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ObjectiveTo observe the clinical efficacy of Feining Paidu decoction on refractory Mycoplasma pneumoniae pneumonia in child patients. MethodA randomized controlled trial （RCT） was conducted， with 96 child patients randomly divided into a control group and an observation group， each containing 48 cases. The control group received intravenous azithromycin （10 mg·kg-1·d-1） for 7 days， intravenous methylprednisolone （1 mg·kg-1·d-1） for 3 days， along with supportive treatments such as fluid infusion and antipyretics. The observation group received oral administration of Feining Paidu decoction once a day for 7 days. Changes in traditional Chinese medicine （TCM） syndrome scores， clinical efficacy， serum soluble B7-H3 （sB7-H3）， serum inflammatory factors， coagulation function， and lung imaging ［computer tomography（CT）］ scores were observed in both groups. Adverse reaction events were also recorded. ResultThe total effective rate in the observation group was 95.74% （45/47）， significantly higher than 80.43% （37/46） in the control group （Z=-3.702， P<0.01）. Compared with the results before treatment， TCM syndrome scores， lung imaging scores， sB7-H3， tumor necrosis factor-α （TNF-α）， interleukin-1β （IL-1β）， interleukin-6 （IL-6）， D-dimer （D-D）， and fibrinogen （FIB） levels in both groups all significantly decreased after treatment （P<0.05， P<0.01）. After treatment， the observation group showed significantly better results in these indicators than the control group （P<0.05， P<0.01）. There was no statistically significant difference in thrombin time （TT） in the control group before and after treatment， while the observation group showed a significant prolongation after treatment （P<0.05）. There were no statistically significant differences in activated partial thromboplastin time （APTT） and prothrombin time （PT） between the two groups before treatment， and no serious adverse reactions occurred in either group. ConclusionFeining Paidu decoction combined with conventional treatment can alleviate inflammatory responses， improve hypercoagulable states， promote the absorption of pulmonary inflammation， and enhance the clinical efficacy of refractory Mycoplasma pneumoniae pneumonia in children.
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Objective:To investigate the clinical characteristics and etiology of pulmonary embolism in children, and to discuss the efficacy and safety of anticoagulation therapy.Methods:The data of 30 children with pulmonary embolism, who were treated with anticoagulation therapy in the Department of Pediatrics, Provincial Hospital Affiliated to Shandong First Medical University from January 2017 to December 2021, were analyzed retrospectively.The etiology, clinical characteristics, complications, outcomes and prognosis after anticoagulation treatment were analyzed.Results:There were 17 males and 13 females, with an average age of (8.95±2.58) years (age range: 4-13 years). The follow-up duration was 3-59 months.(1) The symptoms included cough in 30 cases (100.0%), fever in 29 cases (96.7%), shortness of breath in 27 cases (90.0%), chest pain in 15 cases (50.0%), hemoptysis in 9 cases (30.0%), bloody secretions under bronchoscopy but no hemoptysis in 4 cases (13.3%), and respiratory failure in 2 cases (6.7%). (2) The protopathy was Mycoplasma pneumoniae infection in 23 cases (76.7%), whose symptoms accorded with refractory Mycoplasma pneumoniae pneumonia.About 16 cases (53.3%) were positive for Mycoplasma pneumoniae drug resistance mutation 2063A>G or 2064A>G.Two cases (6.7%) had nephrotic syndrome.One case (3.3%) had purpura nephritis (nephrotic syndrome type). One case (3.3%) was lupus nephritis (nephrotic syndrome type). One case (3.3%) was hereditary protein S deficiency.One case (3.3%) had osteomyelitis and Staphylococcus aureus sepsis.One case (3.3%) had congenital heart disease.(3) Complications included limb thrombosis in 7 cases (23.3%), atrial thrombosis in 2 cases (6.7%), thoracic and abdominal deep venous thrombosis in 2 case (6.7%), cerebral infarction in 2 cases (6.7%), and splenic infarction in 1 case (3.3%). (4) Imaging examination showed that 30 children had lung consolidation/atelectasis (100.0%), and 24 cases had pleural effusion (80.0%). (5) Coagulation function examination suggested D-dimer increased to ≥ 5 mg/L in 21 cases (70.0%). (6) One case (3.3%) was given thrombolytic therapy with urokinase at the acute stage.Nine cases (30.0%) were treated with heparin/low molecular weight heparin.Twenty-one cases (70.0%) first received anticoagulation therapy with heparin/low molecular weight heparin and later took oral anticoagulant.Four cases (13.3%) were treated with Warfarin and 17 cases (56.7%) with Rivaroxaban.The anticoagulant treatment lasted 1-9 months.No recurrence of embolism or sequelae of chronic thromboembolic pulmonary hypertension was observed. Conclusions:Infection, especially Mycoplasma pneumoniae infection, is the main cause of pulmonary embolism in children.The symptoms of pulmonary embolism in children are atypical, so it is difficult to distinguish this disease from primary underlying diseases.Bronchoscopy can help find occult pulmonary hemorrhage.Unexplained shortness of breath in children of any age suggests the possibility of pulmonary embolism.Combination of clinical symptoms and necessary examination contribute to early diagnosis of pulmonary embolism.Then selection of appropriate anticoagulant drugs and timely anticoagulant therapy can improve the prognosis of children.
