儿童难治性肺炎支原体肺炎危险因素及支原体耐药的相关性分析

Study on risk factors of refractory mycoplasma pneumoniae pneumonia in children and drug resistance of mycoplasma

目的儿童难治性肺炎支原体肺炎的危险因素及支原体耐药情况进行分析。方法采用回顾性对照研究,2010年至2013年我院住院的肺炎支原体肺炎患儿为研究对象,其中72例符合难治性肺炎支原体肺炎诊断标准为病例组,随机选取同期我院相似年龄、性别的76例一般肺炎支原体肺炎患儿为对照组,对特应性体质、临床表现、实验室检查(CRP、血沉、痰培养、咽拭子快速支原体培养及药敏)、胸部影像学检查等危险因素进行比较,对肺炎支原体进行药物敏感性分析,并对难治性肺炎支原体肺炎相关临床因素进行Logistic回归分析。结果病例组较对照组在特应性体质、发热持续10天以上、全身皮疹、CRP≥40mg/L、血沉≥50mm/h、痰细菌培养阳性、肺部大片状高密度均匀一致实变阴影、支原体对大环内酯类耐药的病例数明显增加,差异具有统计学意义(P<0.05);病例组中14例患儿家长拒绝应用激素等药物,结果 12例发热时间>15天,5例遗留肺不张,2例肺坏死;药敏实验结果显示,病例组对红霉素、阿奇霉素等药物具有较高的耐药率。对两组病例进行Logistic回归分析,发现特应性体质、发热持续10天以上、CRP≥40mg/L、血沉≥50mm/h、肺部大片状高密度实变影≥2/3肺叶,这些因素影响明显(分别为P=0.000;P=0.011;P=0.000;P=0.003;P=0.004)。结论特应性体质、发热持续10天以上、CRP≥40mg/L、血沉≥50mm/h、肺部大片状高密度实变影≥2/3肺叶,是难治性肺炎支原体肺炎的危险因素;难治性肺炎支原体肺炎对红霉素、阿奇霉素等大环内酯类药物具有较高的耐药率。

Objective To analyze the risk factors and drug resistance of refractory mycoplasma pneumoniae pneumonia （RMPP） in children. Methods During the period of 2010 -2013, 148 patients with MPP were selected. 76 of them were diagnosed as general MPP, and 72 cases with RMPP. The atopie physiques, clinical manifestation, laboratory findings （ CRP, ESR, sputum culture and drug susceptibility） , chest x - ray and therapeutic effect were analyzed. And the clinical factors associated with RMPP was analyzed by Logistic regression analysis. Results The manifestation rate of positive atopic system, fever more than 10 days, skin rash, CRP ≥40 mg/L, ESR ≥50mm/ h, positive culture, large patch of high density shadow in lung film and mycoplasma resistance to most macrolides drugs was higher in the RMPP group than the MPP group （P 〈 0. 05 ）. Among 14 cases without steroid treatment, 12 suffered from fever more than 15 days, 5 sequenced atelectasis, and 2 had lung necrosis. Antibiotic sensitivity test showed higher resistance to erythromycin and azithromycin in the RMPP group. It is found that atopic physique, fever more than 10 days, CRP ≥40 mg/L, ESR≥50mm/h and large patch of high density shadow more than or equal to 2/ 3 of the lob were significantly associated with RMPP （ P = 0. 000 ; P = 0.011 ; P = 0. 003 ; P = 0. 004, P = 0. 000 ）. Conclusion Atopic physique, fever more than 10 days, CRP≥40 mg/L, ESR≥50mm/h, and large patch of high density shadow≥2/3 of the lob are risk factors for RMPP. The high rate of macrolides resistance is observed in patients with RMPP.