肺炎支原体23SrRNA基因突变与婴幼儿肺炎支原体肺炎临床相关性研究

Clinical correlation of mycoplasma pneumoniae pneumonia in infants and young children with 23S rRNA gene mutation of Mycoplasma pneumoniae

目的探讨肺炎支原体23S rRNA基因突变与婴幼儿肺炎支原体肺炎的临床相关性,从而提高临床诊疗能力。方法选取确诊为肺炎支原体肺炎的婴幼儿115例,根据肺炎支原体23S rRNA结构域V区是否发生点突变将患儿分为大环内酯类耐药组和大环内酯类敏感组,分析比较2组患儿临床特征及实验室结果。结果 115例患儿的肺炎支原体Ig M抗体阳性率为51.30%,肺炎支原体DNA阳性率为100%;93例肺炎支原体23S rRNA结构域V区发生A2063G点突变,22例未发生突变,大环内酯类耐药率为80.87%;大环内酯类耐药组患儿的总热程、住院时间、C-反应蛋白(CRP)、乳酸脱氢酶(LDH)均高于大环内酯类敏感组患儿,差异均有统计学意义(P均<0.05)。结论大环内酯类耐药肺炎支原体所致的婴幼儿肺炎支原体肺炎病程相对较长,需引起临床医生的重视,CRP、LDH升高有助于预测大环内酯类耐药肺炎支原体感染。

Objective To investigate the clinical relationship between mycoplasma pneumoniae pneumonia（MPP） in infants and young children and 23 S rRNA gene mutation of Mycoplasma pneumoniae（MP）,so as to improve the clinical diagnosis and treatment ability. Methods A total of 115 infants and young children with MPP were enrolled. Based on the specific point mutations of domain V of 23 S rRNA,children with MP infection were divided into the macrolide-resistant group and macrolide-sensitive group. The clinical characteristics and laboratory results between the two groups were analyzed and compared.Results The positive rate of Ig M antibody was 51. 30% and the positive rate of MP DNA was 100% in 115 cases. 22 cases had no gene mutation,while 93 cases had an A2063 G transition in domain V of 23 S rRNA. The resistance rate of MP macrolide was 80. 87%. The total heat time,hospitalization time,C-reactive protein（CRP） and lactate dehydrogenase（LDH） were significantly higher in children with macrolide-resistant group than those in macrolide-sensitive group,and the differences were statistically significant（P〈0. 05）. Conclusion Macrolide-resistant MP course of disease is relatively long,which needs the attention of clinical pediatricians. Elevated CRP and LDH might be the significant predictors of macrolide-resistant Mycoplasma pneumoniae infection.