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Objective:To investigate the clinical characteristics and etiology of pulmonary embolism in children, and to discuss the efficacy and safety of anticoagulation therapy.Methods:The data of 30 children with pulmonary embolism, who were treated with anticoagulation therapy in the Department of Pediatrics, Provincial Hospital Affiliated to Shandong First Medical University from January 2017 to December 2021, were analyzed retrospectively.The etiology, clinical characteristics, complications, outcomes and prognosis after anticoagulation treatment were analyzed.Results:There were 17 males and 13 females, with an average age of (8.95±2.58) years (age range: 4-13 years). The follow-up duration was 3-59 months.(1) The symptoms included cough in 30 cases (100.0%), fever in 29 cases (96.7%), shortness of breath in 27 cases (90.0%), chest pain in 15 cases (50.0%), hemoptysis in 9 cases (30.0%), bloody secretions under bronchoscopy but no hemoptysis in 4 cases (13.3%), and respiratory failure in 2 cases (6.7%). (2) The protopathy was Mycoplasma pneumoniae infection in 23 cases (76.7%), whose symptoms accorded with refractory Mycoplasma pneumoniae pneumonia.About 16 cases (53.3%) were positive for Mycoplasma pneumoniae drug resistance mutation 2063A>G or 2064A>G.Two cases (6.7%) had nephrotic syndrome.One case (3.3%) had purpura nephritis (nephrotic syndrome type). One case (3.3%) was lupus nephritis (nephrotic syndrome type). One case (3.3%) was hereditary protein S deficiency.One case (3.3%) had osteomyelitis and Staphylococcus aureus sepsis.One case (3.3%) had congenital heart disease.(3) Complications included limb thrombosis in 7 cases (23.3%), atrial thrombosis in 2 cases (6.7%), thoracic and abdominal deep venous thrombosis in 2 case (6.7%), cerebral infarction in 2 cases (6.7%), and splenic infarction in 1 case (3.3%). (4) Imaging examination showed that 30 children had lung consolidation/atelectasis (100.0%), and 24 cases had pleural effusion (80.0%). (5) Coagulation function examination suggested D-dimer increased to ≥ 5 mg/L in 21 cases (70.0%). (6) One case (3.3%) was given thrombolytic therapy with urokinase at the acute stage.Nine cases (30.0%) were treated with heparin/low molecular weight heparin.Twenty-one cases (70.0%) first received anticoagulation therapy with heparin/low molecular weight heparin and later took oral anticoagulant.Four cases (13.3%) were treated with Warfarin and 17 cases (56.7%) with Rivaroxaban.The anticoagulant treatment lasted 1-9 months.No recurrence of embolism or sequelae of chronic thromboembolic pulmonary hypertension was observed. Conclusions:Infection, especially Mycoplasma pneumoniae infection, is the main cause of pulmonary embolism in children.The symptoms of pulmonary embolism in children are atypical, so it is difficult to distinguish this disease from primary underlying diseases.Bronchoscopy can help find occult pulmonary hemorrhage.Unexplained shortness of breath in children of any age suggests the possibility of pulmonary embolism.Combination of clinical symptoms and necessary examination contribute to early diagnosis of pulmonary embolism.Then selection of appropriate anticoagulant drugs and timely anticoagulant therapy can improve the prognosis of children.
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Objective:To analyze the clinical features of severe refractory mycoplasma pneumoniae pneumonia (SRMPP) in children, and explore its risk factors complicated with extrapulmonary organ dysfunction.Methods:The clinical data of children with SRMPP who were admitted to the Department of Critical Care Medicine of Shanghai Children's Hospital from July 2017 to June 2019 were retrospectively summarized. The patients were divided into two groups according to the occurrence of extrapulmonary organ dysfunction: the extrapulmonary organ dysfunction group and the respiratory dysfunction group. The differences of clinical features and laboratory indexes between the two groups were compared, and the risk factors of extrapulmonary organ dysfunction were screened out by logistic regression analysis.Results:A total of 107 cases with SRMPP were admitted to the Pediatric Intensive Care Unit during the past two years, and there were 44 cases (41.1%) complicated with pleural effusion, 17 cases (15.9%) with plastic bronchitis, 104 cases (97.2%) with positive results for macrolide resistance genes (2063, 2064), with an in-hospital mortality rate of 2.8% (3/107). Among 107 children with SRMPP, there were 51 cases (47.7%) with extrapulmonary organ dysfunction, 43 cases (40.2%) with cardiovascular dysfunction, 13 cases (12.1%) with coagulation dysfunction, 11 cases (10.3%) with gastrointestinal dysfunction, 4 cases (3.7%) with renal dysfunction, 4 cases (3.7%) with brain dysfunction, 3 cases (2.8%) with liver dysfunction, and 16 cases (15.0%) with multiple organ dysfunction. Compared with the respiratory dysfunction group, the incidence of capillary leak syndrome was higher (52.9% vs. 17.9%, P < 0.001), the capillary leak index was increased [11.71 (4.63, 27.07) vs. 5.78 (2.07, 15.71), P =0.019], serum albumin was decreased [(32.2 ± 5.6)g/L vs. (34.7 ± 6.7)g/L, P=0. 041], and prothrombin time was prolonged significantly [12.7 (11.7, 13.8)s vs. 12.0 (11.4, 13.0)s, P=0. 009]. Logistic regression analysis showed that capillary leak syndrome ( OR=0. 278, 95% CI 0.102-0.759, P=0. 013) and prolonged prothrombin time ( OR=1. 443, 95% CI 1.018-2.046, P=0. 039) were independent risk factors for SRMPP complicated with extrapulmonary organ dysfunction. Conclusions:Approximately 50% of children with SRMPP have dysfunction of extrapulmonary organs, such as circulation, coagulation and gastrointestinal disorders. Capillary leak syndrome and prolonged prothrombin time are independent risk factors for SRMPP complicated with extrapulmonary organ dysfunction.
