摘要
目的通过研究大环内酯类耐药肺炎支原体(macrolide-resistantmycoplasmapneumoniae,MRMP)感染与儿童难治性肺炎支原体肺炎(refractory mycoplasma pneumoniae pneumonia,RMPP)的关系,以探讨其在儿童RMPP及时诊治中的临床意义。方法回顾性分析714例RMPP患儿的临床资料。对患儿进行支气管镜检查和支气管肺泡灌洗液(bronchoalveolar lavage fluid,BALF)检查,提取BALF中的MP-DNA,检测其23S rRNA V区突变位点,并根据检测结果,分为大环内酯类耐药组和对照组(非大环内酯类耐药)。结果共计714例RMPP患儿,其中大环内酯类耐药组509例,对照组205例。男369例(54.7%),女345例(45.3%)。大环内酯类耐药组的年龄、发热时间及住院时间均高于对照组(P<0.0001)。大环内酯类耐药组RMPP患儿的白细胞(white blood cell count,WBC)、中性粒细胞百分比(percentage of neutrophil,NE%)、超敏C反应蛋白(high sensitive C-reactive protein,hs-CRP)、乳酸脱氢酶(lactate dehydrogenase,LDH)及白细胞介素-6(interleukin-6,IL-6)值均高于对照组(P<0.05,P<0.0001)。大环内酯类耐药组RMPP患儿的肺实变、胸腔积液、坏死性肺炎、重症(severe MPP,SMPP)/危重症(fulminant MPP,FMPP)、气管内絮状及黏性分泌物、严重黏膜病变(糜烂、溃疡或坏死等)、支气管炎性狭窄、支气管内塑型痰栓及肺外并发症的发生率均高于对照组(P<0.05,P<0.0001)。结论MRMP感染可导致进RMPP的发生。MRMP感染可能会加重RMPP患儿病情。对RMPP患儿及时地实施纤维支气管镜检查,并采集BALF样本进行检测,准确地评估RMPP患儿的呼吸道病变及判断是否存在MRMP感染等的情况,对指导临床的正确诊治有重要的参考价值。
Objective To elucidate the clinical significance in facilitating timely diagnosis and treatment of RMPP in children by investigating the association between infection caused by macrolide-resistant Mycoplasma pneu-moniae(MRMP)and refractory Mycoplasma pneumoniae pneumonia(RMPP)in pediatric patients.Methods The clinical data of 714 hospitalized children with refractory Mycoplasma pneumoniae pneumonia(RMPP)were retro-spectively analyzed.Bronchoscopy and bronchoalveolar lavage fluid(BALF)were performed on each subject,and the BALFs were collected to detect mutation sites in the V region of 23S rRNA for Mycoplasma pneumoniae DNA.Based on the gene detection results,children with RMPP were categorized into a macrolide-resistant group and a control group(non-macrolide-resistant group).Results A total of 714 children diagnosed with refractory Mycoplasma pneumoniae pneumonia(RMPP)were enrolled in this study,including 509 cases in the macrolide-resistant group and 205 cases in the control group.Among them,there were 369 males(54.7%)and 345 females(45.3%).The macrolide-resistant group exhibited higher average age,fever duration,and hospitalization days compared to the control group.Furthermore,elevated levels of white blood cell count(WBC),neutrophil percentage(NE%),high-sensitivity C-reactive protein(hs-CRP),lactate dehydrogenase(LDH),and interleukin-6(IL-6)were observed in the macrolide-resistant group when compared to the control group(P<0.05 or P<0.0001).Compared to the control group,children with macrolide-resistant Mycoplasma pneumoniae pneumonia(RMPP)exhibited higher incidences of lung consolidation,pleural effusion,necrotic pneumonic lesions,severe MPP(SMPP)/fulminant MPP(FMPP),flocculent and viscous tracheal secretions,severe mucosal lesions(erosion,ulceration or necrosis),bronchial inflammatory stenosis,endo-bronchial plastic phlegm plugs and extra-pulmonary complications(P<0.05 or P<0.0001).Conclusions MRMP infection can contribute to the development of RMPP,potentially exacerbating respi-ratory conditions in affe
作者
陈茜茜
林秋玉
张湘云
张笃飞
CHEN Qianqian;LIN Qiuyu;ZHANG Xiangyun;ZHANG Dufei(Depart-ment of Pediatrics,Hainan Women and Children′s Medical Center,Haikou 570000,Hainan,China)
出处
《实用医学杂志》
CAS
北大核心
2024年第22期3190-3195,共6页
The Journal of Practical Medicine
基金
海南省省级临床医学建设项目(编号:2021-75)
海南省卫生健康科技联合项目(编号:琼科2024-22)。
