Wang Lijun, Xie Qiuling, Xu Shanshan, Li Huajun, Zhang Liya, Ai Jingwen, Liu Quanhua, Chu Caiting, Zhang Xi, Zhang Wenhong, Huang Lisu
Department of Infectious Diseases, Xinhua Children's Hospital, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 200092, Shanghai, China.
Department of Infectious Diseases, Huashan Hospital, Fudan University, 200040, Shanghai, China.
Pediatr Res. 2023 Jan;93(1):198-206. doi: 10.1038/s41390-021-01874-z. Epub 2022 Apr 22.
To explore the effectiveness of flexible bronchoscopy in pediatric Mycoplasma pneumoniae pneumonia (MPP).
This retrospective cohort study included children with MPP admitted between 2016 and 2019 in Shanghai. Tracheobronchial manifestations, etiologic findings, therapeutic effect, and health-economic indicators were assessed in bronchoscopy (plus bronchoalveolar lavage (BAL)) and non-bronchoscopy group. We used propensity-score matching and multivariable logistic regression to investigate the effect of bronchoscopy and BAL on disease recovery.
In 900 children with MPP, 24/278 (8.6%) of those who underwent bronchoscopy had sputum plugs. Coinfection rate was four-fold enhanced by BAL (19.6% vs. 4.5%, p < 0.01) in patients with severe MPP (SMPP) and nearly doubled (10.8% vs. 5.9%, p = 0.03) in those without SMPP, compared with no BAL. Total of 224 (24.9%) patients had multilobar consolidation; after BAL, a significantly shorter lesion-resolution duration was observed on imaging (OR: 0.2, 95% CI: 0.0-0.7). However, longer fever duration (OR: 2.8, 95% CI: 1.7-4.8), hospital stay (OR: 3.1, 95% CI: 1.9-5.1), and higher costs were found in the bronchoscopy group than in the non-bronchoscopy group.
Through BAL, coinfection may explain one-fifth of causes for SMPP. Bronchoscopy with BAL may increase the detection rate of pathogen and resolve pulmonary lesions in patients with multilobar consolidation.
Flexible bronchoscopy with bronchoalveolar lavage is of great assistance in the timely detection of coinfection, sputum plug and inflammatory polyps in children with Mycoplasma pneumoniae pneumonia (MPP), and improves the recovery of lung damage in MPP patients with multilobar consolidation. This study provides new insights into the indications of flexible bronchoscopy for the diagnosis and treatment of pediatric patients with MPP.
探讨柔性支气管镜检查在小儿支原体肺炎（MPP）中的有效性。
这项回顾性队列研究纳入了2016年至2019年在上海住院的MPP患儿。对支气管镜检查（加支气管肺泡灌洗（BAL））组和非支气管镜检查组的气管支气管表现、病因学结果、治疗效果和卫生经济指标进行评估。我们采用倾向评分匹配和多变量逻辑回归来研究支气管镜检查和BAL对疾病恢复的影响。
在900例MPP患儿中，接受支气管镜检查的24/278例（8.6%）有痰栓。与未进行BAL相比，在重症MPP（SMPP）患者中，BAL使合并感染率提高了四倍（19.6%对4.5%，p<0.01），在非SMPP患者中几乎翻倍（10.8%对5.9%，p=0.03）。共有224例（24.9%）患者出现多叶实变；BAL后，影像学上观察到病变消散时间显著缩短（OR：0.2，95%CI：0.0-0.7）。然而，支气管镜检查组的发热持续时间更长（OR：2.8，95%CI：1.7-4.8）、住院时间更长（OR：3.1，95%CI：-5.1），且费用高于非支气管镜检查组。
通过BAL，合并感染可能解释了SMPP五分之一的病因。支气管镜检查联合BAL可能提高病原体的检出率，并使多叶实变患者的肺部病变得到缓解。
柔性支气管镜检查联合支气管肺泡灌洗对及时发现小儿支原体肺炎（MPP）患儿的合并感染、痰栓和炎性息肉有很大帮助，并改善了多叶实变MPP患者的肺损伤恢复情况。本研究为柔性支气管镜检查在小儿MPP诊断和治疗中的应用指征提供了新的见解。