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OBJECTIVES@#To study the value of autotaxin (an autocrine motility factor) level in serum and bronchoalveolar lavage fluid (BALF) in predicting refractory Mycoplasma pneumoniae pneumonia (RMPP) in children and its correlation with interleukin-6 (IL-6), interleukin-8 (IL-8), and C-reactive protein (CRP).@*METHODS@#A retrospective analysis was performed on 238 children with Mycoplasma pneumoniae pneumonia who were admitted from January 2019 to December 2021. According to disease severity, they were divided into two groups: RMPP (n=82) and general Mycoplasma pneumoniae pneumonia (GMPP; n=156). The two groups were compared in terms of the levels of autotaxin, IL-6, IL-8, and CRP in serum and BALF to study the value of autotaxin level in serum and BALF in predicting RMPP in children, as well as the correlation of autotaxin level with IL-6, IL-8, and CRP in children with RMPP.@*RESULTS@#Compared with the GMPP group, the RMPP group had significantly higher levels of autotaxin, IL-6, IL-8, and CRP in serum and BALF (P<0.05). For the children with RMPP, the levels of autotaxin, IL-6, IL-8, and CRP in serum and BALF in the acute stage were significantly higher than those in the convalescent stage (P<0.05). The receiver operating characteristic (ROC) curve showed that the level of autotaxin in serum and BALF had a good value in predicting RMPP in children, with an area under the curve of 0.874 (95%CI: 0.816-0.935) and 0.862 (95%CI: 0.802-0.924), respectively. The correlation analysis showed that the level of autotaxin in serum and BALF was positively correlated with IL-6, IL-8, and CRP levels (P<0.001).@*CONCLUSIONS@#The level of autotaxin in serum and BALF increases and is correlated with the degree of disease recovery and inflammatory cytokines in children with RMPP. Autotaxin can be used as a predictive indicator for RMPP in children.
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Child , Humans , C-Reactive Protein , Cytokines , Interleukin-6 , Interleukin-8 , Mycoplasma pneumoniae , Pneumonia, Mycoplasma/diagnosis , Retrospective StudiesABSTRACT
Mycoplasma pneumoniae pneumonia (MPP) complicated with cerebral venous sinus thrombosis (CVST) is rare.We retrospectively analyzed the clinical data of two patients with refractory mycoplasma pneumoniae pneumonia (RMPP) complicated with CVST who were hospitalized in Xi′an children′s Hospital from December 2018 to April 2019, inquired the relevant literature, analyzed the clinical diagnosis and treatment characteristics, and discussed the diagnosis and treatment measures of RMPP complicated with CVST.Two cases were 6-year-old girls with fever and cough as the main symptoms.After physical examination, the respiratory sounds of the affected lung decreased, and the sounds of phlegm and dampness could be heard in both lungs.Mycoplasma pneumoniae (MP) antibody and RNA were positive.Chest CT showed lobar pneumonia with a large number of pleural effusion.The effect of macrolide antibiotics anti infection treatment was not good.Headache symptoms occurred during the course of the disease, and serum D-dimer increased significantly.Brain MRI showed CVST, including 1 case with lower extremity pain, and B-ultrasound showed right lower extremity arterial embolism.After anti infection, thrombectomy, anticoagulation and symptomatic treatment, 2 cases were discharged.When children with MPP, especially those with RMPP, have extracranial thrombosis and/or neurological symptoms, accompanied by elevated serum D-dimer, the possibility of CVST should be considered, and brain MRI examination should be performed in time to confirm and actively treat, which can reduce or avoid the occurrence of sequelae.Thrombosis may be related to excessive inflammatory reaction and vascular endothelial injury caused by MP infection.
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Objective:To study the macrolides resistance of Mycoplasma pneumoniae(MP) in Suzhou area, and try to explore the relationship between drug resistance and refractory Mycoplasma pneumoniae pneumonia (RMPP). Methods:From a series of hospitalized children who were diagnosed as Mycoplasma pneumoniae pneumonia (MPP) from October 2013 to September 2014 in Suzhou area, 48 children were treated with Azithromycin (10 mg/kg, once a day, intravenous drip for 5-7 days), and the clinical symptoms and chest imaging were still progressing so they were clinically diagnosed as RMPP, and 34 children who were successfully treated with macrolides antibiotics (MA) were clinically diagnosed as general MPP (GMPP). MP DNA was extracted from the airway secretion of children in the two groups, and the point mutations of 2063 and 2064 of 23S rRNA were sequenced, and according to the MP 23S rRNA sequencing results, the children were divided into macrolides antibiotic resistant MP group (MRMP) and macrolides antibiotic sensitive MP group (MSMP). The clinical characteristics of the two groups were compared. Results:In the MRMP group, the incidence of RMPP was 62.2% (46/74 cases), while in MSMP group, the incidence of RMPP was 25.0% (2/8 cases). The point mutation of MP 23S rRNA had no significant effect on the occurrence of RMPP ( χ2=2.719, P=0.099). Compared with MRMP group, MSMP group presented shorter fever time and less glucocorticoid use.No significant differences between the two groups were found in chest imaging examination, as well as some laboratory results, including the total number and classification of white blood cell (WBC), C-reactive protein (CRP), alanine aminotransferase (ALT), lactate dehydrogenase (LDH) and creatine kinase isoenzyme (CK-MB). Conclusions:The fever duration of MPP lasted more than 1 week, suggesting the possibility of macrolides resistance of MP, but macrolides resistance did not aggravate the occurrence of RMPP.It is unreliable to judge the MRMP by chest imaging features and laboratory results.
