儿童耐药肺炎支原体DNA拷贝量与临床预后相关性分析

目的探究儿童耐药肺炎支原体(MP)DNA拷贝量及其与临床预后的相关性。方法选取1年内反复MP感染且不规律应用大环内酯类抗菌药物≥2次的110例患儿为研究组,采集咽拭子标本进行MP培养及药敏试验,根据MP耐药情况将患儿分为耐药组(27例)和敏感组(15例),MP检测阳性患儿实施阿奇霉素序贯治疗,观察患儿的临床特点及预后情况,荧光定量PCR检测MP-DNA拷贝量,测定血清白介素-6(IL-6)、降钙素(PCT)、急性期应激反应蛋白(hs-CRP)水平及白细胞总数、血沉。结果MP培养显示,110例患儿中MP阳性感染患儿42例,阳性率38.18%,42例MP阳性中27例阿奇霉素敏感,15例耐药;耐药组治疗2周后治愈率为59.26%(17/27);4周后治愈率为77.78%(21/27);敏感组治疗2周后治愈率为100%(15/15);耐药组发热时间、住院时间均高于敏感组(P<0.05);耐药组患儿MP-DNA拷贝量、血清hs-CRP、IL-6水平显著高于敏感组(P<0.05),白细胞总数、PCT、血沉与敏感组无显著差异(P>0.05);多因素分析发现,MP-DNA拷贝量、血清hs-CRP水平是影响耐药MP感染患者预后的独立危险因素。结论儿童耐药肺炎支原体DNA拷贝量异常增加,与临床预后相关。

Analysis of correlation between DNA copy quantity and clinical prognosis of drug-resistant Mycoplasma pneumoniae in children

Objective To investigate the DNA copy quantity of drug-resistant Mycoplasma pneumoniae(MP)in children and its correlation with clinical prognosis.Methods 110 children with repeated MP infection and irregular application of macrolide antibiotics(≥2 times)in the Pediatric Department of our hospital from December2017 to December 2018 were selected as the study group.Pharyngeal swab specimens were collected for MP culture and drug sensitivity test,and according to the drug resistance of MP,the children were divided into the drug resistance group(27 cases)and the sensitive group(15 cases).Azithromycin sequential therapy was performed in MP positive children.The clinical characteristics and prognosis of the children were observed,the copy quantity of MP-DNA was detected by fluorescence quantitative PCR,and the levels of serum interleukin-6(IL-6),calcitonin(PCT),stress response protein(hs-CRP),total white blood cells(WBC)and erythrocyte sedimentation rate(ESR)were measured.Results MP culture showed that 42 of 110 cases were MP positive,and the positive rate was 38.18%.Among the 42 cases,27 cases were azithromycin sensitive and 15 cases were drug resistant.The cure rate of drug-resistant group was 59.26%(17/27)after 2 weeks of treatment.The cure rate was 77.78%(21/27)after 4 weeks.The cure rate of the sensitive group was 100%(15/15)after 2 weeks of treatment.The duration of fever and hospital stay in the drug-resistant group were longer than those in the sensitive group(P<0.05).MP-DNA copy quantity,serum hs-CRP and IL-6 levels in the drug-resistant group were significantly higher than those in the sensitive group(P<0.05).There was no significant difference in total white blood cells,PCT,and ESR between the drug-resistant group and the sensitive group(P>0.05).Multivariate analysis showed that MP-DNA copy quantity and serum hs-CRP level were independent risk factors affecting the prognosis of patients with drug-resistant MP infection.Conclusion The DNA copy quantity of drug-resistant Mycoplasma pneumoniae in children increases abnormally,which is related to clinical prognosis.