大环内酯类耐药和敏感的肺炎支原体肺炎临床特点病例对照研究

The clinical characteristics of macrolide-resistant Mycoplasma pneumoniae pneumonia in Children : a case-control study

目的分析大环内酯类耐药肺炎支原体(MP)肺炎临床特点。方法纳入2014年1月至2015年12月北京儿童医院呼吸科病房收治的MP肺炎患儿,入院当天采集咽拭子行MP的DNA及大环内酯类耐药基因检测,根据耐药检测结果分为大环内酯类耐药(MR)组和敏感(MS)组,分析两组的临床特点和疗效指标。结果 225例行大环内酯类耐药基因检测的病例进入本文分析,MR组195例和MS组30例。两组均表现为高热及咳嗽,在性别、年龄、最高体温、重症肺炎所占的比例,急性期外周血WBC、中性粒细胞计数和CRP水平方面的差异无统计学意义;两组均表现为大叶性实变影,以右肺单侧为主,但MR组发生双侧病变的比例略高于MS组(P=0.056)。MR组较MS组的总病程[(18.3±6.1)vs(16.5±4.2)d,P=0.031]及使用大环内酯类药物后的发热时间[(7.0±4.3)vs(4.7±3.4)d,P=0.003]均显著延长。对MS组患儿行疗效分析发现,初选大环内酯类药物较初选β-内酰胺类药物治疗患儿的总发热时间[(9.6±3.5)vs(12.1±5.6)d,P<0.001]和总病程[(16.1±4.1)vs(19.3±6.6)d,P<0.001]显著缩短。结论 MP耐药率较高。MP耐药患儿发生双侧肺病变的风险增高、总病程及发热时间显著延长。早期诊断并及时应用大环内酯类药物治疗仍能缩短大环内酯类耐药患儿的病程和发热时间。

Objective To analyze the clinical characteristics of macrolide-resistant Mycoplasma pneumoniae（ MP） pneumonia.Methods Children with Mycoplasma pneumoniae pneumonia in the Respiratory Department of Beijing Children ＇s Hospital were included,from January 2014 to December 2015. All children were taken swabs for DNA and drug-resistant gene detection on admission,and were divided into macrolide-resistant group（ MR） and macrolide-sensitive（ MS） group according to the detection results,the clinical data and curative effect indexes were compared between these two groups. Results 225 patients who were detected for the drug-resistant gene were analyzed,including 195 MR cases and 30 MS cases. All patients in two groups were with high fever and cough,and there were no significant differences in gender,age,highest temperature,the proportion of severe pneumonia,acute peripheral blood leukocyte count,acute phase proportion of neutrophils,acute phase CRP value between these two groups; The chest X-ray films of all cases showed lobar consolidation,mainly with unilateral lesion of right lung,but the proportion of bilateral lesions in MR group was higher than that in MS group（ P = 0. 056）. The total course and the fever time after using macrolide in MR group were significantly longer than those in MS group [total course（ 18. 3 ± 6. 1） vs（ 16. 5 ± 4. 2） d,P = 0. 031;（ 7. 0 ± 4. 3） vs（ 4. 7 ± 3. 4） d,P = 0. 003]. Analyzing curative effect,the total fever time and the total course in the group using macrolide at beginning were significantly longer than those in the group using other antibiotics at beginning [total fevertime（ 9. 6 ± 3. 5） vs（ 12. 1 ± 5. 6） d; total course（ 16. 1 ± 4. 1） vs（ 19. 3 ± 6. 6） d; P〈0. 001]. Conclusion The resistant rate of MP was 87. 6% in Beijing Children＇s Hospital. The patients with MR-MPs had higher risk for bilateral lesions,longer fever time and total course than the patients with MS-MPs. There was no difference for other clinical characteristics between these two groups.In addition,early application of macrolide could shorten course and fever time of patient with MR-MP.