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Objective:To investigate the efficacy of azithromycin combined with different-dose methylprednisolone therapy for refractory mycoplasma pneumoniae pneumonia(RMPP)in children.Methods:Two hundred and twenty cases of RMPP admitted to Chengdu Women′s and Children′s Central Hospital between January 2014 and December 2019 were selected.They were treated with azithromycin combined with 1~2 mg/(kg·d)(low-dose)of methylprednisolone for 3 days, then they were divided into 2 groups, 152 cases with effective treatment in the control group A(effective group), 68 cases with ineffective treatment in observation group B(ineffective group). Among group B, according to the IgG, IgM and IgA as defined in Zhu Futang Practice of Pediatrics, 45 cases with normal immunity named normal-immune group B, change methylprednisolone dose to 10~30 mg/(kg·d)(high-dose)for 3 days, and 23 cases with low immunity named weakened-immune group B, change methylprednisolone dose to 10~30 mg/(kg·d)for 3 days and give immunomodulator therapy, that is human immunoglobulin for intravenous injection(IVIG)200 mg/(kg·d)for 3 days.After treatment, duration of fever, lung inflammation, extrapulmonary complications, hospitalization days and other indicators were compared.Results:Comparison between group A and group B, the lung rale absorption time[(11.32±3.62)d vs(10.00±2.32)d], lung consolidation absorption rate(64.10% vs 83.33%), pulmonary atelectasis retentive rate(52.38% vs 82.60%), effusion absorption rate(66.67% vs 100.00% ), the incidence rate of extrapulmonary complications(38.82% vs 25.00%), the disappearance time of complications[(10.96±2.98)d vs(8.94±2.86)d], the average hospitalization stay[(12.30±3.56)d vs(11.25±3.84)d]were significantly different( P<0.05). Comparison between normal-immune group B and weakened-immune group B after giving high doses of methylprednisolone, the fever dropped time[(10.51±3.26)h vs(8.60±3.31)h], the lung rale absorption time[(10.51±2.24)d vs(9.00±2.19)d], lung consolidation absorption rate(72.00% vs 100.00%), the average hospitalization stay[(12.00±3.96)d vs(9.78±3.19)d]were significantly different( P<0.05). Conclusion:Compared to low-dose of methylprednisolone, azithromycin combined with high-dose methylprednisolone therapy is better for RMPP.For the children with weakened immunity, better curative effect was obtained by IVIG.
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Objective@#To explore the risk factors for refractory Mycoplasma pneumoniae pneumonia (RMPP) in patients with plastic bronchitis.@*Methods@#A retrospective analysis was performed in RMPP children receiving bronchoscopy admitted to the Children′s Hospital of Soochow University from January 2013 to December 2017.According to the bronchoscopic findings, the patients were divided into plastic bronchitis group and non-plastic bronchitis group.The children′s gender, age, clinical manifestations, laboratory findings, imaging features, bronchoscopy findings and treatment were collected.Logistic regression was used to analyze the risk factors for plastic bronchitis in children with RMPP.@*Results@#A total of 198 children with RMPP were enrolled in the study, including 151 (76.3%) children in the non-plastic bronchitis group and 47 (23.7%) children in the plastic bronchitis group.There was no difference in the ratios of gender, age, proportion of fever, cough and wheezing between the 2 groups(all P>0.05). Compared with the non-plastic bronchitis group, children stayed longer at hospital in the plastic bronchitis group [13(8, 23) d vs. 9(7, 19) d](P<0.01). The longer the duration of fever (OR=6.10, 95% CI: 1.60-23.50), the lower the percen-tage of lymphocytes (L%) (OR=0.90, 95% CI: 0.81-0.98), and the higher the lactate dehydrogenase (LDH) (OR=1.03, 95% CI: 1.01-1.08), the higher the C reactive protein (CRP) (OR=1.10, 95% CI: 1.01-1.16) was, which was an independent risk factor for morphine bronchitis in RMPP (all P<0.05). The duration of fever, L%, CRP and LDH were 11 days, 30%, 50 mg/L and 550 U/L, respectively.@*Conclusions@#The duration of fever ≥11 days, the L%<30%, LDH>550 U/L, and CRP>50 mg/L ware independent risk factors for bronchitis in RMPP.
