Objective:To explore the clinical features and risk factors for pediatric severe Mycoplasma pneumoniae pneumonia (SMPP) complicated with pulmonary embolism. Methods:SMPP patients admitted to Department of Pediatrics, Jiaxing First Hospital and Pediatric Intensive Care Unit, Shanghai Children′s Hospital from December 2019 to December 2023 were included in this retrospective case-control study.According to whether they were complicated with pulmonary embolism, SMPP patients were divided into a pulmonary embolism group and a non-pulmonary embolism group.Clinical characteristics of the two groups, including general data, laboratory examination and imaging data were compared and analyzed.The t-test and Mann-Whitney rank-sum test were used to compare the measurement data, and the χ2 test was used to compare the count data.The risk factors of SMPP patients developing pulmonary embolism were analyzed by the univariate method. Results:There were 10 out of 62 SMPP children developing pulmonary embolism, showing an incidence of 16.13%.In the pulmonary embolism group, there were 5 boys and 5 girls, with a median age of 7.50 (5.75, 9.25) years.There were 52 children in the non-pulmonary embolism group, including 29 boys and 23 girls, with a median age of 6.50(5.00, 8.00)years.The hospitalization time, body temperature, total white blood cell count, neutrophil count, C-reactive protein levels, lactate dehydrogenase levels, prothrombin time, activated partial thromboplastin time, D-dimer (D-D) levels, fibrinogen degradation product levels, pleural effusion and atelectasis rates in the pulmonary embolism group were significantly higher than those in the non-pulmonary embolism group (all P<0.05). Fibrinogen levels in the pulmonary embolism group were significantly lower than those in the non-pulmonary embolism group ( P<0.05). Univariate Logistic regression analysis showed that the D-D level was a risk factor for SMPP patient developing pulmonary embolism.The receiver operating characteristic curve analysis revealed that the D-D level had the largest area under the curve for predicting pulmonary embolism of 0.990(95% CI: 0.972-1.000, P<0.001), with a sensitivity of 100%, a specificity of 92%, and a cut-off value of 4.63 mg/L. Conclusions:SMPP children complicated with pulmonary embolism are prone to high inflammation and impaired coagulation function.The increase of D-D levels is a risk factor for the development of pulmonary embolism in SMPP.

Objective:To explore the clinical features and risk factors for pediatric severe Mycoplasma pneumoniae pneumonia (SMPP) complicated with pulmonary embolism. Methods:SMPP patients admitted to Department of Pediatrics, Jiaxing First Hospital and Pediatric Intensive Care Unit, Shanghai Children′s Hospital from December 2019 to December 2023 were included in this retrospective case-control study.According to whether they were complicated with pulmonary embolism, SMPP patients were divided into a pulmonary embolism group and a non-pulmonary embolism group.Clinical characteristics of the two groups, including general data, laboratory examination and imaging data were compared and analyzed.The t-test and Mann-Whitney rank-sum test were used to compare the measurement data, and the χ2 test was used to compare the count data.The risk factors of SMPP patients developing pulmonary embolism were analyzed by the univariate method. Results:There were 10 out of 62 SMPP children developing pulmonary embolism, showing an incidence of 16.13%.In the pulmonary embolism group, there were 5 boys and 5 girls, with a median age of 7.50 (5.75, 9.25) years.There were 52 children in the non-pulmonary embolism group, including 29 boys and 23 girls, with a median age of 6.50(5.00, 8.00)years.The hospitalization time, body temperature, total white blood cell count, neutrophil count, C-reactive protein levels, lactate dehydrogenase levels, prothrombin time, activated partial thromboplastin time, D-dimer (D-D) levels, fibrinogen degradation product levels, pleural effusion and atelectasis rates in the pulmonary embolism group were significantly higher than those in the non-pulmonary embolism group (all P<0.05). Fibrinogen levels in the pulmonary embolism group were significantly lower than those in the non-pulmonary embolism group ( P<0.05). Univariate Logistic regression analysis showed that the D-D level was a risk factor for SMPP patient developing pulmonary embolism.The receiver operating characteristic curve analysis revealed that the D-D level had the largest area under the curve for predicting pulmonary embolism of 0.990(95% CI: 0.972-1.000, P<0.001), with a sensitivity of 100%, a specificity of 92%, and a cut-off value of 4.63 mg/L. Conclusions:SMPP children complicated with pulmonary embolism are prone to high inflammation and impaired coagulation function.The increase of D-D levels is a risk factor for the development of pulmonary embolism in SMPP.

Objective To investigate the diagnostic value and clinical significance of hypersensitive C-reactive protein(hs-CRP),procalcitonin(PCT)combined with interleukin-6(IL-6)in children with severe hand-foot-mouth disease.Methods A total of 62 children hospitalized in our hospital from January 2022 to December 2022 were collected as research objects.According to the severity of infection,they were divided into observation group(severe infection group)with 29 cases and control group(mild infection group)with 33 cases.The differences of general data,total leukocyte count,neutrophil count,lymphocyte count,platelet count,hs-CRP,PCT,IL-6 and creatine kinase isoenzyme(CK-MB)between the two groups and their clinical applications were analyzed and compared.Results The total white blood cell count,neutrophil count,lymphocyte count,hs-CRP,PCT and IL-6 in the observation group were higher than those in the control group,and the difference has statistically significant.Receiver operator characteristic(ROC)curve analysis of hs-CRP predicted the sensitivity and specificity of severe infection of hand-foot-mouth disease were 79.3%and 93.9%(95%CI:0.852-10.985,P<0.05);The sensitivity and specificity of PCT were 93.1%and 84.8%(95%CI:0.907-1,P<0.05);The sensitivity and specificity of IL-6 were 96.6%and 87.9%(95%CI:0.945-1,P<0.05).Conclusions In hand-foot-mouth classification,PCT and IL-6 are highly sensitive.Although hs-CRP is less sensitive than the former,its specificity is higher than the former.Therefore,the combination of hs-CRP,PCT and IL-6 has higher value for hand-foot-mouth classification.

