| Objective: To analyze the clinical features of severe or refractory Mycoplasma pneumoniae pneumonia (MPP) treated by bronchoalveolar lavage in children and explore the difference of the clinical features with lesions of lung in various degree.Methods: Ninety-five cases of mycoplasma pneumoniae pneumonia treated by bronchoalveolar lavage clinical information in children in Respiratory Department of Dalian Children's Hospital from October 2008 to September 2010 are respectively collected and then their clinical manifestations, laboratory tests, chest imaging, bronchoscopy,treatment and prognosis are reviewed. Accordingly, chest imaging are carried out to check and the studied cases are divided two groups:the mild group of pulmonary lesions is defined as having an area of consolidation in less than one lobe,while the severe group is defined as having an area of consolidation over one lobe and/or any consolidation with pleural effusion and explore the relationship between clinical features and test results with pulmonary lesions.Result: The average age of children with the studied mycoplasma pneumonia was 6.57±2.64 years old, as well, the mean duration of fever was 16.29±7.07 days and the median length of hospital stay was 18.30±5.82 days.19 cases (20%) patients suffered extrapulmonary symptoms mainly with myocardial damage, and 5 patients suffered multiple organ dysfunction syndrome.40 cases (42.1%) children suffered a mix of bacteria and (or) virus infection.Chest imaging showed all of the cases have one or multiple lobes involved with pulmonary consolidation,58 cases (61.1%) patients with severe pulmonary lesions, including 49 cases (51.6%) of pleural effusion, 25 cases (26.3%) of pleurisy, 47 cases (49.5%) of multiple lobes involvement and 34 cases (35.8%) of atelectasis.Bronchoscopy showed visible lesions of mucosal hyperemia, edema and increased secretion of other luminal swelling, 68 cases (71.6%) with tube ridge widened, 27 cases (28.4%) with lung segment / sub-segmental bronchus necrosis clogging the nozzle. Intravenous glucocorticosteroid treatment was used for 28 patients (29.5%), and 17 cases(17.9%) of children had got rid of the fever in 1st to 3rd days after adding glucocorticoid, 42 patients (44.2%) treated with bronchoalveolar lavage defervesced in the 1st to 3rd days after the treatment.Prognosis of lung showed 73.5% atelectasis reexpansion,35.8% of children with pulmonary infiltrates have been most or completely absorbed. The severe group associated with higher C-reactive protein (CRP) values than the mild group (Ρ= 0.02).The severe group are more common in the presence of extrapulmonary symptoms and MP-IgM antibody seroconversion cases (Ρ= 0.04,Ρ= 0.04).Mixed bacterial infection of MPP patients have longer duration of fever (Ρ= 0.04).Conclusion: 1.The MPP treated by bronchoalveolar lavage in children is mostly found in older children;2. In cases there is a higher proportion of mixed infections and with bacterial infection is one of the factors prolonged the illness;3.The cases'treatment of joint use of macrolides and bronchoalveolar lavage showed a positive effect and glucocorticosteroid therapy also showed a short-term positive effect;4. For the severe pulmonary lesions cases, CRP was significantly higher and serum MP-IgM antibody seroconversion and the presence of extrapulmonary symptoms are related to the severe patients,it indirect suggest that when the pulmonary lesions are severe, the direct attack function and the immunity disorder are more significant after infection of MP. |
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