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Objective@#To explore the levels and clinical significance of MCP-4, IL-25, TNF-α and CysLTR-1 in bronchoalveolar lavage fluid(BALF)of children with refractory mycoplasma pneumoniae pneumonia(RMPP)and their correlation with serum C-reactive protein(CRP).@*Methods@#One hundred and nine children diagnosed as RMPP who underwent fiberoptic bronchoscopy in acute stage(course of disease within 2 weeks)were selected as the experimental group.According to the manifestations of mucosa, secretions and lumen under bronchoscope, the patients were divided into RMPP1 group(68 cases of severe pathological injury under bronchoscope)and RMPP2 group(41 cases of mild pathological injury under bronchoscope). They were divided into RMPP1 wheezing group(20 cases), RMPP1 non- wheezing group(48 cases), RMPP2 wheezing group(15 cases)and RMPP2 non-wheezing group(26 cases).15 children with non-mycoplasma pneumoniae pneumonia(NMPP)and non-wheezing lobar pneumonia in the same period were selected as control group 1.At the same time, 15 children without pneumonia underwent bronchial foreign body(FB)removal as control group 2.The levels of MCP-4, IL-25, TNF-α and CysLTR-1 in BALF of children in experimental group were determined by double antibody sandwich ELISA.Serum CRP, D dimer(DD), ALT and peripheral blood neutrophil percentage(N%)were also detected.@*Results@#(1)The levels of CRP, DD, ALT and N% in RMPP1 group with severe bronchoscopic manifestations were higher than those in RMPP2 group with relatively mild bronchoscopic manifestations(all P<0.05). (2)The mean levels of IL-25(117.8 ng/L), TNF-α(26.01ng/L), CysLTR-1(0.71 ng/L)and MCP-4(53.38 ng/L)in RMPP1 wheezing group were higher than those in the other five groups(P<0.05). The mean levels of IL-25(85.79 ng/L), TNF-α(19.2 ng/L), CysLTR-1(0.59 ng/L)and MCP-4(44.16ng/L)cells in RMPP2 wheezing group were higher than those in RMPP2 non-wheezing group, NMPP group and FB group(all P<0.05). There was no statistical difference between the other two groups(P>0.05). (3)CRP was positively correlated with IL-25, MCP-4 and TNF-a(all P<0.05), but not with CysLTR-1.@*Conclusion@#(1)Clinical laboratory indicators such as CRP, DD, ALT and N% can assist in early identification of RMPP.The higher the above indicators, the more serious performance of RMPP under microscope.(2)Cytokines MCP-4, IL-25, CysLTR-1 and TNF-α all participate in the pathogenesis of RMPP, and may play an important role in the occurrence of wheezing and development of asthma in children induced by MP infection.(3)Serum CRP levels were positively correlated with the levels of IL-25, MCP-4 and TNF-α in BALF of RMPP wheezing children.Both MCP-4 and IL-25 selectively affected Th2-induced Th2 cells.CRP is associated with IL-25 and MCP-4 who mediated immune inflammation injury.It is speculated that CRP may also cause Th2-mediated immune inflammation injury by affecting Th2 cells.
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Objective To explore the levels and clinical significance of MCP-4,IL-25,TNF-α and CysLTR-1 in bronchoalveolar lavage fluid (BALF) of children with refractory mycoplasma pneumoniae pneumonia (RMPP) and their correlation with serum C-reactive protein (CRP).Methods One hundred and nine children diagnosed as RMPP who underwent fiberoptic bronchoscopy in acute stage (course of disease within 2 weeks) were selected as the experimental group.According to the manifestations of mucosa,secretions and lumen under bronchoscope,the patients were divided into RMPP1 group (68 cases of severe pathological injury under bronchoscope) and RMPP2 group (41 cases of mild pathological injury under bronchoscope).They were divided into RMPP1 wheezing group (20 cases),RMPP1 non-wheezing group (48 cases),RMPP2 wheezing group (15 cases) and RMPP2 non-wheezing group (26 cases).15 children with non-mycoplasma pneumoniae pneumonia (NMPP) and non-wheezing lobar pneumonia in the same period were selected as control group 1.At the same time,15 children without pneumonia underwent bronchial foreign body (FB) removal as control group 2.The levels of MCP-4,IL-25,TNF-α and CysLTR-1 in BALF of children in experimental group were determined by double antibody sandwich ELISA.Serum CRP,D dimer (DD),ALT and peripheral blood neutrophil percentage (N％) were also detected.Results (1) The levels of CRP,DD,ALT and N％ in RMPP1 group with severe bronchoscopic manifestations were higher than those in RMPP2 group with relatively mild bronchoscopic manifestations (all P ＜ 0.05).(2) The mean levels of IL-25 (117.8 ng/L),TNF-α (26.01ng/L),CysLTR-1 (0.71 ng/L) and MCP-4 (53.38 ng/L) in RMPP1 wheezing group were higher than those in the other five groups (P ＜ 0.05).The mean levels of IL-25 (85.79 ng/L),TNF-α (19.2 ng/L),CysLTR-1 (0.59 ng/L) and MCP-4 (44.16ng/L) cells in RMPP2 wheezing group were higher than those in RMPP2 non-wheezing group,NMPP group and FB group (all P ＜0.05).There was no statistical difference between the other two groups (P ＞ 0.05).(3) CRP was positively correlated with IL-25,MCP-4 and TNF-a (all P ＜ 0.05),but not with CysLTR-1.Conclusion (1) Clinical laboratory indicators such as CRP,DD,ALT and N％ can assist in early identification of RMPP.The higher the above indicators,the more serious performance of RMPP under microscope.(2) Cytokines MCP-4,IL-25,CysLTR-1 and TNF-α all participate in the pathogenesis of RMPP,and may play an important role in the occurrence of wheezing and development of asthma in children induced by MP infection.(3) Serum CRP levels were positively correlated with the levels of IL-25,MCP-4 and TNF-α in BALF of RMPP wheezing children.Both MCP-4 and IL-25 selectively affected Th2-induced Th2 cells.CRP is associated with IL-25 and MCP-4 who mediated immune inflammation injury.It is speculated that CRP may also cause Th2-mediated immune inflammation injury by affecting Th2 cells.
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Mycoplasma pneumoniae is one of the main pathogens of common community-acquired pneumonia in children.The incidence of refractory mycoplasma pneumoniae pneumonia has been increasing in recent years,and the drugs are limited in children. Fiberoptic bronchoscopy plays an important role in the diagnosis and treatment of refractory mycoplasma pneumoniae pneumonia in children. In this paper,the diagnostic and therapeutic value of fiberoptic bronchoscopy in the treatment of refractory mycoplasma pneumoniae pneumonia in children was expounded from the aspects of endobronchial lesions,pathogen and cytokine analysis in bronchoalveolar lavage fluid,bronchoalveolar lavage,airway cleaning and local drug injection under bronchoscopy.
