Journal of Shandong University (Health Sciences) ›› 2022, Vol. 60 ›› Issue (12): 52-57.doi: 10.6040/j.issn.1671-7554.0.2022.0252

Previous Articles     Next Articles

Inflammatory characteristics of lobar pneumonia in children with exact pathogens

XIE Xinyi1,2, ZHANG Amin1, ZHENG Wenyu1,2, NING Haonan1,2, YAN Xiankang1,2, MA Chenhui1,2, LI Fuhai1   

  1. 1.Department of Pediatrics, Qilu Hospital of Shandong University, Jinan 250012, Shandong, China;
    2. Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong, China
  • Published:2022-12-01

PDF (PC)

644

Abstract: Objective To explore the inflammatory characteristics of lobar pneumonia in children based on accurate etiology. Methods The clinical data of 153 children with lobar pneumonia hospitalized in the Department of Pediatrics, Qilu Hospital of Shandong University during June 2021 and December 2021 were retrospectively analyzed. According to the detection results of metagenomic next-generation sequencing(mNGS)of the bronchoalveolar lavage fluid(BALF), the single infection group was infected with mycoplasma pneumoniae(MP)(n=52), and the mixed infection group was infected with streptococcus pneumoniae(SP)and MP(n=26). Results MP was detected in the BALF of 133 cases(86.9%). The neutrophil and neutrophil to lymphocyte ratio in the single infection group were significantly higher than those in the mixed infection group(Z=-2.411, P=0.016; Z=-2.025, P=0.043). The number of leukocytes in the two groups 8 days before the onset of disease was significantly lower than that 8 days after the onset(Z=-2.399, P=0.016; Z=-2.109, P=0.035). The cells in BALF were mainly neutrophils. There was no significance in the numbers of neutrophils and macrophages 8 days before and after the onset of disease in the single infection group(t=1.334, P=0.190; t=-0.082, P=0.935). In the mixed infection group, the number of neutrophils 8 days before onset was significantly higher than that 8 days after onset, while the number of macrophages was significantly lower(t=2.707, P=0.025; t=-6.087, P<0.001). Conclusion Lobar pneumonia in children is mostly mixed infection caused by MP and SP, with strong local and systemic inflammatory response. There are frequently refractory cases.

Key words: Lobar pneumonia, Mycoplasma pneumoniae, Streptococcus pneumoniae, Immunoregulation, Children

CLC Number: 

