Abstract: Objective　To learn about the detection of drug-resistant mutation sites in the 23S rRNA V region of bronchial alveolar lavage fluid（BALF） in children with mycoplasma（MP） infectious lobar pneumonia，and compare the clinical data of children in the site mutation group with those without the mutation. Methods　The clinical data of 69 cases of BALF in children with lobar pneumonia admitted between January 2018 and January 2019 to the Department of Pediatrics，First Affiliated Hospital，School of Medicine，Shihezi University，were analyzed retrospectively. The MP-DNA and 23 SrRNA V region mutation sites（A2063G，A2064G，A2063C，and A2063T） were detected by real-time fluorescence quantitative PCR（RTQ-PCP） in the above specimens. According to the results，the MP-positive children were divided into the site mutation group and the non-mutation group，and the clinical data of the two groups were compared. Results　Of the 48 children with MP infectious lobar pneumonia，37 cases（77.1%） of site mutations were detected. The mutation rates from high to low were A2063G，A2064G，A2063C and A2063T；the patients in the site mutation group were with higher serum CRP，PCT and LDH levels，increased proportion of extrapulmonary complications，prolonged fever，length of hospital stay，prolonged use of antibiotics and antipyretics，and significantly increased proportion of methylprednisolone and IVIG. The above differences were statistically significant（P＜0.05）. Conclusion　The detection rate of resistance mutation sites in 23S rRNA V region of children with MP infectious lobar pneumonia in this area is high，and A2063G and A2064G are still the main types. There are multiple resistance mutation sites in the same child. In the children with MP infectious lobar pneumonia whose CRP，PCT and LDH levels are increased significantly and are with severe pulmonary disease，and the possibility of MP resistance should be considered when there are more extrapulmonary complications and longer average fever and hospital stay.

Key words: Mycoplasma pneumoniae, lobar pneumonia, gene mutation, child

摘要： 目的　了解儿童肺炎支原体（MP）感染性大叶性肺炎肺泡灌洗液（BALF）中23S rRNA V区耐药突变位点的检出情况，比较位点突变组及未突变组患儿的临床资料。方法　回顾性分析2018年1月至2019年1月石河子大学医学院第一附属医院儿科69例确诊为大叶性肺炎且行纤维支气管镜肺泡灌洗术患儿的临床资料。采用实时荧光定量PCR（RTQ-PCP）法对上述标本行MP-DNA及23 SrRNA V区突变位点（A2063G、A2064G、A2063C及A2063T）检测。根据结果将MP阳性患儿分为位点突变组及未突变组，比较两组患儿的临床资料。结果　48例MP感染性大叶性肺炎患儿中，共37例（77.1%）检测到位点突变,突变率由高到低依次为A2063G、A2064G、A2063C、A2063T；突变组患儿血清C反应蛋白（CRP）、降钙素原（PCT）及乳酸脱氢酶（LDH）水平较未突变组高，合并肺外并发症比例增多，发热持续时间、住院时间、大环内酯类抗生素应用天数及退热天数延长，且应用甲泼尼龙、静脉注射免疫球蛋白（IVIG）比例显著增高，以上差异均有统计学意义（P＜0.05）。结论　该地区MP感染性大叶性肺炎患儿23S rRNA V区耐药突变位点检出率高，仍以A2063G、A2064G为主，且同一患儿体内存在多种耐药突变位点；对于血清CRP、PCT及LDH水平显著增高，肺外合并症多、平均发热及住院时间长的大叶性肺炎患儿应考虑MP耐药可能。

关键词: 肺炎支原体, 大叶性肺炎, 基因突变, 儿童