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OBJECTIVE： To introduce the pharmaceutical care for refractory mycoplasma pneumoniae （MP） pneumonia combined with cerebral infarction in child by clinical pharmacist， and to improve further understanding of MP-induced cerebral infarction and the management level of the clinical pharmacist. METHODS： Clinical pharmacist provided whole course pharmaceutical care for a child case of refractory PM pneumonia complicated with cerebral infarction admitted to the Children’s Hospital of Fudan University in Oct. 2018. The drug use in anti-infection， anti-inflammatory， treatment of cerebral infarction， possible drug interactions and suspected ADR were analyzed during treatment. RESULTS： The child admitted to the hospital for treatment due to MP pneumonia. During the treatment， the child suffered from cerebral infarction symptoms. The child was given a series of treatment programs， such as Azithromycin for injection for anti-infection， Methylprednisolone sodium succinate for injection for anti-inflammation， Nadroparin calcium injection for anticoagulation， Mannitol injection for reducing intracranial pressure， Dextran 40 glucose injection anti-thrombosis， Compound glycyrrhizin injection for protecting liver function， Hydrotalcite tablets for protecting gastric mucosa， intravenous immunoglobulin symptomatic supportive treatment. During the treatment， due to the poor therapeutic effect of Azithromycin for injection， it was considered that the patient may have cerebral infarction caused by refractory MP infection， so the patient’s prognosis was good when Azithromycin injection was replaced with Levofloxacin hydrochloride injection for anti-infection. For the increase of liver enzyme during the treatment， clinical pharmacist suggested that anti-infection combined with liver protection was provided for the child and then the liver enzyme returned to normal. During the treatment， clinical pharmacist mainly monitored the interaction and possible adverse reactions among anticoagulants， glucocorticoids， liver protecting drugs， drugs for reducing cranial pressure， antipyretic and analgesic drugs， and at the same time， made medication publicity and education for the family members of the child， and inform them of the adverse reactions of drugs to be paid attention to and the precautions for taking stomach protecting drugs， glucocorticoids and other drugs. CONCLUSIONS： Cerebral infarction caused by refractory MP pneumonia in children is because of excessive immune response directly or indirectly mediated by MP. The principle of treatment is to inhibit the inflammatory response， to solve the primary disease， and symptomatic supportive treatment. Multi-drug combination is needed in the course of treatment， so it is more necessary for the clinical pharmacist to participate in the whole process and to manage the drug refinement and ensure the safety of drug use.
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Objective To investigate the risk factors of single and multiple bronchoscopic lavage therapy in children with refractory Mycoplasma pneumoniae pneumonia(RMPP).Methods Retrospective analysis was conducted of the clinical data of 332 RMPP children at Department of Respiratory Disease,Children's Hospital of Soochow University from January 2011 to December 2016.The patients were divided into the single group and the multiple group (≥2 times),and the correlative index were compared between the 2 groups.Logistic regression analysis was performed to analyze the risk factors of multiple bronchoscopic lavage therapy in RMPP patients.Results Among 332 children,223 cases were in the single group and 109 cases in the multiple group.Children undergoing multiple bronchoscopy had the fever duration ≥ 10 days before the bronchoscopy and course of disease ≥ 10 days before the bronchoscopy,more than those in the single group [118 cases (52.9％) vs.71 cases (65.1％),69 cases (29.6％) vs.45 cases(41.3％)],and the differences were statistically significant(all P ＜ 0.05).At the same time,the use of glucocorticoid,macrolide,glucocorticoid combined with macrolide antibiotics in the first week of illness were significantly lower in the multiple groups than those in the single group,and the differences were statistically significant (all P ＜ 0.05).In the multiple group,the percentage of neutrophils (N),C-reactive protein (CRP),CRP ＞ 44 mg/L,lactate dehydrogenase (LDH) and LDH ＞ 480 U/L were higher than those in the single group,and the differences were significant (all P ＜ 0.05).In addition,the mixed infection and pleural effusion of multiple group were higher than those of the single group.The proportion of bronchoscopy in the multiple group was higher than that of the single group.In bronchoscopy,the mucus plug blocking and mucosal erosion were more than those of the single group,and the differences were statistically significant (x2 =5.397,13.31,all P ＜ 0.05).After adjusted by multiple regression analysis,6 factors were independent risk factors for multiple bronchoscopic procedures.They were the fever duration before the bronchoscopy ≥ 10 days[odds ratio (OR) =19.504,95 ％ confidence interval (CI):7.350-51.754,P =0.000],the unuse of macrolide antibiotics in the first week of illness (OR =5.072,95％ CI:2.230-11.537,P =0.000),the unuse of glucocorticoid in the first week of illness (OR =14.051,95 ％ CI:4.755-41.522,P =0.000),CRP ＞ 44 mg/L (OR =2.638,95 ％ CI:1.356-5.133,P =0.004),LDH ＞ 480 U/L(OR =2.326,95％ CI:1.302-4.157,P =0.004) and mucosal erosion (OR =11.15,95％ CI:2.503-49.715,P =0.002).Conclusion Severe inflammatory reaction and whether or not to actively resist infection and inflammation in the early stage,were important risk factors for multiple bronchoscopic procedures.
