肺炎支原体肺炎患儿支气管肺泡灌洗液中肺炎支原体耐药基因和13种病原检测结果分析

Analysis of drug resistance gene in Mycoplasma pneumoniae and 13 pathogens in bronchoalveolar lavage fluid of children with Mycoplasma pneumoniae pneumonia

目的:了解肺炎支原体肺炎(MPP)患儿支气管肺泡灌洗液(BALF)中肺炎支原体(MP)耐药基因和13种呼吸道病原的分布情况。方法:回顾性选择2018年1月至2019年1月北京大学第三医院和北京大学第一医院100例MPP患儿的BALF标本,采用荧光定量PCR法检测MP核酸及其耐药基因,采用多重PCR核酸检测技术测定甲型流感病毒、甲型流感病毒H_(1)N_(1)、甲型流感病毒H_(3)N_(2)、乙型流感病毒、人副流感病毒、腺病毒、人博卡病毒、人鼻病毒、肺炎衣原体、人偏肺病毒、MP、人冠状病毒和呼吸道合胞病毒核酸,采用 χ^(2)检验进行分析。 结果:100例BALF标本,荧光定量PCR法检测MP及耐药基因,83例(83.00%)MP阳性,其中78例(93.98%)耐药,均为23S rRNA结构域V区A2063G的点突变。多重PCR法检测13种呼吸道病原,89例(89.00%)阳性。79例(79.00%)检测到MP,其中74例(74.00%)仅检出MP,5例(5.00%)同时检出MP合并其他病原。10例(10.00%)检测出其他病原。0~4岁组病毒检出率高于>4~6岁组( P=0.042)和>6岁组( P=0.002),差异均有统计学意义。 结论:MPP患儿的BALF标本绝大部分可检测到MP,耐药现象严重,以A2063G的点突变为主。少数BALF标本中可检测到其他呼吸道病原和2种或3种病原。

Objective To investigate drug resistance gene in Mycoplasma pneumoniae(MP)and the distribution of 13 respiratory pathogens in bronchoalveolar lavage fluid(BALF)of children with Mycoplasma pneumoniae pneumonia(MPP).Methods A total of 100 BALF of children with MPP in Peking University Third Hospital and Peking University First Hospital from January 2018 to January 2019 were collected.Fluorogenic quantitative PCR was used to detect nucleic acid and it′s drug resistance gene of MP and multiple PCR method was adopted to detect influenza A virus,influenza A virus-H_(1)N_(1),influenza A virus-H_(3)N_(2),influenza B,human parainfluenza virus,adenovirus,human bocavirus,human rhinovirus,Chlamydia pneumoniae,human metapneumovirus,MP,human coronavirus,and respi-ratory syncytial virus gene,and the results were compared by using Chi square test.Results In 100 BALF samples,MP and drug resistance gene were detected by fluorogenic quantitative PCR.Totally,83 cases(83.00%)were MP positive and 78 cases(93.98%)were drug resistant.All of them had the point mutations A2063G in V region of 23S rRNA domain.A total of 13 kinds of respiratory pathogens were detected by multiplex PCR method,and 89 cases(89.00%)were positive.Totally,79 cases(79.00%)were MP positive,of which 74 cases(74.00%)detected only MP,and 5 cases(5.00%)detected MP combined with other pathogens.Other pathogens were detected in 10 cases(10.00%).The virus detection rate of 0-4 years old group was higher than that of>4-6 years old group(P=0.042)and>6 years old group(P=0.002),and the differences were statistically significant.Conclusions MP can be detected in most BALF samples of MPP children,the drug resistance phenomenon is serious,and the main point mutation is A2063G.There were other respiratory pathogens and 2 or 3 pathogens were detected in a small number of BALF samples.