  • R725.6
[1] 张丽, 章伟, 袁博, 等. 儿童大叶性肺炎肺泡灌洗液病原学及临床研究[J]. 临床儿科杂志, 2020, 38(8): 607-611. ZHANG Li, ZHANG Wei, YUAN Bo, et al. Etiology and clinical analysis of bronchoalveolar lavage fluid in children with lobar pneumonia [J]. Journal of Clinical Pediatrics, 2020, 38(8): 607-611.
[2] Xing Y, Wang D, Sheng K, et al. Dynamic change of Mycoplasma pneumoniae pneumonia in hospitalized children in a general hospital: a 3-year retrospective analysis [J]. Transl Pediatr, 2020, 9(4): 522-531.
[3] 江载芳, 申坤玲, 沈颖. 诸福棠实用儿科学[M]. 8版. 北京: 人民卫生出版社, 2015: 1262-1265.
[4] 王雪, 高密密, 尹力, 等. 儿童肺炎支原体肺炎并发大叶性肺炎的危险因素[J]. 中华医院感染学杂志, 2021, 31(2): 277-280. WANG Xue, GAO Mimi, Yin Li, et al. Risk factors for lobar pneumonia in children with Mycoplasma pneumoniae pneumonia [J]. Chinese Journal of Nosocomiology, 2021, 31(2): 277-280.
[5] Guo DX, Hu WJ, Wei R, et al. Epidemiology and mechanism of drug resistance of mycoplasma pneumoniae in Beijing, China: a multicenter study [J]. Bosn J Basic Med Sci, 2019, 19(3): 288-296.
[6] 王艳蕊, 王桂芳, 宋丽芳, 等. 儿童肺炎支原体感染的流行病学特征分析[J]. 中国病原生物学杂志, 2020, 15(2): 230-232. WANG Yanrui, WANG Guifang, SONG Lifang, et al. Epidemiological analysis of mycoplasma pneumoniae infection in children [J]. Journal of Pathogen Biology, 2020, 15(2): 230-232.
[7] 中华医学会儿科学分会呼吸学组. 儿童肺炎支原体肺炎诊治专家共识(2015年版)[J]. 中华实用儿科临床杂志, 2015, 30(17): 1304-1308.
[8] 马彩霞, 陈镜龙, 陆泳, 等. 肺泡灌洗液宏基因组测序在儿童重症肺炎支原体肺炎混 合感染中的诊断价值[J]. 临床儿科杂志, 2020, 38(12): 891-895. MA Caixia, CHEN Jinglong, LU Yong, et al. Diagnostic value of metagenomics next-generation sequencing of bronchalveolar lavage fluid for mixed infection in children with severe mycoplasma pneumoniae pneumonia [J]. Journal of Clinical Pediatrics, 2020, 38(12): 891-895.
[9] Schroeder MR, Stephens DS. Macrolide resistance in streptococcus pneumoniae [J]. Front Cell Infect Microbiol, 2016, 6: 98. doi: 10.3389/fcimb.2016.00098.
[10] Wang X, Cong Z, Huang W, et al. Molecular characterization of streptococcus pneumoniae isolated from pediatric patients in Shanghai, China [J]. Pediatr Pulmonol, 2020, 55(8): 2135-2141.
[11] 葛梦蕾, 殷芳, 赵汉青, 等. 肺炎支原体抗体滴度和RNA检测在儿童肺炎支原体肺炎诊疗中的应用价值[J]. 中华检验医学杂志, 2020, 43(11): 1106-1111. GE Menglei, YIN Fang, ZHAO Hanqing, et al. Application value of Mycoplasma pneumoniae antibody titer and RNA detection in diagnosis and treatment of Mycoplasma pneumoniae pneumonia in children [J]. Chinese Journal of Laboratory Medicine, 2020, 43(11): 1106-1111.
[12] 邹晓辉, 曹彬. 呼吸道感染病原学诊断年度进展2021[J]. 中华结核和呼吸杂志, 2022, 45(1): 78-82. ZOU Xiaohui, CAO Bin. Advances in pathogen diagnosis of respiratory infection diseases in 2021 [J]. Chinese Journal of Tuberculosis and Respiratory Diseases, 2022, 45(1): 78-82.
[13] Alzoubi O, Khanfar A.Association between neutrophil to lymphocyte ratio and mortality among community acquired pneumonia patients: a meta-analysis [J]. Monaldi Arch Chest Dis, 2021, 92(3). doi:10.4081/monaldi.2021.2050.
[14] Qi X, Dong Y, Lin X, et al. Value of neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, and red blood cell distribution width in evaluating the prognosis of children with severe pneumonia [J]. Evid Based Complement Alternat Med, 2021, 2021: 1818469. doi: 10.1155/2021/1818469.
[15] Rizo-Téllez SA, Méndez-García LA, Flores-Rebollo C, et al. The neutrophil-to-monocyte ratio and lymphocyte-to-neutrophil ratio at admission predict in-hospital mortality in Mexican patients with severe SARS-CoV-2 infection(Covid-19)[J]. Microorganisms, 2020, 8(10): 1560. doi: 10.3390/microorganisms8101560.
[16] Abensur Vuillaume L, Le Borgne P, Alamé K, et al. Neutrophil-to-lymphocyte ratio and early variation of NLR to predict in-hospital mortality and severity in ED patients with SARS-CoV-2 infection [J]. J Clin Med, 2021, 10(12): 2563. doi:10.3390/jcm10122563.