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Objective To investigate the clinical significance of the expression of pulmonary surfactant associated pro-tein(SP)in bronchoalveolar lavage fluid(BALF)of children with refractory Mycoplasma pneumoniae pneumonia(RMPP). Methods Thirty children with RMPP were selected from January 2015 to December 2016 in the People's Hospital of Hebi City. The lung function of the children was detected in acute and recovery stage,and bronchoalveolar lavage was performed with fiexible bronchofiberscope. The BALF was collected,and the levels of SP-A,SP-B,SP-C and SP-D in BALF were detected by enzyme linked immunosorbent assay. Results The forced expiratory volume in one second (FEV 1 ),forced vital capacity (FVC)and FEV1 / FVC in RMPP children at acute stage were (1. 34 ± 0. 23)L,(1. 75 ± 0. 28)L and (68. 25 ± 6. 21)％respectively;and they were (1. 71 ± 0. 35)L,(1. 98 ± 0. 36)L and (88. 57 ± 8. 16)％ respectively in the children at recov-ery stage. The FEV1 ,FVC and FEV 1 / FVC in RMPP children at recovery stage were significantly higher than those in the chil-dren at acute stage (t = 4. 839,3. 070,14. 859;P < 0. 05). The levels of SP-A,SP-B,SP-C and SP-D in the RMPP children at acute stage were (50. 19 ± 10. 06),(42. 95 ± 12. 42),(36. 81 ± 8. 14)and (21. 57 ± 5. 46)μg·L - 1 respectively;and they were (135. 20 ± 18. 13),(108. 42 ± 20. 33),(142. 63 ± 21. 87)and (72. 69 ± 8. 54)μg·L - 1 respectively in the children at recovery stage. The levels of SP-A,SP-B,SP-C and SP-D in BALF of RMPP children at recovery stage were significantly higher than those in the children at acute stage (t = 22. 457,15. 052,24. 837,27. 623;P < 0. 05). Conclusion The detection of SP-A,SP-B,SP-C and SP-D levels in BALF plays a guiding role in the diagnosis,disease assessment,treatment and prognosis judgment of RMPP.
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Objective To investigate the relationship between surfactant associated protein-A(SP-A) in bronchoalveolar lavage fluid(BLAF) and lung function in children with refractory mycoplasma pneumoniae pneumonia(RMPP).Methods Thirty children with RMPP were selected from January 2015 to December 2016 in the People's Hospital of Hebi City.The partial pressure of oxygen in artery (PaO2),partial pressure of carbon dioxide in artery (PaCO2),forced expiratory volume in one second(FEV1) and forced vital capacity (FVC) of the children were detected at acute and convalescent periods.The BALF was collected by bronchoalveolar lavage,and the level of SP-A in BALF was detected by enzyme linked immunosorbent assay.Results The level of SP-A in BALF of children with RMPP at ac ute and convalescent period was (3.63 ± 0.09) and (5.86 ± 0.17)mg · L-1 respectively,the level of SP-A in BALF of children with RMPP at acute phase was significantly lower than that at convalescent period(t =-63.499,P ＜ 0.05).The PaO2 and PaCO2 in children with RMPP at acute phase were (49.25 ±7.32) and (47.16 ±6.48)mmHg respectively,and they were (76.54 ±6.48) and (36.20 ± 5.61)mmHg respectively at convalescent period;the PaO2 in children with RMPP at acute phase was significantly lower than that at convalescent period (t =-15.289,P ＜ 0.05),and the PaO2 in children with RMPP at acute phase was significantly higher than that at convalescent period(t =7.004,P ＜ 0.05).The FEV1,FVC and FEV1/FVC in RMPP children at acute phase were (1.36 ±0.67),(1.68 ± 0.31) L and 69.85 ± 8.34 respectively;and they were (1.89 ± 0.58),(1.99 ± 0.53) L and 87.32 ± 9.52 respectively at convalescent period;the FEV1,FVC and FEV1/FVC in RMPP children at acute phase were significantly lower than those at convalescent period(t =-3.276,-2.765,-7.560;P ＜ 0.05).The level of SP-A in BALF of children with RMPP was positively correlated with PaO2 (r =0.921 6,P ＜ 0.05),but there was no significant correlation between SP-A level and PaCO2 (r =1.211 4,P ＜ 0.05).The level of SP-A in BALF was positively correlated with FEV1,FVC and FEV1/FVC (r =0.831,0.905,0.803;P ＜ 0.05).Conclusion The level of SP-A in BALF was positively correlated with lung function of children with RMPP.The detection of SP-A level in BALF is helpful to assess the lung function and pathogenetic condition of children with RMPP.
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Objective To investigate the value of pulmonary function tests during the early periods in the diagnosis and treatment of children with refractory mycoplasmapneumoniae pneumonia.Methods The clinical data of 67 children with refractory mycoplasma pneumoniae pneumonia (RMPP) and non-refractory mycoplasma pneumoniae pneumonia(non-RMPP) were retrospectively analyzed in the Department of Pediatrics,Shenyang Hospital of China Medical University.Thirty RMPP and 37 non-RMPP were detected by lung function test in the acute and recovery phase.Results The pulmonary function index (FVC、FEV1、PEF、MEF75、MEF50、MEF25 、MMEF75/25)of acute phase more decreased than recovery phase in PMPP group,and the same as nonRMPP group(P ＜ 0.05).In the acute phase,pulmonary function index (FVC、FEV1、PEF、MEF75、MEF50、MEF25 、MMEF75/25) of RMPP group decreased more than non-RMPP group (P ＜ 0.05).In the recovery phase,pulmonary function index (FVC 、FEV1 、PEF、MEF75 、MEFS0、MEF25 、MMEF75/25) of RMPP group decreased more than non-RMPP group (P ＜ 0.05).The pulmonary function index (FVC、FEV1、PEF、MEF75、MEF50 、MEF25 、MMEF75/25)of recovery phase of RMPP and non-RMPP group decreased more than control group (P ＜ 0.05).Conclusion Early and dynamic detection of the pulmonary function index in MPP is beneficial to identify the RMPP earlier,and necessary to give intervention treatment,in order to prevent the occurrence of complications.
