中国实用儿科杂志

中国实用儿科杂志 ›› 2023, Vol. 38 ›› Issue (5): 376-380.DOI: 10.19538/j.ek2023050612

• 论著 • 上一篇    下一篇

儿童难治性肺炎患儿肺炎支原体大环内酯类耐药基因突变分析

  

  1. 1.潍坊医学院临床医学院，山东  潍坊  261000；2.山东大学附属儿童医院呼吸介入科，山东  济南  250022
  • 出版日期:2023-05-06 发布日期:2023-06-14
  • 通讯作者: 孟晨，电子信箱：mengchen.6666@163.com
  • 基金资助:
    山东省重点研发计划（2021SFGC0503）

Analysis of gene mutation of macrolides resistance in children with refractory Mycoplasma pneumoniae pneumonia

  1. School of Clinical Medicine，Weifang Medical University，Weifang  261000，China
  • Online:2023-05-06 Published:2023-06-14

摘要： 目的    了解儿童难治性肺炎支原体肺炎（RMPP）患儿23S rRNAＶ区耐药基因突变情况，比较突变与未突变患儿的临床资料。方法    回顾性分析2021年10月至2022年3月山东大学附属儿童医院呼吸介入科332例确诊RMPP并行可弯曲支气管镜（以下简称支气管镜）检查及肺泡灌洗术患儿的临床资料。提取患儿BALF标本中MP-DNA，采用实时荧光聚合酶链式反应（PCR）法对大环内酯类药物作用靶位MP 23S rRNAＶ区的2063和2064位点进行突变检测，并根据耐药基因检测结果将其分为耐药组与非耐药组，比较两组患儿的临床资料。结果    332例RMPP患儿中，耐药组患儿270例，非耐药组患儿62例。耐药组患儿发热时间长于非耐药组；实验室指标：外周血血常规（白细胞计数、中性粒细胞百分比）、C-反应蛋白（CRP）、血清乳酸脱氢酶（LDH）、血浆D-二聚体（D-Di）、免疫球蛋白E（IgE）等值均较非耐药组高（P<0.05）；出现中-大量胸腔积液比例高，且易发生坏死性肺炎；耐药组患儿支气管镜下表现以黏膜糜烂、溃疡、坏死，支气管内塑形性栓子，脓性肺泡灌洗液为主。结论    肺炎支原体（MP）耐药突变可能导致并促进RMPP的发生。耐药突变MP感染可能会加重RMPP患儿病情，其影像学及支气管镜下表现更重。支气管镜下表现对早期识别耐药性MP感染具有一定的意义。

关键词: 肺炎支原体, 大环内酯类耐药, 基因突变, 难治性肺炎支原体肺炎, 支气管肺泡灌洗液

Abstract: Objective    To investigate the mutations of 23SrRNAV gene in bronchoalveolar lavage fluid （BALF） of children with refractory Mycoplasma pneumoniae pneumonia （RMPP），and compare the clinical data of children with and without mutations. Methods    The clinical data of 332 hospitalized children diagnosed with RMPP as subjects from October 2021 to March 2022 in the Children's Hospital Affiliated to Shandong University were analyzed retrospectively. Bronchoscopy and BALF were performed on each subject and MP-DNA in the BALF was taken to detect the 23 SrRNA V region mutation sites（A2063G，A2064G）in BALF，and they were divided into drug-resistant gene positive group and drug-resistant gene negative group. Results    Of the 332 children with MP infectious RMPP，270 cases of site mutations were detected（P<0.05）. The patients in the site mutation group were with higher WBC，NE%，CRP，LDH，D-Di and IgE levels，increased proportion of having moderate to large amount of pleural effusion and longer time of fever，and they were more likely to suffer from necrotic pneumonic. The drug resistance gene positive group mainly showed mucosal erosion，ulcer，necrosis，plastic phlegm plug and purulent BALF. Conclusion    MP drug resistance mutations may lead to or even promote the occurrence of RMPP. Drug-resistant mutated MP infection may aggravate the condition of children with RMPP，and their imaging manifestation and bronchoscopy are more severe. Bronchoscopic manifestations have certain significance for early identification of drug resistant MP infection.

Key words: Mycoplasma pneumoniae, macrolides resistant, gene mutation , refractory Mycoplosma pneumoniae pneumonia, bronchoalveolar lavage fluid