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Objective:To summarize the clinical characteristics of plastic bronchitis caused by severe mycoplasma pneumoniae pneumonia in children, to find the risk factors for plastic bronchitis, and to provide references for judging the prognosis and comprehensively formulating treatment plans.Methods:We retrospectively analyzed the clinical data(146 cases)of children with severe mycoplasma pneumoniae pneumonia who underwent bronchoscopy in the Department of Pediatric Respiratory Medicine of Shengjing Hospital of China Medical University from January 2017 to December 2019.According to whether it was plastic bronchitis, all patients were divided into plastic bronchitis group(68 cases) and non-plastic bronchitis group(78 cases), and the gender, age, laboratory examination indicators, imaging characteristics and treatment of children were collected under the circumstances.The single factor with clinical significance and statistical significance would be subjected to multivariate Logistic regression analysis.Results:There were no significant differences in gender, age, heat duration, white blood cell count, C-reactive protein value, and interleukin-6 value between the two groups(all P>0.05). The percentage of neutrophils, alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase, D-dimer, number of cases of pleural effusion, length of hospital stay, and number of endoscopy in the plastic bronchitis group were higher than those in non-plastic bronchitis group, the number of right upper lobe consolidation cases was less than that in the non-plastic bronchitis group, and the differences were statistically significant( P<0.05). Multiple Logistic regression analysis showed that pleural effusion( OR=4.898, 95% CI 2.195-10.926) and lactate dehydrogenase ( OR=1.051, 95% CI 1.003-1.101) were independent predictors of plastic bronchitis in children with severe mycoplasma pneumoniae pneumonia. Conclusion:For children with severe mycoplasma pneumoniae pneumonia, if lung CT shows that the upper lobe of the non-right lung is uniformly compacted and complicated with pleural effusion, lactate dehydrogenase is significantly increased, and attention should be paid to the possibility of plastic bronchitis.Timely improvement of fiberoptic bronchoscopy may shorten the course of the disease and reduce the occurrence of complications.
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Post-infectious bronchiolitis obliterans(PIBO) is a rare serious chronic lung disease characterized by irreversible small airway fibrosis.Lower respiratory infections are the most common causes in children.Its major clinical characteristics are recurrent or persistent cough, wheezing, shortness of breath, hypoxia, crackles, and persistent for above 6 weeks.Clinical diagnosis mainly depends on clinical manifestations, lung function and high-resolution CT examination.At present, there is no unified standard of treatment, mainly empirical treatment.Most of the children have a poor prognosis, and a small number of children can achieve good results through early diagnosis and intervention.
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Objective:To investigate the clinical characteristics and imagological changes of atopic children with ADV pneumonia.Methods:One hundred and twenty cases of children with ADV pneumonia selected from Shengjing Hospital of China Medical University Pediatric Respiratory Department from June 2018 to December 2019.According to whether had atopy and severity of pneumonia, the children were divided into atopic group 42 cases (mild pneumonia 30 cases, severe pneumonia 12 cases)and non-atopic group 78 cases(mild pneumonia 50 cases, severe pneumonia 28 cases). The children were treated according to the guidelines of ADV pneumonia diagnosis and treatment.Laboratory examination, clinical manifestations, clinical features during hospitalization, pulmonary imaging changes at admission, at discharge and follow-up 1 month after discharge were statistically analyzed.Results:There were statistically significant differences in the proportion of severe cough and wheezing between the atopic children and non-atopic children with mild pneumonia( P=0.041, P=0.004, respectively). There was no statistically significant difference between the two groups in the proportion of children with small airway changes indicated by lung CT at admission and 1 month after discharge( P>0.05). The risk of wheezing during hospitalization of atopic children was 2.32 times as much as that of non-atopic children with mild pneumonia.The risk of developing severe cough was 1.72 times as much as that of non-atopic children with mild pneumonia.There were statistically significant differences in the proportion of wheezing after admission and after discharge between the atopic children and non-atopic children with severe pneumonia( P=0.002, P=0.034, respectively). There were significant differences in the proportion of small airway changes at admission and at discharge between the two groups( P=0.001, P=0.009, respectively). The risk of wheezing during hospitalization of atopic children was 1.94 times as much as that of non-atopic children with severe pneumonia.The risk of wheezing after discharge was 1.98 times as much as that of the non-atopic children with severe pneumonia.The risk of small airway change on admission in atopic children group was 1.25 times as much as that of non-atopic children with severe pneumonia.The risk of having small airway changes 1 month after discharge in atopic children group was 2.31 times as much as that of non-atopic children with severe pneumonia. Conclusion:Atopic children with ADV pneumonia had severe cough and wheezing, and atopic children with severe pneumonia are prone to small airway changes, long imaging recovery time and regular follow-up, which should be paid attention by clinicians.