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Objective To investigate the clinical,laboratory and imaging characterstics of refractory Mycoplasma pneumoniae pneumonia(RMPP) with lobar pneumonia change and efficacy of the therapy with different doses of glucocorticoids in children.Methods The clinical data of 103 children with Mycoplasma pneumoniae pneumonia(MPP) between September 2015 and February 2016 were investigated.Among the 103 children,there were 52 cases of RMPP and 51 cases of non-refractory MPP.The clinical features,laboratory examination and imaging characteristics were compared between the two groups.For the children with RMPP,the change of clinical symptoms and imaging were observed after the treatment with routine dose and large dose of glucocorticoids.Then,for the children with poor imaging,fiber bronchoscope can be used,the differences of airway mucosa injury and immune cells in the bronchoavleolar lavage fluid were compared after the treatment with routine dose and large dose of glucocorticoids.Results The children in the RMPP group had longer febrile time and hospital stay and were more likely to suffer from extrapulmonary complications.Peripheral blood neutrophil count,CRP,PCT,LDH and D-dimers were higher than these in the MPP group.At the same time it was more common that two or more pulmonary lobes were involved synchronally or pleural effusion appeared,the differences were statistically significant(P ＜ 0.05);There were no statistical differences that the clinical symptoms,imaging change,airway mucosa injury and the proportion of immune cells in BALF between the children in the RMPP group after the treatment with routine dose and large dose of glucocorticoids (P ＞ 0.05).Conclusion It should be alert to the occurence of RMPP in children with MPP when there was a persistent fever,extrapulmonary complications,increased levels of inflammatory index significantly,pleural effusion or two or more pulmonary lobes involvement.Compared with the treatment with routine dose of glucocorticoids in children with RMPP,it does not show a clear advantage with large dose of glucocorticoids on the clinical symptoms and inhibition of airway mucosa injury.
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Objective To investigate the specpfic electric fiberobronchoscopic manifestations of refractory Mycoplasma pneumoniae pneumonia(RMPP) and explore the level of IL-17,IL-18,PTX3 in bronchoalveolar lavage fluid(BALF) and their clinical sigfinance.Methods To select patients who were diagnosed as MPP and examined by fiberobronchoscopy in acute stage.Dividing them into groups:(1) RMPP group (60cases):dividing RMPP patients into three groups according to if they were treated by systemic corticosteroids or immunoglobulin before the examination of fiberbronchoscope,① RMPP-A group:both are not used.②RMPP-B group:use systemic corticosteroids.③ RMPP-C:both are used.(2)general MPP group(35 cases).15 children with foreign body in bronchus were enrolled as control group.Firstly,to analysis the electric fiberobronchoscopic manifestations of all the cases.Secondly,the cases who had BALF samples in all group were selected,the levels of IL-17,IL-18 and PTX3 are detected by ELISA.Results Under electric fiberobronchoscopy,that the proportions of RMPP group with mucosal erosion,necrotic mucous membrane peeling,sputum bolt blockage in bronchial lumen or moulding are higher than general MPP group.The levels of IL-17,IL-18 and PTX3 in BALF of all MPP cases are higher than control group (P ＜ 0.05),but only the difference of IL-18 between RMPP group and general MPP group has statistical significance (P ＜ 0.05).The levels of IL-17,IL-18 and PTX3 in BALF of RMPP-B group are all higher than RMPP-A group (P ＜ 0.05).Conclusion Mucosal erosion,necrotic mucosa peeling and sputum bolt,moulding are the characteristic manifestations of RMPP,and can help identify RMPP.IL-17,IL-l8 and PTX3 all participated in the pathogenesis of RMPP.Only the level of IL-18 in BALF can be the predictive marker of RMPP.Systemic corticosteroids may inhibit the levels of IL-17,IL-18 and PTX3 of RMPP patients.
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Objective To investigate the application value of serum immunoglobulin(Ig) and C-reactive protein(CRP) and lung function detection in the diagnosis and treatment of child refractory mycoplasma pneumoniae pneumonia(RMPP).Methods Eighty-two cases of child RMPP treated in these 3 hospitals from January 2015 to June 2016 were selected as the pneumonia group and contemporaneous 30 baseline data matched children undergoing physical examination served as the control group.The levels of serum IgA,IgG,IgM,IgE and CRP,forced expiratory volume at 1 s (FEV1),forced vital capacity (FVC) and other pulmonary function indexes were compared between the two groups.Their application value in diagnosis was analyzed.Results Compared with the control group,serum IgA and IgG levels,FEV1 and FVC in the pneumonia group were decreased,while serum IgE and CRP levels were increased (P＜0.05).Compared with before treatment,serum IgA and IgG levels,FEV1 and FVC after treatment in the pneumonia group were increased,while serum IgE and CRP levels were decreased(P＜0.05).Serum IgA and IgG levels,FEV1 and FVC before and after treatment in the ineffective cases of the pneumonia group were lower than those in the effective cases,while serum IgE and CRP levels were higher than those in the effective cases (P＜0.05).Serum IgA,IgG,IgE and CRP levels in children cases of RMPP were related to FEV1 arnd FVC level and treatment effective rate.Conclusion Serum IG,CRP and lung function detection has larger application value in diagnosing child RMPP and is worth clinical promotion.