耐大环内酯类药物的肺炎支原体肺炎患儿临床特征及治疗

Clinical features and treatment of macrolide-resistant Mycoplasma pneumoniae pneumonia in children

摘要:

目的 分析大环内酯类药物耐药的肺炎支原体肺炎患儿的临床特征，并探讨其治疗方案。方法 采集136例肺炎支原体肺炎患儿的咽拭子或支气管肺泡灌洗液标本，实时荧光定量PCR检测23s rRNA编码基因2063/2064 A：G突变情况，依结果分为突变耐药组（耐药组，n=81）和野生型敏感组（敏感组，n=55），分析两组患儿的年龄构成、呼吸道症状、肺外并发症、实验室检查指标、影像学改变、治疗方式及住院天数。结果 耐药组较敏感组发热时间、高热时间延长，有血氧饱和度降低的例数多（P < 0.05）；耐药组谷丙转氨酶（ALT）、乳酸脱氢酶（LDH）水平高于敏感组（P < 0.05）。常规使用阿奇霉素治疗对敏感组疗效好，而耐药组更多需要加用激素治疗。结论 耐大环内酯类药物的肺炎支原体感染单从某一项临床特征无法鉴别，但发热和高热时间延长、血氧饱和度降低，以及ALT、LDH升高有一定提示作用。对于耐药肺炎支原体肺炎患儿，阿奇霉素配合激素可能是更佳的治疗模式。

Abstract:

Objective To study the clinical features of macrolide-resistant Mycoplasma pneumoniae pneumonia and its treatment regimens in children.Methods The samples of throat swab or bronchoalveolar lavage fluid were collected from 136 children with Mycoplasma pneumoniae pneumonia. Quantitative real-time PCR was used to detect 2063/2064 A:G mutation in 23S rRNA, and according to such results, the children were divided into drug-resistance group with 81 children and sensitive group with 55 children. The two groups were compared in terms of age composition, respiratory symptoms, extrapulmonary complications, laboratory markers, imaging changes, treatment regimens, and length of hospital stay.Results Compared with the sensitive group, the drug-resistance group had significantly longer duration of pyrexia and severe fever, a significantly higher percentage of children with reduced blood oxygen saturation, and significantly higher levels of alanine aminotransferase (ALT) and lactate dehydrogenase (LDH) (P < 0.05). The conventional azithromycin treatment had a good clinical effect in the sensitive group, while corticosteroid therapy was usually needed in the drug-resistance group.Conclusions Macrolide-resistant Mycoplasma pneumoniae infection cannot be identified based on a single clinical feature, but prolonged duration of pyrexia and severe fever, reduced blood oxygen saturation, and increased ALT and LDH can suggest the presence of this disease. Azithromycin combined with glucocorticoids may be a good treatment regimen for children with macrolide-resistant Mycoplasma pneumoniae pneumonia.