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Objective:To explore the clinical characteristics of children with atopic mycoplasma pneumoniae pneumonia and to provide evidence for the diagnosis and treatment of children with atopic mycoplasma pneumoniae pneumonia.Methods:One hundred and eighty cases of children diagnosed with mycoplasma pneumoniae pneumonia in Shengjing Hospital of China Medical University from January 2018 to December 2018 were selected. According to whether they had atopic constitution, they were divided into atopic mycoplasma pneumoniae pneumonia(AMPP)group(84 cases)and non-atopic mycoplasma pneumoniae pneumonia(NAMPP)group(96 cases). The clinical data of age, sex, fever time, hospital stay, application time of macrolides, white blood cells, CRP, LDH, and lung CT were collected from the two groups, and the differences in clinical manifestations, laboratory examinations and imaging manifestations of the two groups were analyzed retrospectively.Results:(1)Both the absolute value of eosinophils and total IgE values in the AMPP group were higher than those in the NAMPP group, and the difference was statistically significant( P<0.05). The incidence of severe mycoplasma pneumoniae pneumonia(SMPP)and/or refractory mycoplasma pneumoniae pneumonia(RMPP)and chest imaging manifestations of interstitial pneumonia in the AMPP group was higher, and the difference was statistically significant( P<0.05). (2)The incidence of wheezing in the AMPP group was 48.81%(41 cases/84 cases), which was significantly higher than that in the NAMPP group 22.92%(22 cases/96 cases). The duration of cough and wheezing in the AMPP group was longer than that in the NAMPP group( P<0.05), with statistically significant differences( P<0.05). (3)In the AMPP group, 36.90%(31 cases /84 cases)of the children received intravenous methylprednisolone treatment, which was significantly higher than the 20.83%(20cases /96 cases)of the NAMPP group. Lung rales absorption time in the AMPP group[(9.73±3.59)d] was significantly longer than that in the NAMPP group[(7.52±2.44)d], and the difference was statistically significant( P<0.05). Lung CT examination showed that the absorption of lung inflammation in the AMPP group was worse than that in the NAMPP group, with a statistically significant difference( P<0.05). The hospitalization time of children in the AMPP group[(10.88±4.17)d] was longer than that in the NAMPP group[(9.68±2.68)d], with a statistically significant difference( P<0.05). Conclusion:The condition of AMPP is more serious than that of NAMPP, and it is more likely to cause incomplete absorption of pulmonary inflammation.
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Objective To investigate the effects of atomized budesonide on neonatal bronchopulmonary dysplasia after discharge from hospital to 6 months of gestational age correction.Methods Analyse clinical data of fifty children with BPD,observe the effects of atomized budesonide (0.5mg inhaled q12h,at least 4weeks,course(15.4 ±6.16) weeks.When wheezing or dyspnea occurred:1mg of budesonide and 1.25ml of albuterol and ipratropium bromide inhaled q12h,2 ～ 4weeks.When respiratory frequency,heart rate and blood oxygen saturation reached normal,three concave improved obviously,lung rale disappeared,gradually reduce to no treatment)improving the clinical symptoms of children with BPD in 6 months after discharge,and observe the effects of atomized budesonide on reducing respiratory tract infection (including upper respiratory tract infection,pneumonia,wheezing and hospitalization).Results Through budesonide aerosol therapy,respiratory frequency and heart rate of children with BPD could be reduced,blood oxygen saturation could be elevated,and three concave could be improved at corrected gestational age of 3 months and 6 months.(P ＜ 0.05),and at 3 months of corrected gestational age,the mean therapy time in treatment group is(56.8 ±26.9) d,this shows that 4weeks'treatment of budesonide aerosol could improve clinical symptoms;Also with budesonide aerosol therapy,the time of oxygen inhalation after hospital could be shortened (P ＜0.05);but respiratory infection of children with BPD in 6 months after discharge could not reduced (P ＞ 0.05).Conclusion The treatment of budesonide atomization can improve the clinical symptoms of children with BPD after discharge from hospital to 6 months of gestational age correction,improve oxygen and shorten the time of oxygen inhalation after hospital,cannot reduce the incidence of respiratory infection.
