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Objective:To explore the clinical features and risk factors of severe mycoplasma pneumoniae pneumonia(SMPP) in children, and to provide guidance for early identification of SMPP.Methods:The clinical data of 263 children with mycoplasma pneumoniae pneumonia admitted to the Respiratory Department at Anhui Children′s Hospital from January 2019 to December 2021 were analyzed retrospectively.According to the severity of the disease, the patients were divided into severe group( n=88) and mild group( n=175). The general conditions, clinical manifestations, laboratory examination, imaging features and bronchoscopic findings between two groups were compared and statistically analyzed. Results:There was no significant difference in sex and onset season between two groups( P>0.05). The age of severe group was older than that of mild group( P<0.05). According to the age group, the incidence of SMPP in the infant group(14.10%) was lower than that in the preschool group (45.00%) and the school age group (37.65%) ( P<0.05), but there was no significant difference between preschool group and school age group ( P>0.05). The degree of fever and the proportion of extrapulmonary complications in severe group were higher than those in mild group, and the duration of fever, length of hospital stay and use of macrolides in severe group were longer than those in mild group ( P<0.05). There were significant differences in white blood cell count/lymphocyte count, C-reactive protein (CRP), prealbumin, glutamic pyruvic transaminase, lactate dehydrogenase (LDH), immunoglobulin G, immunoglobulin A, procalcitonin, erythrocyte sedimentation rate (ESR) and D-dimer between two groups(all P<0.05). There was significant difference in the copies of mycoplasma pneumoniae DNA in bronchoalveolar lavage fluid between two groups ( P<0.05). The proportion of large shadow, pleural thickening, atelectasis, pleural effusion, bronchoalveolar lavage and airway mucus thrombus blockage in severe group were higher than those in mild group ( P<0.05). Multivariate Logistic regression analysis showed that hot course ( OR=1.294, 95% CI: 1.127-1.485), CRP level( OR=1.027, 95% CI: 1.003-1.052), LDH level( OR=1.006, 95% CI: 1.002~1.011), D-dimer level( OR=1.406, 95% CI: 1.065~1.875), ESR( OR=1.042, 95% CI: 1.008-1.077), large shadow( OR=21.811, 95% CI: 6.205~76.664) and pleural effusion( OR=5.495, 95% CI: 1.604-18.826) were independent risk factors for SMPP.ROC curve analysis showed that thermal path, CRP level, LDH level, D-dimer level and ESR had high predictive value in the diagnosis of SMPP, and the best thresholds were 8.50 d, 25.625 mg/L, 412.50 IU/L, 0.98 mg/L and 36.5 mm/h, respectively. Conclusion:Children with SMPP had high degree of fever, long duration of fever, length of hospital stay, long use of macrolides, significantly increased inflammatory indexes, and severe changes in pulmonary imaging and bronchoscopy.Hot course, CRP level, LDH level, D-dimer level, ESR, large shadow and pleural effusion are risk factors for SMPP.It is helpful for early identification of SMPP when the hot course is >8.50 d, CRP>25.625 mg/L, LDH > 412.50 IU/L, D-dimer > 0.98 mg/L, ESR > 36.5 mm/h.
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Objective To investigate changes in tracheal bronchus (TB) under bronchoscopy and its clinical features in children.Methods The bronchoscopy datum,clinical manifestations and treatments of 46 children with TB from Department of Respiratory Medicine,Anhui Provincial Children's Hospital,were retrospectively analyzed.Results Among 46 cases,31 patients had displaced TB,13 patients had supernumerary TB,and 2 patients had trachea diverticulum.Meanwhile,in 45 cases was located at the right tracheal wall and 1 case was located at the posterior tracheal wall.Besides,20 cases were found accompanied with one type of tracheo bronchial anomalies,and the other 3 patients had 2 types of anomalies.Luminal stenosis,mucous membrane longitudinal fold and/or mucous plug were mostly revealed by bronchoscopy.Clinically,the main symptom s included recurrent or persistent cough,wheezing,refractory pneumonia,atelectasis or hyperinflation in the right upper lobe.Some cases showed no symptoms and were found accidentally by using chest CT or bronchoscope to check other diseases.Through anti-inflammatory and bronchoalveolar lavage (BAL) treatment,symptoms were improved or disappeared in 38 cases,the efficient rate was 82.6％.Conclusions TB is not unusual in pediatric patients,and mainly be found at the right wall of the trachea.Displaced TB is the most common type and frequently accompanied with the other anomalies.TB should be considered when recurrent or persistent cough,wheezing,or refractory pneumonia,atelectasis or hyperinflation in the right upper lobe occurred.Bronchoscopic technology is an important tool in the diagnosis and treatment of children with TB and may be used widely in pediatric diseases clinically.