新发传染病电子杂志2024，Vol.9Issue(6)：42-47,6.DOI:10.19871/j.cnki.xfcrbzz.2024.06.008
大环内酯类耐药的儿童难治性肺炎支原体肺炎临床特征分析
Analysis of clinical characteristics of refractory Mycoplasma pneumoniae in macrolide-resistant children
摘要
Abstract
Objective Via observing the clinical characteristics of refractory Mycoplasma pneumoniae pneumonia(RMPP)caused by macrolide-resistant Mycoplasma pneumoniae(MRMP)infection in children,to explore its clinical significance in the timely diagnosis and treatment of children with RMPP.Method The clinical data of 1226 hospitalized children with RMPP from January 2022 to December 2023 in the Hainan Women and Children's Medical Center were analyzed retrospectively.Bronchoscopy and bronchoalveolar lavage fluid(BALF)were performed on each subject and MRMP-DNA in the BALF were taken to detect the 23S rRNA V region mutation sites.Children with RMPP were divided into macrolide-resistant group and control group(non-macrolide-resistant group)depending on the gene detection results.Result A total of 1226 children with RMPP were recruited,including 869 cases in the macrolide-resistant group and 357 cases in the control group.Among them,there were 369 males(51.7％)and 555 females(48.3％).The average age in the macrolide-resistant group[(6.12±2.98)years old]was higher than that in the control group[(2.82±2.19)years old](P＜0.001).The fever time in the macrolide-resistant group[(6.61±1.77)d]was longer than that in the control group[(5.33±1.09)d](P＜0.001).Compared with the children with RMPP in the control group,the values of white blood cell count(WBC),percentage of neutrophil(NE％),high sensitive C-reactive protein(hs-CRP),lactate dehydrogenase(LDH),and interleukin-6(IL-6)were higher in the macrolide-resistant group,the differences were statistically significant(P＜0.05);Compared with the children with RMPP in the control group,the incidences of severe MPP(SMPP)/fulminant MPP(FMPP),extra-pulmonary complications,severe mucosal lesions(erosion,ulcer or necrosis),endotracheal plastic phlegm plug,pleural effusion and necrotic pneumonic were higher in the macrolide-resistant group,the differences were statistically significant(P＜0.05).The average hospitalization day in the macrolide-resistant group[(6.59±1.63)d]was longer than that in the control group[(5.32±1.38)d](P＜0.001).Conclusion The clinical manifestations of RMPP children caused by MRMP infection were more serious,with longer fever time,longer hospital stay,more severe inflammatory reaction and more intrapulmonary and extrapulmonary complications.Timely implementing bronchoscopy in children with RMPP and collecting BALF samples for testing may have important values for guiding the correct clinical diagnosis and treatment.关键词
肺炎支原体/耐大环内酯/基因突变/难治性肺炎支原体肺炎/支气管肺泡灌洗液/纤维支气管镜检查Key words
Mycoplasma pneumonia/Macrolides resistant/Gene mutation/Refractory mycoplasma pneumoniae pneumonia/Bronchoalveolar lavage fluid/Fiberoptic bronchoscopy分类
医药卫生引用本文复制引用
郑君,吴琪晔,曾霞,张笃飞..大环内酯类耐药的儿童难治性肺炎支原体肺炎临床特征分析[J].新发传染病电子杂志,2024,9(6):42-47,6.基金项目
1.海南省省级临床医学建设项目(2021-75) （2021-75）
2.海南省卫生健康科技联合项目[WSJK2024MS214,2024,琼科(2024)22号] （2024）
