| Objective: To investigate the infection of Mycoplasma pneumoniae in children with community acquired pneumonia(CAP)and mycoplasma pneumonia(MPP)in our hospital by analyzing the clinical data,laboratory tests and imaging data of children with MPP in different age groups,so as to evaluate the disease of mycoplasma pneumonia in children with community acquired pneumonia.Provide the basis for the condition and prognosis,and provide the objective basis for the diagnosis and treatment of MPP in local children with community acquired pneumonia and prevention and treatment measures.Methods: A retrospective analysis was made on children aged 1 month to 14 years who met the criteria of community acquired pneumonia in our hospital from January 2015 to December 2016.Blood samples were collected on the day of admission.Serum Mycoplasma pneumoniae antibodies were detected by Passive Agglutination and ELISA.The titers of single serum MP-Ig G were more than 1:160,or the titers of double serum MP-Ig G were increased 4 times or more,or the titers of MP-Ig M were positive.Positive diagnosis of MP infection can be confirmed.If Mycoplasma pneumoniae infection is negative or weakly positive and highly suspected,the second blood sample will be taken 7-10 days after the first blood sampling,and the above test will be re-examined.Total 574 cases.According to the age of the children,they were divided into four age groups,namely,under 1,3,6 and over 6 years old.Clinical data,laboratory testing and imaging data were collected retrospectively.The differences of clinical manifestations,laboratory testing data,pulmonary imaging findings and the incidence of refractory MPP among different groups were compared.SPSS22.0 software was used for data analysis.Results:(1)General data: Among 574 cases of MP pneumonia,118 cases(20.6%)were in the 1-year-old group,162 cases(28.2%)were in the 3-year-old group,128 cases(22.3%)were in the 6-year-old group,and 166 cases(28.9%)were in the 6-year-old group.(2)Seasonal characteristics: MP infection can occur in all seasons of the year.The positive rate of MP infection is the highest in spring,followed by winter and summer,and the lowest in autumn.There is a significant difference in the positive rate of MP infection among different seasons(P < 0.001).(3)Clinical features: The average duration of fever in the four groups was 3.75(+2.13d),4.65(+2.43d),5.11(+3.04d)and 4.83(+2.34d),respectively.The duration of fever was shorter in the group aged 1 and longest in the group aged 6(P<0.001).~ The proportion of high fever was 26.6% in the 6-year-old group and 22.8% in the 6-year-old group(P=0.048).The proportion of wheezing symptoms decreased with age(P < 0.001).The proportion of cough symptoms increased with age(P < 0.001).The incidence of hypoxemia was the highest at the age of 1(29.7%),followed by the age of 3(16.7%)and the lowest at the age of 6(7.8%).There was a significant difference in the proportion of hypoxemia among different groups(P < 0.001).The proportion of lung rale > 6 years old group was the highest(46.3%)and that of 1 year old group was the lowest(17.8%).The difference between groups was significant(P < 0.001).(4)Children’s MP pneumonia had diverse chest imagery,The proportion of bronchial pneumonia was higher in the 1 year old group,and the proportion of lobar pneumonia in the 6 year old group was higher(P<0.05),there was no significant difference in the incidence of atelectasis and pleural effusion in different groups(P>0.05).(5)Laboratory data: The results of blood routine examination showed that there were significant differences in white blood cell,neutrophil,lymphocyte and platelet counts among different groups(P<0.05).The highest level of white blood cell was in the age of 1,with an average of 13.2(+5.4 *109/L);the highest level of neutrophil was in the age of 6,with an average of 60.9(+17.8 *109/L);and the highest level of platelet was in the age of 1,with an average of 408.9(+143)..9*109/L.The results of biochemical test showed that CRP level was the highest in the group of 6 years old,with an average level of 16.1(+18.2 mg/L),and LDH level was the highest in the 6 year old group,with an average level of 392.5(+380.0 U/L).(6)Extrapulmonary complications: There was no significant difference in the incidence of urinary system complications,skin complications,neurological complications and multiple organ dysfunction among different age groups(P > 0.05).The incidence of myocardial damage was 26.3%(P=0.032)at the age of 1,23.7%(P=0.002)at the age of 1,and 21.1%(P=0.001)and 17.5%(P=0.001)at the age of 1 and 3 respectively.The incidence of electrolyte disorders was higher in the group of ~1 years old and the group of ~3 years old,15.3% and 12.7% respectively(P=0.002).(7)The proportion of refractory MP P in the four groups was 5.9%,6.8%,12.5% and 14.5%,respectively.The proportion of refractory MP P in the group of ~6 years old and > 6 years old was significantly higher(P=0.038).Conclusion:(1)MPP is not uncommon in children under 3 years old,and more attention should be paid to infant MPP in clinic.(2)The clinical symptoms of MPP children of different ages may vary considerably.Low fever,cough and wheezing are the main symptoms in young children,digestive disorders are the most common extrapulmonary symptoms,and the chest imaging changes are atypical.High fever and cough are the main symptoms in school-age and pre-school-age children,and atelectasis and pleural effusion are more common in chest imaging.(3)RMPP is prone to occur in older children,with clinical manifestations of high fever,quiet respiratory symptoms and serum LDH,CRP levels increased significantly;younger age(≤ 3 years old)MP children still has RMPP Risks,and it is necessary to increase the monitoring and intervention of younger age MP children to improve the prognosis. |
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