小儿支原体肺炎合并气道黏液栓形成的气道微生物菌群变化

Changes of airway microflora caused by Mycoplasma pneumonia pneumonia and airway mucus plug formation in children

目的研究支原体肺炎(MPP)合并气道黏液栓的患儿气道微生物菌群的变化。方法选取2018年1月至2020年1月在我院诊治的116例MPP患儿为研究对象。根据支气管镜检查结果,将56例合并气道黏液栓的MMP患儿纳入MPP合并黏液栓组,60例无气道黏液栓的MPP患儿纳入单纯MPP组。用16S r RNA测序技术分析各组患儿支气管灌洗液中气道菌群的组成,比较各组气道微生物菌群分布差异,采用Pearson相关性分析探讨MPP合并黏液栓组菌属与临床参数的相关性。结果单纯MPP组和MPP合并黏液栓组的优势菌门是软壁菌门、拟杆菌门、厚壁菌门。MPP合并黏液栓组软壁菌门和变形菌门相对丰度显著高于单纯MPP组(P=0.012、0.001),两组的拟杆菌门、厚壁菌门、放线菌门和梭杆菌门相对丰度间差异无统计学意义(P>0.05)。单纯MPP组和MPP合并黏液栓组的优势菌属包括支原体属、放线菌属、鞘氨醇单胞菌属、苯杆菌属、伊丽莎白菌属、普氏菌属、链球菌属和韦荣球菌属。相比于单纯MPP组,MPP组合并黏液栓组支原体属、放线菌属的相对丰度较高(P<0.001),鞘氨醇单胞菌属和伊丽莎白菌属相对丰度较低(P<0.001)。单纯MPP组和MPP合并黏液栓组的苯杆菌属、普氏菌属、链球菌属和韦荣球菌属的相对丰度差异无统计学意义(P>0.05)。相比于单纯MPP组,MPP合并黏液栓组菌群多样性及相对丰度差异不具有统计学意义(P>0.05)。MPP合并黏液栓组链球菌属的相对丰度与患儿年龄呈显著负相关(r=-0.524,P=0.014),和发热时间呈显著正相关性(r=0.684,P=0.002)。结论MPP合并气道黏液栓患儿气道菌群的变化可能是气道黏液栓形成的重要因素,MPP合并气道黏液栓患儿链球菌属的相对丰度与患儿年龄呈负相关,与发热时间呈正相关,值得临床深入研究。

Objective To observe the changes of airway microflora in children with Mycoplasma pneumonia pneumonia(MPP)accompanied by airway mucus plugs(MP).Methods A total of 116 children with MPP diagnosed and treated in our hospital from January 2018 to January 2020 were enrolled.According to the results of bronchoscopy,56 children with MPP and mucus plugs were selected as the MPP+MP group,while 60 children without airway mucus plugs were as the MPP group.16S rRNA sequencing technology was used to analyze the composition of the airway flora in the bronchial lavage fluid in each group.The differences in the distribution of airway microbial flora between groups were analyzed statistically.The correlation between the genus and clinical parameters in the MPP+MP group were analyzed using Pearson correlation analysis.Results The dominant phyla in the two groups were Teneribacteria,Bacteroidetes and Firmicutes.The relative abundances of Teneribacteria and Proteobacteria in MPP+MP group were significantly higher than those in MPP group(P=0.012,0.001).There were no differences in the relative abundance values between Actinobacteria and Fusobacterium(P>0.05).The dominant genera in the two groups included Mycoplasma,Actinomyces,Sphingomonas,Benzobacterium,Elizabethania,Prevotella,Streptococcus and Veronicus.Compared with the MPP group,the relative abundances of Mycoplasma and Actinomyces were higher,while those of Sphingomonas and Elizabethania were lower in the MPP+MP group(P<0.001).There were no significant differences in the relative abundances of Metabenzus,Prevotella,Streptococcus and Veronicus between groups(P>0.05).Compared with the MPP group,the MPP+MP group had no significant differences in the abundance and diversity of the flora(P>0.05).The relative abundance of Streptococcus in the MPP+MP group was significantly negatively correlated with the age of the children(r=-0.524,P=0.014),and significantly positively correlated with the duration of fever(r=0.684,P=0.002).Conclusion The change of airway flora in MPP children with airway mucus plugs may be an important factor in the formation of airway mucus plugs.The relative abundance of Streptococcus in MPP children with airway mucus plugs is negatively related to the age of the children,and positively related to the duration of fever,which is worthy of further clinical research.