[17] 陈瑞芳, 周信英, 何国芳, 等. 中性粒细胞/淋巴细胞比值在评价儿童支原体性肺炎严重程度中的临床应用价值[J]. 中国妇幼保健, 2022, 37(4): 641-644.
[18] 张永娟, 昝丽娜, 孙峰, 等. NLR和CRP在疱疹性咽峡炎合并肺炎支原体感染患儿中的应用价值[J]. 检验医学, 2020, 35(5): 458-460.
[19] 李欢欢, 王军. RMPP患儿血常规、免疫球蛋白、D-D表达及预测塑型性支气管炎发生风险的效能研究[J]. 河北医科大学学报, 2021, 42(8): 914-919. LI Huanhuan, WANG Jun. Blood routine, immunoglobulin, D-D expression and their efficiency of predicting the risk of plastic bronchitis in children with RMPP [J]. Journal of Hebei Medical University, 2021, 42(8): 914-919.
[20] 姜静婧. IgE介导的自身免疫及炎症反应的研究进展[J]. 国际儿科学杂志, 2021, 48(11): 780-784. JIANG Jingjing. Advance in IgE-mediated autoimmune disorders and inflammation responses [J]. International Journal of Pediatrics, 2021, 48(11): 780-784.
[21] Ye Q, Mao JH, Shu Q, et al. Mycoplasma pneumoniae induces allergy by producing P1-specific immunoglobulin E [J]. Ann Allergy Asthma Immunol, 2018, 121(1): 90-97.
[22] Zhou L, Li Y, Xu Z, et al. Increased total serum immunoglobulin E is likely to cause complications of mycoplasma pneumoniae pneumonia in children [J]. Front Cell Infect Microbiol, 2021, 11: 783635. doi: 10.3389/fcimb.2021.783635.
[23] Poddighe D, Comi EV, Brambilla I, et al. Increased total serum immunoglobulin E in children developing mycoplasma pneumoniae-related extra-pulmonary diseases [J]. Iran J Allergy Asthma Immunol, 2018, 17(5): 490-496.
[24] 黄美霞, 郑燕, 潘丹峰, 等. 血浆D-二聚体水平与儿童肺炎支原体肺炎疾病严重度及预后的相关性研究[J]. 四川大学学报(医学版), 2022, 53(1): 160-165. HUANG Meixia, ZHENG Yan, PAN Danfeng, et al. The association between the level of Plasma d-dimer and disease severity and prognosis of mycoplasma pneumoniae pneumonia in children [J]. Journal of Sichuan University(Medical Sciences), 2022, 53(1): 160-165.
[25] 王宏杰. 地塞米松对大叶性肺炎患儿体征消失时间及血清炎症因子水平的影响[J]. 数理医药学杂志, 2021, 34(12): 1799-1801. WANG Hongjie. The effect of dexamethasone on the disappearance time of physical signs and the levels of serum inflammatory factors in children with lobar pneumonia [J]. Journal of Mathematical Medicine, 2021, 34(12): 1799-1801.
[26] 袁晓旭, 贾春梅, 姜采荣. 肝细胞生长因子对儿童重症肺炎支原体肺炎的早期诊断及动态监测意义[J]. 临床儿科杂志, 2021, 39(11): 855-859. YUAN Xiaoxu, JIA Chunmei, JIANG Cairong. Significance of hepatocyte growth factor in early diagnosis and dynamic monitoring of severe mycoplasma pneumoniae pneumonia in children [J]. Journal of Clinical Pediatrics, 2021, 39(11): 855-859.
[27] Morgan DJ, Casulli J, Chew C, et al. Innate immune cell suppression and the link with secondary lung bacterial pneumonia [J]. Front Immunol, 2018, 9: 2943. doi: 10.3389/fimmu.2018.02943.
[28] Zhao QY, Shi SJ, Sun DQ, et al. Correlation between galectin-3 level in bronchoalveolar lavage fluid and cellular immunity in children with refractory Mycoplasma pneumoniae pneumonia [J]. Zhongguo Dang Dai Er Ke Za Zhi, 2019, 21(2): 150-154.
[29] 蔡辰, 胡培培, 陆敏, 等. 肺泡灌洗液中细胞因子及细胞学水平与重症肺炎支原体肺炎的相关性[J]. 中华实用儿科临床杂志, 2020, 35(18): 1421-1424. CAI Chen, HU Peipei, LU Min, et al.Correlation of cytokine and cytology levels in bronchoalveolar alveolar lavage fluid of children with severe Mycoplasma pneumoniae pneumonia [J]. Chinese Journal of Applied Clinical Pediatrics, 2020, 35(18): 1421-1424.
[30] 彭凯岚, 曾焱华. 肺炎支原体P1蛋白的研究进展[J]. 中国人兽共患病学报, 2021, 37(4): 362-367. PENG Kailan, ZENG Yanhua. Research progress on the P1 protein of mycoplasma pneumoniae [J]. Chinese Journal of Zoonoses, 2021, 37(4): 362-367.
[31] 胡杨, 刘春峰. 儿童肺炎支原体相关肺外并发症临床表现及发病机制[J]. 中国小儿急救医学, 2021, 28(1): 7-11. HU Yang, LIU Chunfeng. Clinical manifestations and pathogenesis of mycoplasma pneumoniae-associated extrapulmonary complications in children [J]. Chinese Pediatric Emergency Medicine, 2021, 28(1): 7-11.
[32] 叶玲飞. 儿童肺炎支原体感染肺外损害的分析[D]. 合肥:安徽医科大学, 2020.
[1] YANG Jing, ZHANG Lei. Early childhood multi-niche viromes: unclassified phage diversity and host features [J]. Journal of Shandong University (Health Sciences), 2026, 64(5): 116-124.