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The incidence of bronchopulmonary dysplasia is very high,and is still the major cause of chronic pulmonary disease in infancy.Although the mechanism is not completely clear.Recent studies have demonstrated that preterm delivery,immature lung development,postnatal injury from mechanical ventilation,oxygen exposure,infection and inflammatory response contribute to it.The association between BPD and genetics reported recently.However,relative therapeutic methods are rarely reported.This review summarizes the pathogenesis and therapy of BPD.
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Objective To observe the efficacy of bacterial lysate(bronchovaxom) in the acute phase of respiratory tract infection and to prevent recurrent respiratory tract infections.Methods From April 2014 to A-pril 2015,in pediatric respiratory ward of Shengjing hospital of China Medical University,80 children with recur-rent respiratory tract infection were randomly divided into treatment group and control group,with 40 cases in each group.The control group patients were received routine anti-infection and symptomatic treatment,the treat-ment group patients were received oral bacterial lysis products for 3 months on basis of the conventional anti-in-fection and symptomatic treatment.To observe the duration of clinical symptoms of two groups of children with respiratory tract infection in the acute phase,antibiotic use and hospital stay changes;observed the number of re-spiratory infections occurred again within 1 year;measured the levels of serum immunoglobulin before and 6 months after treatment. Results Compared with the control group,the duration of symptoms such as fever, cough and other symptoms of respiratory tract infection,the duration of pulmonary rales,the use of antibiotics and the length of hospital stay were significantly shortened in the treatment group,and the number of respiratory infections was significantly reduced,the difference significant(P<0.05).After treatment,the levels of IgG and IgA in the treatment group were significantly higher than those before treatment,and the immunoglobulin IgG and IgA in the treatment group were significantly higher than those in the control group(P<0.05).Conclusion Oral bacterial lysis products to prevent respiratory infections,not only can reduce the duration of various clini-cal symptoms of respiratory tract infection,shorten the use of antibiotics and hospital stay,and can improve chil-dren's immunity,reduce the number of respiratory infections again.
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Objective To understand the correlation of gene detection of Mycoplasma pneumoniae and clinical refractory Mycoplasma pneumoniae pneumonia.Methods (1) For children with Mycoplasma pneumoniae pneumonia in our hospital with serum Mycoplasma pneumoniae antibody positive,we collected the pharyngeal swab specimens over the same period,applied nested PCR to amplify 23SrRNA gene and undergoing electrophoresis and find out 97 cases of both positive,conducted DNA sequencing analysis of macrolide resistant gene to isolate the mutants,compared clinical manifestations of drug-resistance gene group with no drug-resistance gene mutation group.(2) Ninety-seven cases of mycoplasma pneumonia (MPP) patients were devided into the general MPP group (68 cases) and refractory MPP group (29 cases),retrospectively analyzed clinical manifestation,laboratory examination and differences of imaging performance.Multivariate logistic regression analysis for the performance of refractory Mycoplasma pneumoniae pneumonia was carried out to examine whether there is relevance between the mutant of drug-resisting gene and refractory Mycoplasma pneumonia.Results (1) Seventeen of 97 cases (17.5％) were found out without mutations,the other 80 cases (82.5％) exist drug-resistance gene mutations.(2) Mutation of drug-resistance gene group showed high CRP values,heating time,hospitalization time,macrolide drug application time,application of macrolides fever time and longer cough,by statistical analysis with statistical significance,higher incidence of lobar pneumonia.(3) Compared to general MPP group,refractory MPP group showed high peripheral blood neutrophil percentage percentage,CRP,calcitonin) and lactate dehydrogenase (LDH) values,heating time,hospitalization time,macrolide drug application time,application of macrolides fever time and longer cough.There was significant difference (P ＜ 0.05);macrocyclic lactones drug application time and resistance gene mutation and refractory Mycoplasma pneumonia were correlated.Conclusion MPP drug-resistant genes are widespread.Drug resistance gene mutations group shows long clinical symptoms duration,slow recovery rate,higher CRP value,higher rates of lobar pneumonia.Compared with ordinary MPP group,there are higher drug resistance mutation rate,inflammatory indexes and lactate dehydrogenase value,large ring lactone class drugs after a longer time of cough and fever in RMPP group.Drug application time and resistant gene mutations are associated with RMPP.