Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy · 2026
Prognostic significance of an integrated diagnostic and therapeutic strategy combining bronchoscopy and CT score with monocyte subsets in pediatric patients with severe refractory Mycoplasma pneumoniae pneumonia.
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Li Dandan, Lang Yanmei, Li Fangfang, Zhao Yunxia
Аннотация
OBJECTIVE: This study aimed to investigate the clinical efficacy and predictive significance of an integrated strategy combining bronchoscopy, CT scoring, and monocyte subsets to guide personalized treatment in pediatric severe refractory Mycoplasma pneumoniae pneumonia (RMPP).
METHODS: A total of 260 severe RMPP children (December 2022-May 2024) were assigned to a control group (n = 130, receiving guideline-based conventional therapy including azithromycin and empirically administered corticosteroids) or an experimental group (n = 130, receiving conventional therapy plus a multimodal intervention). The intervention included: (1) bronchoscopy with bronchoalveolar lavage (BAL) for targeted pathogen diagnosis and airway clearance; (2) CT scoring to quantify lung injury and guide treatment intensity; and (3) monocyte subpopulation analysis to tailor immunomodulatory therapy. Inflammatory markers (TNF-α, IL-6, CRP), symptom duration, hospitalization/ICU stays, 6-month recurrence, and PedsQL quality of life were evaluated.
RESULTS: The experimental group showed significantly shorter fever duration (4.38 vs. 6.49 days, P < 0.001) and cough duration (8.05 vs. 11.63 days, P < 0.001), reduced hospitalization/ICU stays, lower post-treatment TNF-α, IL-6, CRP levels, and a lower 6-month recurrence rate (all P < 0.05). The clinical cure rate was higher (42.30% vs. 30.76%, P < 0.001) and PedsQL scores were superior in the experimental group (P < 0.05). Baseline monocyte subsets, particularly intermediate monocytes (CD14++CD16+), were identified as significant predictors of disease severity and treatment response (AUC = 0.812).
CONCLUSION: An integrated strategy utilizing bronchoscopy, CT scoring, and monocyte subpopulation analysis synergistically enhances severe RMPP prognosis by optimizing personalized treatment, accelerating clinical recovery, mitigating inflammation, and improving long-term outcomes.
METHODS: A total of 260 severe RMPP children (December 2022-May 2024) were assigned to a control group (n = 130, receiving guideline-based conventional therapy including azithromycin and empirically administered corticosteroids) or an experimental group (n = 130, receiving conventional therapy plus a multimodal intervention). The intervention included: (1) bronchoscopy with bronchoalveolar lavage (BAL) for targeted pathogen diagnosis and airway clearance; (2) CT scoring to quantify lung injury and guide treatment intensity; and (3) monocyte subpopulation analysis to tailor immunomodulatory therapy. Inflammatory markers (TNF-α, IL-6, CRP), symptom duration, hospitalization/ICU stays, 6-month recurrence, and PedsQL quality of life were evaluated.
RESULTS: The experimental group showed significantly shorter fever duration (4.38 vs. 6.49 days, P < 0.001) and cough duration (8.05 vs. 11.63 days, P < 0.001), reduced hospitalization/ICU stays, lower post-treatment TNF-α, IL-6, CRP levels, and a lower 6-month recurrence rate (all P < 0.05). The clinical cure rate was higher (42.30% vs. 30.76%, P < 0.001) and PedsQL scores were superior in the experimental group (P < 0.05). Baseline monocyte subsets, particularly intermediate monocytes (CD14++CD16+), were identified as significant predictors of disease severity and treatment response (AUC = 0.812).
CONCLUSION: An integrated strategy utilizing bronchoscopy, CT scoring, and monocyte subpopulation analysis synergistically enhances severe RMPP prognosis by optimizing personalized treatment, accelerating clinical recovery, mitigating inflammation, and improving long-term outcomes.