atopic sensitization.Methods:The pathogen detection results of bronchoalveolar lavage fluid(BALF)and clinical data of 1109 children with RCAP were collected,and then according to the results of pathogen detection in BALF,we divided the children into four groups:the simple MP(Mycoplasma pneumoiae,MP)infection group,the simple bacterial infection group and the simple virus infection group,and coinfection group(A mixture of two or more pathogen infections).And then we compared the laboratory testsand the clinical characteristics among the four groups.Children were diagnosed with MP infection through with the ELISA and the real-time PCR,1050 children with MPP were totally enrolled and divided into 2 groups:atopic MPP group and the non-atopic MPP group.Results:MP,bacteria,viruses and mixed infections could all lead to RCAP,MP was the first pathogen of RCAP,streptococcus pneumoniae was the first bacterial pathogen,and human bocavirus was the first virus pathogen.The patients in pure MP infection group were older,cough more frequently and the mean duration of fever was longer,the incidence of elevated CK-MB was higher and the main pulmonary radiographic presentation was labor pneumonia.Patients in pure bacteria infection group were older,more patientswith atopic constitution,the levels of neutrophils proportion and the incidence of CRP>40mg/L were higher.Patients in pure virus infection group had higher incidence of elevated ALT,the main pulmonary radiographic presentation was bronchopneumonia pneumonia.Patients in coinfection group predisposed to younger children and have longer duration of hospitalization,and more patients with atopic constitution,LDH was higher,the proportion of atelectasis in pulmonary radiographic presentation was higher.Boys aged 1 to 3 years with atopic sensitization could lead to MPP easily after MP infection.Children with MPP with atopic sensitization appearing long thermal process and shortness more frequently,the main pulmonary radiographic presentation was labor pneumonia and easy to combined with mixed infection,the incidence of elevated PLT,CRP,LDH,CK-MB were higher,and were easy to combined with mixed infection,and more likely to develop to RMPP.Conculsion:(1)MP,bacteria,viruses and mixed infections can all lead to RCAP,MP is the first pathogen of RCAP,streptococcus pneumoniae is the first bacterial pathogen,and human bocavirus is the first virus pathogen.(2)The patients in pure MP infection group are older,cough more frequently and the mean duration of fever is longer,the incidence of elevated CK-MB is higher and the main pulmonary radiographic presentation is labor pneumonia.(3)Patients in pure bacteria infection group are older,more patientswith atopic constitution,the levels of neutrophils proportion and the incidence of CRP>40mg/L are higher.(4)Patients in pure virus infection group have higher incidence of elevated ALT,the main pulmonary radiographic presentation is bronchopneumonia pneumonia.(5)Patients in coinfection group predisposto younger children and have longer duration of hospitalization,and more patients with atopic constitution,LDH is higher,the proportion of atelectasis in pulmonary radiographic presentation is higher.(6)Boys aged 1 to 3 years with atopic sensitization could lead to MPP easily after MP infection.Children with MPP with atopic sensitization appearing long thermal process and shortness more frequently,the main pulmonary radiographic presentation was labor pneumonia and easy to combined with mixed infection,the incidence of elevated PLT,CRP,LDH,CK-MB were higher,and were easy to combined with mixed infection,and more likely to develop to RMPP.