To evaluate the effect of bronchoalveolar lavage (BAL) on the clinical prognosis of children with macrolide drug-resistant Mycoplasma pneumoniae pneumonia (MRMPP) in a retrospective cohort study based on propensity score matching (PSM).A retrospective cohort study based on propensity score matching retrospectively collected the clinical data of hospitalized patients diagnosed with mycoplasma macrolide drug-resistant pneumonia (MRMPP) in Respiratory Department of Hunan Children's Hospital from January 2020 to August 2023. According to whether bronchoalveolar lavage (BAL) was performed during hospitalization, the children were divided into BAL group and non-BAL group, and the baseline information of the two groups was matched by propensity scores, and the clinical prognosis was compared. A total of 302 children were screened, and 150 cases were successfully matched, including 59 cases in the BAL group and 91 cases in the non-BAL group. The results showed that the differences between the non-BAL group and the BAL group before PSM(P<0.05) were significantly different in age [(4.60±2.97)years vs (5.41±3.02) years, t=-2.273, P=0.024], shortness of breath (9.4% vs 22.5%, χ2=9.864, P=0.002), and radiographic manifestations [lung interstitial changes (29.8% vs 15.3%, χ2=8.009, P=0.005), lung consolidation (17.3% vs 55.9%, χ2=48.457, P<0.001), spotted flaky infiltrates (52.4% vs 27.9%, χ2=17.056, P<0.001)], bacterial infection (3.2% vs 9.2%, χ2=4.845, P=0.028), duration of azithromycin or doxycycline use [4(2, 5) days vs 5(3, 6) days, Z=-2.374, P=0.018], White Blood Cell Count at admission [7.94 (6.25, 10.34)×109/L vs 7.21 (5.65, 9.01)×109/L, Z=-2.445, P=0.014], D Dimer [0.58 (0.44, 0.83) μg/ml vs 0.80 (0.52, 1.12) μg/ml, Z=-3.154, P=0.002], but there was no significant difference between the two groups in the above indexes after PSM (P>0.05). The duration of hospitalization, cough relief, disappearance of rales and fever in the BAL group was shortened in the BAL group compared with that in the non-BAL group [5 (4, 7) days vs 7 (5, 8) days, Z=-2.373, P=0.018], and the difference was statistically significant (P<0.05). Linear regression analysis of PSM cohort study showed that BAL was negatively correlated with fever time (β=-4.369, 95%CI:-8.600--0.138, P<0.05). In conclusion, BAL can shorten the fever time of MRMPP, and early BAL in addition to conventional treatment has a positive effect on the prognosis of children.
基于倾向性评分匹配（PSM）的回顾性队列研究评估支气管肺泡灌洗术（BAL）对大环内酯类耐药肺炎支原体肺炎（MRMPP）患儿临床预后的影响。采用基于倾向性评分匹配的回顾性队列研究，收集2020年1月至2023年8月湖南省儿童医院呼吸内科诊断为大环内酯类耐药肺炎支原体肺炎（MRMPP）住院患儿的临床资料。根据住院期间是否行支气管肺泡灌洗术（BAL）分为BAL组和非BAL组，通过倾向性评分匹配2组患儿基线信息，比较临床预后情况。共302例患儿接受筛选，150例匹配成功，其中BAL组59例，非BAL组91例，应用单因素分析法筛选出与MRMPP患儿行BAL相关的协变量，并采用线性回归模型分析BAL对MRMPP患儿临床预后的影响。结果显示，PSM前的非BAL组与BAL组在年龄［（4.60±2.97）岁 vs（5.41±3.02）岁，t=-2.273，P=0.024］、气促（9.4% vs 22.5%，χ2=9.864，P=0.002）、影像学表现［肺间质改变（29.8% vs 15.3%，χ2=8.009，P=0.005）、肺实变（17.3% vs 55.9%，χ2=48.457，P<0.001）、点片状浸润（52.4% vs 27.9%，χ2=17.056，P<0.001）］、是否合并细菌感染（3.2% vs 9.2%，χ2=4.845，P=0.028）、阿奇霉素或多西环素使用时间［4（2，5）d vs 5（3，6）d，Z=-2.374，P=0.018］、入院时白细胞计数［7.94（6.25，10.34）×109个/L vs 7.21（5.65，9.01）×109个/L，Z=-2.445，P=0.014］、D二聚体［0.58（0.44，0.83）μg/ml vs 0.80（0.52，1.12）μg/ml，Z=-3.154，P=0.002］等方面，差异有统计学意义（均P<0.05）；在PSM后的两组在上述指标差异无统计学意义（均P>0.05）。通过PSM单因素分析BAL对两组患儿住院时间、咳嗽缓解时间、啰音消失时间及发热时间进行比较，BAL组发热时间较非BAL组时间缩短［5（4，7）d vs 7（5，8）d，Z=-2.373，P=0.018］，差异有统计学意义（P<0.05）。PSM队列研究线性回归分析显示，BAL与发热时间呈负相关（β=-4.369，95%CI：-8.600~-0.138，P<0.05）。综上，行BAL可能缩短MRMPP的发热时间，除常规治疗外，尽早行BAL可对患儿的预后有积极作用。.