肺炎支原体感染者血清流行病学分析及其抗菌药物疗效评价

Seroepidemiology of Mycoplasma pneumoniae infection and evaluation of antibiotics medication

目的分析肺炎支原体感染血清流行病学资料及随访评价部分阳性者抗菌药物疗效。方法用Serodia-MyeolI颗粒凝集试剂盒检测3134份临床疑似肺炎支原体感染者的血清抗体，判断肺炎支原体感染者并分析其流行病学资料，包括抗体总阳性率、男女阳性率差异、季节阳性率差异、年龄组阳性率差异及不同标本来源阳性率的差异等。随访评价部分阳性者抗菌药物疗效，统计使用抗菌药物的天数、不同抗菌药物使用情况，以及治愈、好转及疗效较差的比例等。结果收集3134份临床疑似肺炎支原体感染者的血清标本，其中350份（11．2％）肺炎支原体抗体阳性。女性患者阳性率为12．3％（198／1604），高于9．9％（152／1530）男性患者阳性率，差异有统计学意义（x^2=4．58，P〈0．05）。肺炎支原体抗体阳性率最高季节在第4季度（10～12月），为13．2％（95／719）；肺炎支原体抗体阳性率最高年龄组位于5～9岁，为32．8％（45／137）。儿科门诊及儿科病房为肺炎支原体抗体阳性率最高的标本来源，分别为27．9％（56／201）和26．5％（60／226）。社区获得性肺炎患者肺炎支原体抗体阳性率为28％（7／25），高于其他疾病患者组。随访91例阳性患者中，自出现临床症状至就3／抗体检测的时间为5—120d，平均24．2d。71例（78．O％）患者使用大环内酯类抗菌药物治疗，4例（4．4％）使用喹诺酮类抗菌药物，4例（4．4％）使用头孢类抗菌药物治疗，其余12例（13．2％）使用其他抗菌药物或对症处理。上述抗菌药物治疗时间3—21d，平均8．2d。疗效随访结果是治愈35例（38．5％），好转50例（54．9％），6例（6．6％）疗效较差。结论肺炎支原体抗体阳性率女性高于男性，第四季度和学龄期儿童分别是肺炎支原体感染的高峰季节和高峰年龄组。儿科门诊及病房为肺炎支原体抗体阳性率最高的标本来源。临床医生能够根据肺炎支原体实验室检测结果选择一线抗菌药物并获得良好的疗效。

Objective To analyze the seroepidemiologic of Mycoplasma pneumoniae infection and evaluate antibiotics medication of some positive patients by follow-up. Methods Serodia-MycoII particle agglutination assay was used to detect serum antibodies against Mycoplasma pneumoniae in 3 134 clinically suspected infections. Mycoplasma pneumoniae infection was determined and seroepidemiologic was analyzed by results of the test, including positive antibody rates in whole subjects, in male or female groups, in different seasons or age groups as well as in different sources. Evaluate antibiotics medication of some positive patients by follow-up. The average days of medication were counted, different antibiotics medication and medication effect were analyzed. Results In 3 134 serum samples from clinically suspected Mycoplasma pneumoniae infections, 350 （11.2%） were tested with positive antibodies. The positive antibody rate in female patients was 12. 3% （ 198/1 604）, which was higher than 9. 9% （ 152/1 530） in males （x^2 =4. 58, P 〈0. 05）. The peak season was found in the fourth quarter （October-December） with 13.2% of positive antibody and the highest positive rate （32. 8%, 45/137） was found in school aged （5 -9 years old） children. Samples from pediatrics clinic and ward were tested to have highest positive rates （ 27.9% and 26. 5%, respectively）, comparing that from other sources. Infection due to Mycoplasma pneumoniae was identified in 28% （7/25） of community-acquired pneumonia （CAP） patients, which is higher than other diseases. Based on the follow-up of 91 antibody positive patients, between 5 to 120 days （ mean 24. 2 days ） were counted from appearance of clinical symptoms to clinic visiting/testing. 71 of 91 （78.0%） patients was medicated with macrolide antibiotics, 4 （4. 4% ） with quinolones, 4 （4. 4% ） with cephalosporin, and the rest 12 （ 13.2% ） patients were medicated with other antibiotics or only symptomatic treatment. The average period of antibiotics medication was between 3 to 21 days （ mean 8.2 days）. Medication effect results by follow-up were cure in 35 （38.5%）, improvement in 50 （54. 9% ）, and poor responses in 6 （6. 6% ）. Conclusions Mycoplasma pneumoniae positive rate in female patients was higher than in males, and peak rate was found in the fourth quarter and in school aged children. Samples from pediatrics clinic and ward were tested to have highest positive rates. Physicians could choose first line antibiotics according to laboratory test results of Mycoplasma pneumoniae, and gain good effect.