Study On Evaluation Indicators Of Severe Pneumonia In Children

Objective:To explore the changes and clinical significance of inflammatory cytokines(IL-6,IL-8,IL-10),C-reactive protein(C-reactive protein,CRP),precalcitonin(precalcitonin,PCT),Lactate dehydrogenase(Lactate dehydrogenase,LDH)in children with severe pneumonia,and to study the value of plasma d-dimer level in the evaluation of severe pneumonia in children,analyze the relationship between the level of cytokines and coagulation function with the development of pneumonia,so as to evaluate the severity of pneumonia in children.Method:Cases in hospitalization in the respiratory department of Dalian Municipal Women and Children's Medical Center from July 2017 to January 2018,age<I2years old were selected,According to the diagnostic criteria for severe pneumonia formulated by the respiratory group of the pediatric branch of the Chinese medical association in 2013,the children who had received anticoagulant treatment at admission were excluded,also for children with chronic diseases and basic diseases such as hypertension,diabetes,liver and kidney,primary blood system diseases,family history of coagulation disorders and congenital abnormalities of coagulation factors and immune function,excluded the children with laryngitis,bronchitis and pulmonary dysplasia.the values of IL-6,IL-8 and IL-10 of the inflammatory cytokines were detected by ELISA,and calculate the plasma d-dimer value,CRP,PCT and LDH values of the 44 children's.Results:1.The positive rate of serum CRP level in children with severe pneumonia was 72.7%,comparing with the control group(22.7%),the difference was statistically significant(?~2=11.023,P<0.05);the serum CRP level in the severe pneumonia group was significantly higher than that in the mild pneumonia group,and the difference was statistically significant(Z=-3.547,P<0.05).The positive rate of plasma d-dimer level in children with severe pneumonia was 77.3%,in the control group was 4.6%,difference was statistically significant(?~2=24.068,P<0.05);the plasma d-dimer level in the severe pneumonia group was significantly higher than that in the mild pneumonia group,and the difference was significant too(Z=-5.013,P<0.05).The positive rate of LDH level in children with severe pneumonia was 72.7%,while in the control group the positive rate was 4.6%,the difference was statistically significant(?~2=21.569,P<0.05);the LDH level in the severe pneumonia group was significantly higher than that in the mild pneumonia group(Z=-4.073,P<0.05).The positive rate of PCT level in children with severe pneumonia was 45.5%,in the control group was 9.1%,the difference was statistically significant(?~2=7.333,P<0.05);the PCT level in the severe pneumonia group was significantly higher than that in the mild pneumonia group(Z=-2.457,P<0.05).The differences of serum inflammatory cytokines(IL-6,IL-8 and IL-10)between the two groups were statistically significant(P<0.05).2.The coincidence rate of serum CRP level>40mg/L for children with severe pneumonia was 59%,the diagnostic coincidence rate of severe pneumonia was 45%with abnormal PCT level,the diagnostic coincidence rate of severe pneumonia was 77%with abnormal LDH level,and 81%with plasma d-dimer level.3.Mycoplasma infection and mixed pathogen infection accounted for 68%and 50%in severe pneumonia children.Mycoplasma pneumoniae infection accounted for 65%of all cases.4.Application of corticosteroids account 90%in children with severe pneumonia,the average temperature within 1-2 days of smooth continuous below 37.4?.Conclusion:1.The serum inflammatory cytokines levels(IL-6?IL-8?IL-10)?plasma d-dimer level?CRP?PCT and LDH levels were significantly increased in the severe pneumonia group compared with the mild pneumonia group.2.The value of PCT in the diagnosis of severe pneumonia remains to be discussed.3.Among all the cases,mycoplasma pneumoniae infection accounted for 65%,and mixed infection accounted for 50%.Among children with severe pneumonia,mycoplasma pneumoniae infection accounted for 68%.4.For children with severe pneumonia with a long course of fever,glucoc orticoid can relieve symptoms within 1-2 days,shorten hospitalization time and duration of antibiotic use,and some children can avoid bronchoalveolar lavage.