耐药肺炎支原体肺炎患儿的临床特点及流行基因型特征分析  

Analysis of clinical characteristics and epidemic genotypes of children with Mycoplasma pneumoniae pneumonia

作　　者：郑宝英[1] 闫超[2] 薛冠华[2] 曹玲[1] 孙红妹[2] 

机构地区：[1]首都儿科研究所附属儿童医院呼吸内科,100020 [2]首都儿科研究所细菌研究室,100020

出　　处：《中华实用儿科临床杂志》2017年第10期735-739,共5页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的探讨耐药肺炎支原体（MP）肺炎患儿的临床特点及流行基因型特征。方法选取2013年1月至2015年10月首都儿科研究所附属儿童医院临床诊断为MP肺炎，且咽拭子或肺泡灌洗液MP聚合酶链反应（PCR）检测阳性的96例标本，其中男55例，女41例；1～3岁19例（19.8%），〉3～5岁18例（18.7%），〉5～13岁2个月59例（61.5%）。对所有标本进行23S rRNA耐药基因检测，根据耐药基因检测结果分为耐药组和敏感组。同时，对所有标本进行P1－基因限制性片段长度多态性分析（P1－RFLP）及多位点可变数目串联重复序列分析（MLVA）基因分型，比较耐药组与敏感组及不同基因型MP感染的临床特点，包括患儿年龄、性别、住院时间、症状、体征、发热时间、使用大环内酯类抗生素后体温恢复正常时间、血常规白细胞总数、C反应蛋白（CRP）及胸部X线和/或肺部CT检查等影像学表现。采用SPSS 11.5统计学软件进行处理，P〈0.05为差异有统计学意义。结果96例标本中，81例在23S rRNA中检测到耐药基因，耐药率高达84%。根据耐药基因的检测结果分为耐药组（81例）和敏感组（15例）。耐药组患儿的发热时间、住院时间、并发症发生率、CRP水平均高于敏感组，差异均有统计学意义（t＝2.061、Z＝－3.368，χ^2＝5.856、Z＝－2.165，均P〈0.05）；年龄、白细胞总数、发生叶或段实变比例、应用大环内酯类抗生素后体温恢复正常时间差异均无统计学意义（均P〉0.05）。对96例标本进行P1－RFLP基因分型，5例P1分型未成功，91例中P1－Ⅰ型81例（89.0%），P1－Ⅱc型10例（11.0%）。P1－Ⅰ型较P1－Ⅱc型组患儿住院时间及应用大环内酯类抗生素后体温恢复正常时间长，差异均有统计学意义（Z＝－2.197、2.237，均P〈0.05）；年龄、发热时间、白细胞总数、CRP水平、影像学发生叶或段实变比例、并发症发生率�Objective To explore the clinical features of children infected with macrolide-resistant （MR） Mycoplasma pneumonia（MP） isolates and genetic typing of all isolates.Methods Polymerase chain reaction（PCR） of MP positive in 96 nasopharyngeal or bronchoalveolar lavage fluid （BALF） samples were collected from patients diagnosed as MP pneumonia in the Affiliated Children′s Hospital of the Capital Institute of Pediatrics from January 2013 to October 2015.Fifty-five cases were male, 41 cases were female; 19 cases（19.8%） were 1 to 3 years old, 18 cases（18.7%） were more than 3 to 5 years old, 59 cases（61.5%） were more than 5 to 13 years and 2 months old.These samples were tested for MR associated mutations in the 23S rRNA of MP, and were divided into the MR group and the macrolide-sensitive （MS） group.Furthermore, the genotype of all the isolates were performed by conducting P1- restriction fragment length polymorphism（P1-RFLP） analysis and multiple-locus variable-number tandem-repeat analysis（MLVA） method.The clinical characteristics including the age, gender, hospitalization duration, symptoms, signs, fever duration, fever duration after macrolide therapy, white blood cell count, C-reactive protein （CRP）, chest X-ray and/or chest computed tomography, which were compared between different groups.SPSS 11.5 software was used to analyze the statistical data.Statistical significance was determined at the 0.05 level of a two-tailed test.Results MR mutations were identified in the 23S rRNA gene in 81 specimens（84%）, and the 96 specimens were divided into MR group（81 cases） and MS group（15 cases）. There were statistical differences in fever duration, hospitalization duration, the incidence of complications and CRP level between the MR group and MS group （t=2.061, Z=-3.368, χ2=5.856, Z=-2.165, all P〈0.05）. There were no statistical differences in age, white blood cell count, consolidation percentage on chest radiography and fever duration after macrolide therapy（al

关 键 词：肺炎支原体 耐药性 大环内酯类 基因型 

分 类 号：R725.6[医药卫生—儿科]