| 摘要: |
| 目的：探讨儿童耐大环内酯类肺炎支原体肺炎（MRMPP）临床特征和大环内酯类药物的疗效。方法：前瞻性收集2016-2019年湖南省儿童医院收治的肺炎支原体肺炎（MPP）患儿142例，检测肺炎支原体（MP）的DNA及大环内酯类药物耐药基因，按聚合酶链反应（PCR）结果分为耐药组（MR组）92例和敏感组（MS组）50例，其中MR组按初选抗菌药物分为阿奇霉素组（A组）67例和非大环内酯类组（N组）25例，分析其临床指标、疗效、肺外并发症等。结果：MR组和MS组年龄、性别、白细胞（WBC）、中性粒细胞比值、C反应蛋白（CRP）、降钙素原（PCT）等比较差异无统计学意义（P>0.05）。与MS组比较，MR组总热程、肺部湿啰音消失时间、阿奇霉素疗程、阿奇霉素治疗后发热时间均延长（P<0.05）。A组和N组年龄、抗菌药物疗程、抗菌药物治疗后发热时间、中性粒细胞比值、CRP、PCT等比较差异无统计学意义（P>0.05）。与A组比较，N组总热程、肺部湿啰音消失时间延长（P<0.05）。N组WBC水平高于A组（P<0.01）。MR组总有效率与MS组比较差异无统计学意义（P>0.05）。MR组肺外并发症发生率高于MS组（P<0.05）。结论：MRMPP发病率较高，患儿病程较长、肺外并发症发生率较高，延长阿奇霉素疗程治疗仍有效，及早诊断、早期给予阿奇霉素治疗对改善MP耐药尤为重要。 |
| 关键词: 耐大环内酯类肺炎支原体 儿童 阿奇霉素 肺炎 |
| DOI：doi:10.13407/ j.cnki.jpp.1672.108X.2022.08.010 |
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| 基金项目:湖南省科技创新计划项目,编号2018SK50414 |
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| Clinical Characteristics of Macrolide-Resistant Mycoplasma Pneumoniae Pneumonia in Children |
| He Jie, Zhang Xinping, Zhao Wenjiao, Yang Longgui |
| (Hunan Children’s Hospital, Changsha 410007, China) |
| Abstract: |
| Objective: To probe into the clinical characteristics of macrolide-resistant Mycoplasma pneumoniae pneumonia (MRMPP) in children and the efficacy of macrolide drugs. Methods: A total of 142 children with M. pneumoniae pneumonia (MPP) admitted into Hunan Children’s Hospital from 2016 to 2019 were prospectively collected. DNA and macrolide drug resistance genes of M. pneumoniae (MP) were detected. According to the polymerase chain reaction (PCR) results, all patients were divided into the drug resistance group (MR group) with 92 cases and sensitive group (MS group) with 50 cases. MR group was divided into the azithromycin group (group A) with 67 cases and non-macrolide group (group N) with 25 cases according to primary antibiotics. The clinical indicators, efficacy and extrapulmonary complications were analyzed. Results: There was no significant difference in age, gender, white blood cell (WBC), neutrophilic granulocyte percent, C-reactive protein (CRP) and procalcitonin (PCT) levels between the MR group and the MS group (P>0.05). Compared with the MS group, the total fever duration, disappearance time of pulmonary rales, course of azithromycin treatment, and the fever duration after azithromycin treatment were prolonged in the MR group (P<0.05). There was no significant difference in age, course of antibiotics, fever duration after antibiotics treatment, neutrophilic granulocyte percent, CRP, PCT between the group A and the group N (P>0.05). Compared with group A, the total fever duration and disappearance time of pulmonary rales in group N were prolonged (P<0.05). The level of WBC in the group N was higher than that in the group A (P<0.01). There was no significant difference in total effective rate between the MR group and the MS group (P>0.05). The incidence of extrapulmonary complications in the MR group was higher than that in the MS group (P<0.05). Conclusion: The incidence of MRMPP in children is high, which leads to prolonged course of disease and increased extrapulmonary complications, yet prolonged course of treatment with amphotericin remains effective. Therefore, early diagnosis and early treatment with azithromycin make a significant difference in improving the spread of MP resistance. |
| Key words: macrolide-resistant Mycoplasma pneumoniae pneumonia children azithromycin |
