A Clinical Study Of Mycoplasma Pneumoniae Pneumonia And Pulmonary Atelectasis In Children

Part I The role of the fiber bronchoscopy in children with mycoplasma pneumoniae pneumonia and pulmonary atelectasisObjective: To evaluate the effect of bronchoalveolar lavage in the treatment of children with mycoplasma pneumonia complicated with pulmonary atelectasis.Methods: 243 cases of mycoplasma pneumoniae pneumonia with pulmonary atelectasis admitted to our hospital from May 2015 to November 2015, in line with the Mycoplasma pneumoniae pneumonia and pulmonary, according to whether underwent bronchoalveolar lavage bronchofibroscope lavage was divided into 2 groups, intervention group( 138 cases) and non intervention group(105 cases). The duration of temperature normalized, cough disappeared and hospital stays, and incidence of complications were compared in two groups. Chest X-ray was reexamined to evaluate the lesions absorption after 1 week, 2 weeks, 4 weeks of treatment.Results: The duration of temperature normalized,cough disappeared time,and hospital stays were shorter, pulmonary function abnormalities and HRCH abnormalities were less in intervention group than those in non intervention group, chest lesions absorption evaluated with X-ray was markedly promoted after one-week and two-week treatment, and the differences were significant.(P<0.05).Conclusion: Bronchoalveolar lavage could shorten the duration of fever and hospital stays, improve the symptoms of respiratory tract and promote the absorption of atelectasis, reduce complications.Part II Exploration on the gene copy number in bronchoalveolar lavage fluid and clinical relevance of mycoplasma pneumoniae pneumoniaObjective: To investigate the relationship between MP- DNA copy number in bronchoalveolar lavage fluid and the severity and inflammatory index of MPP in children with MPP.Methods: 122 cases admitted to respiratory ward of our hospital from May 2015 to November 2015, in line with the inclusion and exclusion criteria in the first part,tested positive in MP-DNA of bronchoalveolar lavage fluid(BALF) were selected as research objects. According to the amount of MP-DNA copies, they were divided into low copy group(< 106 copies / ml) and high copy group(equal to or more than 106 copies / ml).Clinical severity and laboratory inflammation index were compared in two groups by retrospective analysis.Results:(1) Comparing with the low copy group, the total fever process was longer(P =0.011); the incidence of pleural effusion increased significantly(P =0.001); inflammation index(percentage of neutrophils, CRP, PCT, LDH) increased significantly(P =0.000,0.003,0.031,0.000), percentage of lymphocytes decreased significantly(P < 0.01) in the high copy group.(2) The MP-DNA BALF copy of the severe MPP group was significantly higher than that of the ordinary MPP group(P =0.000).(3) The MP-DNA copy of MPP in BALF was negatively correlated with the percentage of lymphocytes(r=-0.234, P =0.01), and positively correlated with the percentage of neutrophils, CRP, PCT and LDH( r=0.224,0.380,0.298,0.185,P =0.006,0.000,0.001,0.042).Conclusion:(1) The MP-DNA copy of BALF was expected to be used as an indicator to judge the severity and efficacy of the disease.(2) The MP-DNA copy of BALF was positively correlated with serum CRP, PCT, LDH, and negatively correlated with the percentage of lymphocytesPart III The Study of etiological diagnosis in children with mycoplasma pneumoniae pneumonia and pulmonary atelectasisObjective: To compare the diagnostic value of MP-DNA from BALF,from throat swab and serum MP antibody in children with mycoplasma pneumoniae pneumonia.Methods: 165 cases of mycoplasma pneumoniae pneumonia with pulmonary atelectasis admitted to respiratory ward of our hospital from May 2015 to November 2015,who underwent bronchoalveolar lavage were enrolled. Throat swab specimens were taken on the admission day, and BALF were taken within 3 days of admission. FQ-PCR method was used to detect MP-DNA in the pharyngeal swab and BALF.The blood samples were obtained dynamically on the admission day and during the disease course, and serums were collected in two copies.As a fourfold increase in MP antibody titer of paired serum diagnosed with MP infection,comparison study was made on different samples and different detecting methods.Results: Based on the diagnostic criteria of a fourfold increase in specific antibody titer in paired serum, the first serum MP antibody was detected positive in 81 cases(49.1%),the sensitivity was 46.6%, and the specificity was 44.7%;119 cases(72.1%) were detected MP-DNA positive in BALF,the sensitivity was 99.2%, and the specificity was 95.7%;43 cases(26.1%) were detected MP-DNA positive in pharyngeal swab,the sensitivity was 33.1%, and the specificity was 91.5%.The positive rate of MP antibody in the first serum and MP-DNA in pharyngeal swab were both lower than that of a fourfold increase in specific antibody titer in pair sera(P =0.000,0.000).There was no significant difference between positive rate of MP-DNA in BALF with diagnostic criteria(P =0.903).Conclusion:1.Detection of MP antibody in a single serum and pharyngeal swab was not yet sensitivity and specificity enough,which was not suitable to be diagnostic index of MP infection.2.Detection of MP-DNA in BALF by FQ-PCR was highly sensitivity and specificity, and it could act as a reference index to diagnostic criteria of MP infection.