Objective To explore the expression of cytokine and Toll- like receptors(TLRs) in children′s bacterial infection and its clinical significance. Methods Sixty children patients with systemic inflammatory response syndrome(SIRS)were enrolled in this study from December 2014 to June 2016.They were infected by Gram-positive bacteria(G+), Gram-negative bacteria(G+), and regarded as G+group (30 cases) and G- group (30 cases). In addition, 20 healthy subjects were selected as control group.The levels of tumor necrosis factor(TNF)-α, interferon(IFN)-γ, interleukin(IL)-2, IL-4, IL-6, IL-10 and TLR2, TLR4 in peripheral blood were compared.Results The levels of TNF-α,IFN-γ,IL-2, IL-6 and IL-10 in G+group and G-group were significantly higher than those in the control group, and the levels of IFN-γ,IL-6,IL-10 in G+group were significantly lower than those in G+group(P<0.05). The level of TLR2 in G+group was significantly higher than that in G+group and control group(P<0.05).The level of TLR4 in G+group was significantly higher than that in G+group and control group(P<0.05). After treatment, the levels of TNF-α, IFN-γ, IL-2,IL-4, IL-6,IL-10,TLR2 and TLR4 in SIRS were significantly lower than those before treatment: (5.42 ± 1.34) ng/L vs. (9.13 ± 2.91) ng/L, (3.91 ± 1.26)ng/L vs.(6.69 ± 2.13)ng/L,(2.42 ± 0.34)ng/L vs.(3.28 ± 0.62)ng/L,(3.57 ± 0.69)ng/L vs.(4.55 ±1.17) ng/L, (18.82 ± 3.32) ng/L vs. (253.32 ± 38.21) ng/L, (14.32 ± 2.57) ng/L vs. (45.27 ± 8.24) ng/L, 0.366 ± 0.015 vs.1.084 ± 0.053, 0.424 ± 0.029 vs.0.824 ± 0.068,P<0.01.Conclusions Cytokine spectroscopy and TLRs is involved in the process of bacterial infection. Combined detection has great significance in the diagnosis of bacterial infection and identification of infection in children and can provide reference for clinic.

Objective To study the etiology of comumunity acquired pneumonia (CAP) in children of Jiaxing city and provide the basis for the clinical diagnosis and treatment.Methods An etiological study was performed on 800 young children with CAP in Jinxing First Hospital from Jan 2008 to Dec 2010.Sputum samples were collected for isolating bacteria and checking the antigen of respiratory syncytial virus ( RSV),adenovirus ( ADV),influenza virus (IV) and parainfluenza virus ( PIV ).IgM antibodies of mycoplasma pneumoniae (MP),ADV,W and PIV paired serum samples were detected.The 202 cases with positive etiology were divided into three groups:bacteria group ( 109 cases),virus group (54 cases) and MP group (39 cases).The leukocyte,C-reactive protein (CRP) and procalcitonin (PCT) were detected.Results The etiology of CAP was identified in 202 (25.25％) children of all the 800 cases,the distribution of causal agents was as follows:Streptococcus pneumoniae in 46 cases (22.77％,46/202 ),Haemophilus influenzae in 32 cases (15.84％,32/202),Staphylococcus in 5 cases (2.48％,5/202),Klebsiella pneumoniae in 8 cases (3.96％,8/202),Escherichia coli in 12 cases (5.94％,12/202),MP in 39 cases ( 19.31％,39/202),RSV in 48 cases (23.76％,48/202),ADV in 1 case (0.50％,1/202),IV in 3 cases ( 1.49％,3/202),and PIV in 2 cases ( 0.99％,2/202 ),Streptococcus pneumoniae and RSV mixed infection in 3 cases ( 1.49％,.3/202),Streptococcus pneumoniae and MP mixed infection in 3 cases ( 1.49％,3/202).RSV infection occured mainly in infants less than 1-year-old,Streptococcus pneumoniae oceured in all ages but was mostly in 1 ～ 3years,Haemophilus influenzae infection occured mainly in infants less than 3-year-old,MP infection occured mainly in infants more than six years.The PCT levels of the three groups were (7.78 ±6.14) ng/ml,(0.39 ±0.56) ng/ml,and (0.20 ±0.34) ng/ml,respectively.There were significant differences among the three groups ( P ＜ 0.05 ).Conclusion RSV infection occurs mainly in infants of age less than 1 year,Streptococcus pneumoniae and Haemophilus influenzae infection occur mainly in infants of age 1 ～3 years,while MP is the leading cause of pneumonia in children of age more than 6 years in Jiaxing city.We can decide pathogen on ages,clinical manifestation and PCT level to guide the rational use of drugs.