23S rRNA基因检测在儿童肺炎支原体肺炎大环内酯类耐药中的应用关联研究  

Application of 23S rRNA Gene Detection in Macrolide Resistance in Children with Mycoplasma Pneumoniae Pneumonia

作　　者：李文博 张帆 程云 张子轩[2] Li Wenbo;Zhang Fan;Cheng Yun;Zhang Zixuan(Lu’an Hospital of Anhui Medical University(Lu’an People’s Hospital of Anhui Province),Anhui Lu’an 237000,China;Anhui West Health Vocational College,Anhui Lu’an 237000,China)

机构地区：[1]安徽医科大学附属六安医院(六安市人民医院),安徽六安237000 [2]皖西卫生职业学院,安徽六安237000

出　　处：《儿科药学杂志》2025年第2期32-36,共5页Journal of Pediatric Pharmacy

基　　金：2021年度安徽高校自然科学研究项目,编号KJ2021A1369。

摘　　要：目的:探究23S rRNA基因检测在儿童肺炎支原体肺炎(MPP)大环内酯类药物耐药中的作用。方法:回顾性分析2022年10月至2023年11月于六安市人民医院住院治疗的104例肺炎支原体(MP)感染患儿,采集所有患儿的咽拭子样本,应用药敏试验检测常用抗菌药物对MP的敏感性,观察并分析MPP患儿的耐药情况,根据药敏试验结果将患儿分为耐药组与非耐药组,同时采用实时荧光定量PCR法(RT-qPCR)检测MP-DNA载量,并对其与抗菌药物耐药性的关系进行分析,应用PCR基因测序对23S rRNAⅤ区2063位点基因进行检测,并对2063位点基因型与抗菌药物耐药性的关系进行分析,同时对23S rRNAⅤ区2063位点基因型与MP-DNA载量的关系进行对比分析。结果:检测结果显示,MP在大环内酯类抗菌药物中的耐药性较高,其中在红霉素与罗红霉素药物中的耐药性最高,分别为71.15%、73.08%,阿奇霉素、克拉霉素、乙酰螺旋霉素、克林霉素、耐药率分别为25.00%、34.62%、52.88%、55.77%,在喹诺酮类抗菌药物中的耐药性较低,分别为3.85%、2.88%、0.00%;阿奇霉素、红霉素、克拉霉素以及克林霉素耐药组患儿MP-DNA载量指数明显较该抗菌药物非耐药组患儿更低(P<0.05);通过分析得出,23S rRNA基因2063位点基因突变对大环内酯类抗菌药物耐药产生了显著影响,通过对大环内酯类抗菌药物耐药的病例分析得出,2063位点基因G型突变率>60%;突变型基因组患儿MP-DNA的载量指数较野生型基因组更低(P<0.05)。结论:大环内酯类抗菌药物在治疗MP感染患儿中表现出较高的耐药性,其中23S rRNAⅤ区2063基因位点突变与MP耐药具有密切关联,因此,MP 23S rRNA基因测序能够作为临床治疗MPP患儿时进行耐药检测的有效手段,并为其合理使用抗菌药物提供参考。Objective:To probe into the role of 23S rRNA gene detection in macrolide resistance in children with Mycoplasma pneumoniae pneumonia(MPP).Methods:Retrospective analysis was performed on 104 children with M.pneumoniae(MP)infection admitted into in Lu’an People’s Hospital of Anhui Province from Oct.2022 to Nov.2023.Throat swab samples were collected from all children.Antibiotic sensitivity testing was performed to evaluate the sensitivity of commonly used antibiotics against MP.The drug resistance of children with MPP was observed and analyzed,and the children were divided into drug-resistant group and non-drugresistant group according to drug sensitivity detection results.Real-time quantitative PCR(RT-qPCR)was employed to quantify MPDNA load,and its correlation with antibiotic resistance was analyzed.PCR gene sequencing was used to detect 2063 gene in 23S rRNAⅤregion,and the correlation between 2063 genotype and antibiotic resistance was analyzed.Meanwhile,the correlation between 2063 genotype of 23S rRNAⅤregion and MP-DNA load was compared and analyzed.Results:High resistance rates were observed for macrolide antibiotics,with the highest rates recorded for erythromycin(71.15%)and roxithromycin(73.08%).Moderate resistance was seen for azithromycin(25.00%),clarithromycin(34.62%),acetylspiramycin(52.88%),and clindamycin(55.77%).In contrast,low resistance rates were noted for quinolone antibiotics(3.85%,2.88%,and 0.00%,respectively).Notably,the MP-DNA load index was significantly lower in the resistant groups for azithromycin,erythromycin,clarithromycin,and clindamycin compared with their respective non-resistant counterparts(P<0.05).Analysis revealed that the 2063 mutation in the 23S rRNA gene had a marked impact on macrolide resistance.Analysis of macrolide-resistant cases yielded more than 60% of G-type mutations in the gene at 2063.Furthermore,MP-DNA load was significantly lower in patients with the mutant genotype compared with those with the wild-type(P<0.05).Conclusion:Macrolide antibiotics shows high

关 键 词：23S rRNA基因 儿童 肺炎支原体 大环内酯类 抗菌药物 耐药性 

分 类 号：R725.6[医药卫生—儿科]