天津地区儿童感染肺炎支原体基因型特征分析及其临床特点  

Genotype analysis and clinical characteristics of Mycoplasma pneumoniae infection in children in Tianjin

作　　者：王维[1] 林书祥[1] 王露 张同强[2] 王朝 方玉莲[1] 侯梦珠 武晋英 徐勇胜[2] Wang Wei;Lin Shuxiang;Wang Lu;Zhang Tongqiang;Wang Chao;Fang Yulian;Hou Mengzhu;Wu Jinying;Xu Yongsheng(Tianjin Key Laboratory of Birth Defects for Prevention and Treatment,Tianjin Institute of Pediatric Research,Tianjin Children′s Hospital(Children′s Hospital of Tianjin University),Tianjin 300134,China;Department of Respiratory,Tianjin Children′s Hospital(Children′s Hospital of Tianjin University),Tianjin 300134,China)

机构地区：[1]天津市儿童医院(天津大学儿童医院),天津市儿科研究所,天津市儿童出生缺陷防治重点实验室,300134 [2]天津市儿童医院(天津大学儿童医院)呼吸科,300314

出　　处：《中华微生物学和免疫学杂志》2021年第5期380-387,共8页Chinese Journal of Microbiology and Immunology

摘　　要：目的:了解天津地区儿童感染肺炎支原体(Mycoplasma pneumoniae,Mp)的基因分型、亚型的流行状况及其临床特点。方法:以2017年12月—2019年12月天津市儿童医院收治住院的肺炎患儿作为研究对象,行纤支气管镜术取支气管肺泡灌洗液(BALF)。采用实时荧光定量PCR技术检测Mp培养成功后的阳性标本,进行限制性片段长度多态性聚合酶链反应(PCR-RFLP)和多位点可变数目串联重复序列分析(MLVA)分型。所有病例均搜集详细临床资料和实验室数据。结果:经实时荧光定量PCR和分离培养方法确认后共得到Mp阳性菌株175例,RFLP分型结果显示,Ⅰ型138例(78.9%),Ⅱ型37例(21.1%);MLVA分型结果显示,M3-5-6-2型37例,有B、G、M、S、V、Y这6个亚型;检出M4-5-7-2138例,有E、J、P、U、X、Z和a这7个亚型。M3-5-6-2型中有P1-Ⅰ型1例(2.7%),P1-Ⅱ型36例(97.3%);M4-5-7-2型中有P1-Ⅰ型137例(99.2%),P1-Ⅱ型1例(0.7%)。不同基因型在不同年龄组间分布差异无统计学意义。M3-5-6-2基因型中的B、G、M、S、V、Y型与M4-5-7-2基因型中的E、J、P、U、X、Z、a型共13个基因型在四季分布中有统计学差异。所有Mp感染患儿均有发热和咳嗽的症状。P1-Ⅰ/M4-5-7-2型肺炎患儿在住院时长、发热时长、高热(>39℃)、咳嗽时长、皮肤改变、消化系统症状、肝功能损伤发生率等方面均高于P1-Ⅱ/M3-5-6-2型肺炎患儿,但差异没有统计学意义。P1-Ⅱ型及M3-5-6-2型白细胞计数高于Ⅰ型及M4-5-7-2型;P1-Ⅰ型及M4-5-7-2型乳酸脱氢酶高于Ⅱ型及M3-5-6-2型,且差异有统计学意义。不同基因型患儿在炎性实变、肺不张、胸膜增厚和胸腔积液的发生率差异无统计学意义。结论:天津地区肺炎患儿感染Mp以P1-Ⅰ型/M4-5-7-2型为主,P1-Ⅱ型有上升趋势;P1-Ⅰ型及M4-5-7-2型与临床发热、重症表现等存在一定相关性。Objective To investigate the prevalence and clinical characteristics of Mycoplasma pneumoniae(Mp)genotypes and subtypes in children in Tianjin.Methods Children with pneumonia admitted to Tianjin Children′s Hospital from December 2017 to December 2019 were selected as the research objects.Bronchoalveolar lavage fluid was collected by fiberoptic bronchoscopy.The positive samples were detected by real-time fluorescent quantitative PCR and Mp culture.PCR-restriction fragment length polymorphism(RFLP)and multiple variable number tandem repeats were used for genotyping.Detailed clinical and laboratory data were collected for all cases.Results The results of RFLP showed that there were 138 cases(78.9%)of typeⅠand 37 cases(21.1%)of typeⅡ;37 cases of type M3-5-6-2,including six subtypes B,G,M,S,V and Y;138 cases of M4-5-7-2 were detected,including seven subtypes of E,J,P,U,X,Z and a.In M3-5-6-2 type,there were 1 case of P1-Ⅰtype(2.7%),36 cases of P1-Ⅱtype(97.3%),137 cases of P1-Ⅰtype(99.2%)and 1 case of P1-Ⅱtype(0.7%)in M4-5-7-2 type.There was no significant difference in genotype distribution among different age groups.There were statistical differences in the distribution of four seasons among the 13 genotypes of B,G,M,S,V,Y and E,J,P,U,X,Z,a.All Mp infected children had symptoms of fever and cough.The hospitalization time,fever duration,high fever(>39℃),cough duration,skin changes,digestive system symptoms and liver function injury rate of P1-Ⅰ/M4-5-7-2 pneumonia children were higher than those of P1-Ⅱ/M3-5-6-2 pneumonia children,but the difference was not statistically significant.The WBC count of P1-Ⅱ/M3-5-6-2 types was higher than that of typeⅠand M4-5-7-2;the LDH of P1-Ⅰ/M4-5-7-2 was higher than that ofⅡand M3-5-6-2,with statistical difference.There was no significant difference in the incidence of inflammatory consolidation,atelectasis,pleural thickening and pleural effusion among different genotypes.Conclusions Mp infection in children with pneumonia in Tianjin is mainly P1-Ⅰ/M4-5-7-

关 键 词：肺炎支原体 儿童 基因分型 临床特征 

分 类 号：R725.6[医药卫生—儿科]