肺炎支原体23SrRNA基因突变及其所致肺炎的临床分析  

Mutations of Mycoplasma Pneumoniae 23SrRNA Gene and Clinical Evaluation of Mutational Mycoplasma Pneumoniae Pneumonia

作　　者：韩晓华[1] 路素坤[1] 李书秀[1] 刘立云[1] 陈宁[1] 李书琴[1] 

机构地区：[1]中国医科大学附属盛京医院小儿呼吸科,沈阳110004

出　　处：《中国医科大学学报》2011年第2期162-165,171,共5页Journal of China Medical University

摘　　要：目的了解肺炎支原体23SrRNA基因突变现状,提高对肺炎支原体大环内酯类抗生素耐药基因突变所致肺炎的临床认识和诊治水平。方法对2009年5月至2009年10月我院住院的肺炎支原体肺炎患儿咽试子标本,应用巢式PCR扩增23SrRNA基因并进行电泳检测及DNA测序分析,筛选突变株;并进行总结和分析临床特点。结果应用巢式PCR扩增23SrRNA测出基因序列45例,均存在大环内酯类抗生素耐药基因突变。且变异基因位点均为2063位A→G的点突变,其中2例为2063位点A/G双峰;临床特点表现为91.1%患儿持续性发热伴咳嗽,以中、高度热为主。68.9%外周血白细胞总数正常;45例患儿肺部影像资料显示,双肺炎症14例,大叶性肺炎7例,伴胸腔积液6例。20例有肺外合并症;45例应用红霉素静注治疗有效率91.1%。结论肺炎支原体大环内酯类抗生素作用位点之一23SrRNA 2063普遍存在突变,其所致肺炎的临床表现无特异性;应用大环内酯类抗生素治疗91.1%有效,肺炎支原体此位点突变与其在体内是否耐药尚需进一步研究。Objective To study the mutations of the 23SrRNA gene of Mycoplasma pneumoniae（MP） and improve the recognition of the clinical situation and therapy of patients infected with it.Methods Pharynx specimens from 180 inpatients with Mycoplasma pneumoniae pneumonia（MPP） from May to October of 2009.MP-23SrRNA gene was amplified by nested PCR and DNA sequencing was performed.Then we screened the mutational MP.The characteristics of the inpatients diagnosed with mutational MP pneumonia were analyzed and summarized.Results 23SrRNA gene was found in 45 patients by nested PCR and DNA sequencing.All had A to G mutation at position 2063,in which 2 showed the coexistence of A and G.91.1% of the patients showed continuous fever accompanied by irritating cough;68.9% had normal peripheral blood white blood cell counts.Lung CT or X-ray image of the 45 patients showed inflammation：14 cases showed effusion or cloudy floc shadow in bilateral lungs;7 showed lobar pneumonia,and 6 developed exudative pleurisy.20 cases had complications outside the lungs.All the patients were treated with erythromycin,and the effective rate was 91.1%.Conclusion The 2063 point mutation of 23SrRNA gene is commomn in MPP patients,and the clinical manifestation is diverse.But the macrolides is effective for the treatment of the MPP patients.The relationship between point mutation in 23SrRNA at position 2063 and macrolide-resistant in vivo need further research.

关 键 词：肺炎支原体肺炎 23SrRNA基因突变 临床表现 耐药性 

分 类 号：R563.1[医药卫生—呼吸系统]