| Objective:Mycoplasma pneumoniae pneumonia(MPP)in children with plastic bronchitis(PB)has the characteristics of acute onset and rapid progression,with clinical manifestations such as high fever,cough,wheezing,shortness of breath,difficulty breathing,and even a risk of death.To analyze the clinical risk factors of MPP complicated by PB,and to provide a reference for predicting MPP with PB.Methods:A total of 100 MPP children hospitalized in the West Coast Hospital of Qingdao University Affiliated Hospital from July 16 to November 24,2021 were studied.Comply with Expert consensus on diagnosis and treatment of mycoplasma pneumoniae pneumonia in children(2015)and Guideline of pediatric flexible bronchoscopy in China(2018),the patients were divided into PB group with 29 patients and non-PB group with 71 patients based on the presence or absence of plasticized bronchitis by bronchoscopy.The general data,clinical manifestations,imaging,laboratory tests,and bendable bronchoscopy findings were compared between the two groups to investigate the clinical features and associated risk factors of MPP complicated by PB.Result:1.General data:The male to female ratio in the PB group was higher than that in the non PB group(140%vs 58%),and the ratio of cesarean delivery to cesarean delivery in the PB group was lower than that in the non PB group(81%vs 196%)。There were significant differences in gender and delivery mode between the two groups(X~2=4.066,3.918,P=0.044,0.048).There was no significant difference in age at onset or BMI between the two groups(P>0.05).2.Clinical manifestation:The frequency of fever duration and numbers of thermal fever peak per day were significantly higher in the PB group(9.83±3.62 days,3.48±1.74 times per day)than in the non PB group(7.68±3.62 days,2.28±1.11 times per day),and the percentage of children with persistent high fever>7 days was significantly higher in the PB group(58.6%)than in the non PB group(25.3%).Clinical manifestations:there were significant differences of persistent high fever>7 days,fever duration and numbers of thermal fever peak per day between the two groups(X~2=4.421,t=2.700,4.119,P=0.036,0.009,<0.001).There were no significant differences in cough,fever,fever peaks,wet rales,wheeze,low breath sounds,or wheeze between the two groups(P>0.05).3.Imaging findings:The percentage of children with lung consolidation was significantly higher in the PB group(79.3%)than in the non PB group(38.1%),there was significant difference in lung consolidation between the two groups(X~2=4.253,P=0.039).There was no significant difference in pleural effusion or atelectasis between the two groups(P>0.05).4.Laboratory tests results:There were significant differences of C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),procalcitonin(PCT),lactate dehydrogenase(LDH),creatine kinase isozyme(CKMB),D-dimer,and BALF neutrophil percentage between the two groups(t=2.850,3.299,2.019,4.386,2.227,3.487,z=-2.338,P=0.005,0.001,<0.001,0.028,0.001,0.019).There were no significant differences in white blood cell count,neutrophil count,platelet count,serum phosphorus,serum potassium,serum calcium,blood magnesium,ALT,AST,creatinine,CK,blood lipids,fibrinogen,antithrombin III,and macrophages,lymphocytes,eosinophils in BALF between the two groups(P>0.05).5.Bronchoscopic findings:There was no significant difference in the severity of mucosal erosions,congestion,or stenosis between the two groups(P>0.05).In the PB group,blasts mainly occurred in the basal segment of the left lower lobe of the lung(13cases,44.8%)and in the basal segment of the right lower lobe of the lung(8 cases,27.6%).6.Multivariate analysis of MPP complicated with PB:Number of thermal fever peak per day(OR=1.548,CI=1.030-2.326,P=0.035),LDH(OR=1.005,CI=1.001-1.009,P=0.014),ESR(OR=1.055,CI=1.005-1.107,P=0.031)were the risk factors of MPP complicated with PB.The area under the ROC curve(AUC),cut-off value,sensitivity and specificity were:fever peak frequency 0.722,3.5,0.586,0.859;LDH0.691,338.5,0.586,0.775;ESR 0.754,22.5,0.897,0.662.Conclusion:1.Numbers of thermal fever peak per day,LDH and ESR are independent risk factors for the development of concurrent PB in children with MPP,and should be cautioned against the possibility of PB when the frequency of thermal peaks is>3.5 times/day,LDH>338.5 U/L and ESR>22.5 mm/h.2.When children with MPP had long fever duration and more than seven days of high fever,lung consolidation,It has a certain predictive effect on MPP concurrent PB.3.When MPP complicated with PB,high levels of CRP,PCT,CKMB,D-dimer,and BALF neutrophil ratios reflect severe inflammatory reactions in the body,indicating that we can help evaluate the risk of MPP complicated with PB by monitoring changes in these indicators in clinical practice. |
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