儿童难治性支原体肺炎感染诊治中MP-DNA载量及耐药检测的意义分析

Significance analysis of MP-DNA load and drug resistance in diagnosis and treatment of children with refractory mycoplasma pneumonia in children

目的对MP-DNA载量及耐药检测情况进行分析,探讨其在儿童难治性支原体肺炎感染诊治中的临床意义。方法选择我院2016年12月至2017年12月儿科确诊肺炎支原体肺炎(MPP)的患者206例,根据临床特征以及治疗的效果,分为普通支原体肺炎组(普通组)100例,难治性支原体肺炎(难治组)106例,比较两组患儿咽拭子分泌物标本MP-DNA载量、耐药突变位点检测结果对于难治性支原体肺炎的早期诊断价值。结果难治组MP-DNA检测出的阳性率显著高于普通组,阴性率显著低于普通组P<0.05。难治组患儿对不同抗生素耐药性显著高于普通组患儿的耐药性(P<0.05);进一步对所有耐药患儿针对不同抗生素出现耐药性的耐药突变位点进行分析,2063位A→G突变对大环内脂类抗生素耐药影响更大,60%以上产生大环内脂类药物耐药的病例均检测出2063位点G突变。红霉素、阿奇霉素、罗红霉素、克拉霉素、克林霉素耐药病例基因型分布的差异有统计学意义(P<0.05);而乙酰螺旋霉素、左氧氟沙星、加替沙星、司帕沙星病例基因型分布的差异有统计学意义(P>0.05);对两组患儿临床及实验室特点,难治组患儿高热、肺外并发症、CRP增高、大环内酯类药物应用时间、血沉增高例数及乳酸脱氢酶显著高于普通组(P<0.05);对两组MPP影像学以及并发症进行比较,两组病变发生在双侧、右上侧的分布有显著差异(P<0.05);两组肺内合并症、肺不张及胸腔积液的发生率比较有显著差异(P<0.05)。结论 MP-DNA载量及耐药性的检测可以对难治性支原体肺炎进行早期诊断,有一定的临床价值。

Objective To investigate the clinical significance of MP-DNA load and drug resistance in the diagnosis and treatment of children with refractory mycoplasma pneumonia. Methods 206 patients with mycoplasma pneumoniae pneumonia( MPP) from December 2016 to December 2017 were selected,and they were divided into the ordinary mycoplasma pneumonia group( the normal group,n = 100) and the refractory mycoplasma pneumonia group( the refractory group,n =106) according to clinical features and treatment effect. Their pharyngeal MP-DNA load in swab samples and the testing results of drug resistance mutations for the early diagnostic value of refractory mycoplasma pneumonia were compared between the two groups. Results The positive rate of MP-DNA in the refractory group was significantly higher than that in the ordinary group,and the negative rate was significantly lower than that in the ordinary group( P < 0. 05). The antibiotic resistance of the refractory group was significantly higher than that of the ordinary group( P < 0. 05). Further analysis was conducted on all the mutations of resistance to different antibiotics in all the children,and it was found that the 2063 A→G mutation had greater impact on the antibiotic resistance. The genotype distribution of erythromycin,azithromycin,roxithromycin,clarithromycin and clindamycin resistance cases was statistically significant( P < 0. 05). However,the genotype distribution of acetylspiramycin,levofloxacin,gatifloxacin and sparfloxacin was significantly different( P > 0. 05). The number of cases of quinolone resistance produced by genotypes A and G at locus 2063 was the same( P < 0. 05). For the clinical and laboratory characteristics of children in the two groups,high fever,extrapulmonary complications,increased CRP,time of application of macrolide drugs,increased cases of erythrocyte sedimentation rate and lactate dehydrogenase in the refractory group were significantly higher than those in the general group( P < 0. 05). The imaging and complications of MPP in the two groups were compared,and the distribution of lesions in the bilateral and upper right sides of the two groups showed significant differences( P < 0. 05). There were significant differences in the incidence of intrapulmonary complications,atelectasis and pleural effusion between the two groups( P < 0. 05). Conclusion The detection of MP-DNA load and drug resistance can be used for the early diagnosis of refractory mycoplasma pneumonia.