儿童耐大环内酯类肺炎支原体肺炎的临床分析  

Clinical analysis of macrolide-resistant Mycoplasma pneumoniae pneumonia in children

作　　者：陈玲 张萍 卓玲玲 覃大卫 何永虹 严蜜 郭靖[1] 田昌军 CHEN Ling;ZHANG Ping;ZHUO Lingling;QIN Dawei;HE Yonghong;YAN Mi;GUO Jing;TIAN Changjun(School of Medicine,Jishou University,Zhangjiajie,Hu'nan,416000,China;Department of Neonatology,Zhangjiajie People's Hospital,Zhangjiajie,Hu'nan,427000,China)

机构地区：[1]吉首大学医学院,湖南张家界416000 [2]张家界市人民医院新生儿科,湖南张家界427000

出　　处：《当代医学》2025年第1期128-131,共4页Contemporary Medicine

基　　金：张家界市科技发展专项(202203);湖南省卫生健康委卫生科研课题资助(202115011832)。

摘　　要：目的探究儿童耐大环内酯类肺炎支原体肺炎(Mycoplasma pneumoniae pneumonia,MPP)的临床特征。方法回顾性分析2023年1—11月张家界市人民医院收治的171例MPP患儿的临床资料,并行鼻咽拭子或支气管肺泡灌洗采集标本,标本经靶向/宏基因组二代测序检测23SrRNA编码基因突变情况,比较耐药与敏感患儿年龄分布情况、临床资料、实验室资料及治疗方式。结果171例患儿中,耐药142例,耐药率为83.04%。其中,肺实变发生率为47.95%,进行支气管肺泡灌洗者发生率52.05%。耐药与敏感患儿不同年龄段耐药分布情况比较差异无统计学意义;耐药与敏感患儿性别、大环内酯类药物使用前发热时间、总发热时间、住院时间、C反应蛋白水平、白细胞计数、丙氨酸转氨酶水平、乳酸脱氢酶水平、大环内酯类反应不良、影像学改变情况比较差异均无统计学意义。耐药与敏感患儿阿奇霉素静脉滴注、支气管肺泡灌洗、激素、丙种球蛋白、多西环素治疗比例比较差异无统计学意义。结论儿童耐大环内酯类药物的MPP耐药基因突变率及肺实变率较高,从性别、年龄、临床特征、实验室检查、影像学改变、治疗方式等方面难以区分敏感或耐药。Objective To investigate the clinical features of macrolide-resistant Mycoplasma pneumoniae pneumonia(MPP)in children.Methods Clinical data of 171 children with MPP admitted to Zhangjiajie People's Hospital from January to November 2023 were retrospectively analyzed,nasopharyngeal swab or bronchoalveolar lavage specimens were collected,and 23SrRNA coding gene mutations were detected by targeted/metagenomic second-generation sequencing.The age distribution,clinical data,laboratory data and the choice of treatment were compared between the resistant children and the sensitive children.Results Among the 171 cases,142 cases were drug resistant,and the drug resistance rate was 83.04%.Among them,the incidence of lung consolidation was 47.95%,and bronchoalveolar lavage was 52.05%.There was no significant difference in the distribution of drug resistance of different age between the resistant children and the sensitive children.There were no significant differences in gender,fever time before macrolides,total fever time,hospital stay,C-reactive protein level,white blood cell count,alanine aminotransferase level,lactate dehydroase level,adverse macrolides reaction and imaging changes between the resistant children and the sensitive children.Both groups were treated with azithromycin intravenous infusion,including 101 patients in the drug resistant group and 21 patients in the sensitive group.There were no significant differences in the proportion of azithromycin intravenous infusion,bronchoalveolar lavage,hormone,gammaglobulin and doxycycline treatment between the two groups.Conclusion The MPP gene mutation rate and lung compaction rate of children resistant to macrolides are high,and it is difficult to distinguish sensitive or resistant children from gender,age,clinical characteristics,laboratory examination,imaging changes,treatment methods and other aspects.

关 键 词：儿童 大环内酯类耐药 肺炎支原体 临床特征 治疗 

分 类 号：R725.6[医药卫生—儿科]