24例23SrRNA A2063G基因突变肺炎支原体肺炎临床分析

目的 分析23SrRNA A2063G基因突变引起肺炎支原体肺炎(MPP)的临床特征,从而提高对该疾病的诊治能力.方法 对36例MPP患儿痰标本进行MP-DNA及23SrRNA基因测序,检测耐药基因,在此基础上分为24例大环内酯类耐药组与12例大环内酯类敏感组.比较两组患儿的临床表现、实验室检查、影像学、治疗等资料.结果 36例MPP患儿中24例检出大环内酯类抗生素耐药基因,均为23SrRNA V区A2063G突变,12例为大环内酯类敏感组.大环内酯类耐药组患儿在住院时间(P=0.025),总咳嗽时间(P=0.035),总发热时间(P=0.008),抗生素治疗后发热时间(P=0.010)及病程(P=0.048)方面均高于大环内酯类敏感组.大环内酯类耐药组患儿白细胞计数及CRP较大环内酯类敏感组更高.大环内酯类耐药组12例患儿仅应用大环内酯类治疗5d内体温消退,3例需改用喹诺酮类抗感染;另10例联合激素,6例加用静脉丙种球蛋白,所有患儿预后良好.大环内酯类敏感组8例患儿在大环内酯类治疗后12h~3d体温消退.结论 相比大环内酯类敏感组,23SrRNA A2063G基因突变引起的耐药MPP患儿在住院时间、总咳嗽时间、总发热时间和抗生素治疗后发热时间、病程上更长,白细胞计数及CRP更高.大环内酯类抗生素对部分耐药MPP治疗有效,病情严重者需联合糖皮质激素和静脉丙种球蛋白或根据病情酌情更改抗生素.

Clinical analysis of mycoplasma pneumoniae pneumonia with 23SrRNA A2063G gene mutation in 24 cases

Objective To analyse the clinical manifestations of mycoplasma pneumoniae pneumonia(MPP) with 23SrRNA A2063G gene mutation,and improve the ability of diagnosis and treatment of patient infected with MPP.Methods MP-DNA was detected by fluorescent quantitative real-time PCR in sputum specimens from 36 children with MPP,then we detected the drug resistance gene mutation sites by nest-PCR and DNA sequencing,on this basis we classified into two groups of macrolide-resistant MP and macrolide-sensitive MP,and compared the clinical manifestations,laboratory findings,chest imagings and treatment between two groups.Results Of these 36 cases of MPP,24 cases had macrolide-resistant gene mutation with an A2063G transition in domain V of the 23SrRNA,12 cases had no macrolide-resistant gene mutation.Compared to macrolide-sensitive MP group,macrolide-resistant MP group had longer hospitalization duration,longer total cough period,longer total febrile period,longer fever duration after macrolide therapy,longer course of disease,and had higher white blood cells counts and CRP.In the macrolide-resistant MP group,the temperature subsided within 5 days after macrolide treatment alone of 12 cases,3 cases needed switch to fluoroquinolones therapy,10 cases combined with glucocorticoids and 6 cases combined with intravenous immunoglobulin,all 24 patients had good outcomes.While in macrolide-sensitive MP group,the temperature susided between 12 hours to 3 days after macrolide treatment of 8 cases.Conclusions Compared to patients infected by macrolide-sensitive MP,those mycoplasma pneumoniae pneumonia patients with 23SrRNA A2063G gene mutation have longer hospitalization duration,longer total cough period,longer total febrile period,longer fever duration after macrolide therapy,longer course of disease,and have higher white blood cells counts and CRP.Some macrolide-resistant MPP patients have good response to macrolide antibiotics treatment,while the severe cases need combined with glucocorticoids and immunoglobulin,or should change antibiotics.