肺炎支原体耐药在难治性肺炎支原体肺炎患儿发病中的作用  

Role of macrolides resistance in children with refractory Mycoplasma pneumoniae pneumonia

作　　者：张伟利 张新星[1] 顾文婧[1] 严永东[1] 季伟[1] 朱灿红[1] 邵雪君[1] 郝创利[1] 陈正荣[1] Zhang Weili;Zhang Xinxing;Gu Wenjing;Yan Yongdong;Ji Wei;Zhu Canhong;Shao Xuejun;Hao Chuangli;Chen Zhengrong(Department of Respiratory Disease,Children′s Hospital of Soochow University,Suzhou 215003,Jiangsu Province,China)

机构地区：[1]苏州大学附属儿童医院呼吸科,江苏苏州215003

出　　处：《中华实用儿科临床杂志》2021年第11期822-826,共5页Chinese Journal of Applied Clinical Pediatrics

基　　金：国家自然科学基金(81870006);江苏省重点研发计划(BE2019671);苏州市民生科技项目(SS201869);江苏医学青年重点人才(QNRC2016766);姑苏青年卫生重点人才(GSWS2019047);苏州市临床重点病种专项(LCZX201809)。

摘　　要：目的研究苏州地区肺炎支原体(MP)耐药情况,并试图说明MP耐药与难治性肺炎支原体肺炎(RMPP)之间的关系。方法选取2013年10月至2014年9月在苏州大学附属儿童医院呼吸科确诊MPP而住院治疗的82例患儿,其中48例应用阿奇霉素治疗(10 mg/kg,1次/d,静脉滴注5~7 d),临床症状及胸部影像学仍持续进展,临床确诊为RMPP的患儿(RMPP组)作为试验组,另外34例应用大环内酯类抗生素(MA)治疗有效,确诊为普通肺炎支原体肺炎(GMPP)(GMPP组),从这些患儿气道分泌物中提取MP DNA,并对红霉素作用靶位MP 23S rRNA的2063和2064位点突变进行测序,并根据耐药基因测序结果将其分为MA耐药组(MRMP组)及MA敏感组(MSMP组)。比较2组患儿临床特点。结果在MRMP组中,PMPP发生率为62.2%(46/74例),而MSMP组中,PMPP发生率为25.0%(2/8例),2组患儿耐药基因MP 23S rRNA点突变对RMPP的发生无显著影响(χ^(2)=2.719,P=0.099)。相对于MRMP组,MSMP组患儿发热时间更短,糖皮质激素的应用更少。2组患儿在胸部影像学检查以及一些化验结果,如白细胞总数及分类、C反应蛋白(CRP)、丙氨酸转氨酶(ALT)、乳酸脱氢酶(LDH)和肌酸激酶同工酶(CK-MB)等方面差异均无统计学意义。结论MP肺炎发热持续超过1周,提示MP耐药的可能,MP对MA耐药并未加剧RMPP的发生。通过胸部影像学特征及检验结果方面的差异来判断MP是否耐药并不可靠。Objective To study the macrolides resistance of Mycoplasma pneumoniae(MP)in Suzhou area,and try to explore the relationship between drug resistance and refractory Mycoplasma pneumoniae pneumonia(RMPP).Methods From a series of hospitalized children who were diagnosed as Mycoplasma pneumoniae pneumonia(MPP)from October 2013 to September 2014 in Suzhou area,48 children were treated with Azithromycin(10 mg/kg,once a day,intravenous drip for 5-7 days),and the clinical symptoms and chest imaging were still progressing so they were clinically diagnosed as RMPP,and 34 children who were successfully treated with macrolides antibiotics(MA)were clinically diagnosed as general MPP(GMPP).MP DNA was extracted from the airway secretion of children in the two groups,and the point mutations of 2063 and 2064 of 23S rRNA were sequenced,and according to the MP 23S rRNA sequencing results,the children were divided into macrolides antibiotic resistant MP group(MRMP)and macrolides antibiotic sensitive MP group(MSMP).The clinical characteristics of the two groups were compared.Results In the MRMP group,the incidence of RMPP was 62.2%(46/74 cases),while in MSMP group,the incidence of RMPP was 25.0%(2/8 cases).The point mutation of MP 23S rRNA had no significant effect on the occurrence of RMPP(χ^(2)=2.719,P=0.099).Compared with MRMP group,MSMP group presented shorter fever time and less glucocorticoid use.No significant differences between the two groups were found in chest imaging examination,as well as some laboratory results,including the total number and classification of white blood cell(WBC),C-reactive protein(CRP),alanine aminotransferase(ALT),lactate dehydrogenase(LDH)and creatine kinase isoenzyme(CK-MB).Conclusions The fever duration of MPP lasted more than 1 week,suggesting the possibility of macrolides resistance of MP,but macrolides resistance did not aggravate the occurrence of RMPP.It is unreliable to judge the MRMP by chest imaging features and laboratory results.

关 键 词：肺炎支原体 难治性肺炎支原体肺炎 大环内酯类耐药 儿童 

分 类 号：R725.6[医药卫生—儿科] R446.5[医药卫生—临床医学]