儿童难治性支原体肺炎外周血D-二聚体变化及咽拭子23S rRNA耐药基因2063位点表达

Changes of D-dimer in peripheral blood and expression of 23S rRNA resistance gene 2063 locus in pharyngeal swabs in children with refractory Mycoplasma pneumonia

目的探讨儿童难治性支原体肺炎(RMPP)外周血D-二聚体变化及咽拭子23S rRNA耐药基因2063位点表达。方法回顾性分析2018年7月-2019年2月本科住院病房诊断为RMPP和MPP的住院患儿各30例;对照组取同期健康儿童30例,比较3组外周血D-二聚体变化及咽拭子23S rRNA耐药基因2063位点表达。结果 3组咽部分泌物中MP-DNA阳性率比较,差异有统计学意义(χ~2=51. 71,P <0. 01)。3组D-二聚体水平比较差异有统计学意义(F=51. 71,P <0. 01);RMPP入院时D-二聚体水平比较,有肺外并发症组均显著高于无肺部并发症组(t=9. 70,P <0. 01);RMPP入院第1周D-二聚体水平比较,有肺外并发症组均显著高于无肺部并发症组(t=10. 81,P <0. 01);外周血D-二聚体水平与23S rRNA耐药基因阳性呈正相关(r=0. 84,P <0. 01);外周血D-二聚体与肺外并发症呈正相关(r=0. 71,P <0. 01)。结论外周血D-二聚体水平及咽拭子23S rRNA耐药基因2063位点联合检测对早期识别RMPP有一定参考价值。

Objective To observe the change of dimer in peripheral blood and expression of 23 S rRNA resistance gene 2063 locus in pharyngeal swabs in children with refractory Mycoplasma pneumonia.Methods Thirty cases diagnosed as Mycoplasma pneumoniae pneumonia(MPP)and refractory Mycoplasma pneumonia pneumonia(RMPP)hospitalized in our ward from July2018 to February 2019 were retrospectively analyzed;30 cases of healthy children in the same period were enrolled as the control group.Then the change of dimer in peripheral blood and expression of 23 S rRNA resistance gene 2063 Locus in Pharyngeal Swabs were compared among the 3 groups.Results The positive rate of MP-DNA in pharyngeal secretion among the three groups was significantly different(χ~2=51.71,P<0.01),and there were statistically different of the levels of D dimer among three groups(F=51.71,P<0.01).The level of D-dimer in refractory mycoplasma pneumoniae pneumonia at admission were significantly higher in pulmonary complication group than those in non-pulmonary complications group(t=9.70,P<0.01).The level of D-dimer in refractory mycoplasma pneumoniae at the first week of admission were significantly higher in pulmonary complications group than those in non-pulmonary complications group(t=10.81,P<0.01).The level of D-dimer in peripheral blood was positively correlated with the positive expression of 23 S rRNA resistance gene(r=0.84,P<0.01).The level of D-dimer in peripheral blood was positively correlated with extrapulmonary pulmonary complications(r=0.71,P<0.01).Conclusion The detection of D-dimer levels in peripheral blood combined with 23 S rRNA resistance gene2063 locus in pharyngeal swabs is helpful for the early identification of refractory mycoplasma pneumoniae.