[2] SUN Honglin, GUAN Yuqiang, YU Peiru, LI Lei, DU Qingxia, DING Hao. Feasibility and short-to-medium-term efficacy of stent implantation for the treatment of aortic coarctation complicated by hypertension in children [J]. Journal of Shandong University (Health Sciences), 2026, 64(4): 58-62.
[3] KUANG Li, XU Heyan. From precision assessment to integrated intervention: innovations and future perspectives in the diagnostic and therapeutic paradigm for child and adolescent mental health disorders [J]. Journal of Shandong University (Health Sciences), 2026, 64(3): 10-16.
[4] LI Fanghua, LIU Na, LI Xiaoyu, XU Dianhua, WANG Qian. Research progress on medication adherence in children and adolescents with depressive disorder [J]. Journal of Shandong University (Health Sciences), 2026, 64(3): 24-34.
[5] SUN Jiali, WANG Liang, WANG Changfeng, ZHANG Jie, GUO Lei. Emotional and behavioral problems in children with Klippel-Trenaunay syndrome: characteristics and influencing factors [J]. Journal of Shandong University (Health Sciences), 2026, 64(3): 78-82.
[6] WANG Qian, HU Xiaojing, WANG Aiqing, SUN Qiang, MENG Chunyan, LI Fanghua. Visual analysis of non-suicidal self-injury literature about children and adolescents with depressive disorder [J]. Journal of Shandong University (Health Sciences), 2026, 64(3): 93-107.
[7] WANG Yueqi, SONG Dongyu, LI Yuli, XIE Hao, ZHANG Yuerong. Mediating role of childrens difficulties and prosocial behaviour in the relationship between family resilience and grandparenting stress [J]. Journal of Shandong University (Health Sciences), 2026, 64(1): 57-64.
[8] CAO Luofei, WANG Shanshan, WANG Jinrong, JIANG Heyun, MIAO Yu, MA Guangzeng. Analysis of the characteristics of bronchial dilation test in children with FeNO elevation during asthma exacerbation [J]. Journal of Shandong University (Health Sciences), 2025, 63(6): 38-44.
[9] CHEN Xujun, HE Guowei. Focus on further more use of arterial grafts in coronary artery bypass grafting in patients with coronary heart disease in China [J]. Journal of Shandong University (Health Sciences), 2025, 63(5): 1-5.
[10] MO Xuming, WANG Qingfeng. Application of coronary artery bypass grafting in pediatric cardiovascular disease [J]. Journal of Shandong University (Health Sciences), 2025, 63(5): 40-46.
[11] LI Ling, YAN Yuhan, KONG Qingyu, WANG Minmin, ZHAO Haizhao, ZHAO Cuifen. Correlation between orthostatic intolerance symptom scores, catecholamine and emotional disorders in children with vasovagal syncope [J]. Journal of Shandong University (Health Sciences), 2025, 63(5): 71-78.
[12] WANG Mengyuan, ZHANG Chunyan, YU Wenwen, KOU Linna, WANG Shifu. Composition and antifungal susceptibility surveillance of clinically isolated fungi from children and adults in Shandong Province from 2018 to 2021 [J]. Journal of Shandong University (Health Sciences), 2025, 63(4): 83-93.
[13] SHI Wenxin, FAN Youjun, CHEN Yuan, LIU Haiyan, SUN Lifeng, GUO Lu. Two cases of pediatric celiac disease and literature review [J]. Journal of Shandong University (Health Sciences), 2025, 63(2): 51-57.
[14] XIAO Changchun, YU Linling, YAN Derui, ZHU Yu. Effects of ozone on emergency room visits of respiratory diseases among children in Hefei City [J]. Journal of Shandong University (Health Sciences), 2025, 63(2): 95-103.
[15] DING Yangkun, LIU Tao, LIU Yu, YU Jiazhi, MU Pengfei. Influencing factors of bacterial culture negative after the first surgery of acute hematogenous osteomyelitis caused by Staphylococcus aureus [J]. Journal of Shandong University (Health Sciences), 2025, 63(12): 53-60.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
Copyright 2018 © Editorial office of Journal of Shandong University (Health Sciences)
Supported by Beijing Magtech Co.Ltd