儿童肺炎支原体肺炎多重耐药基因位点突变分析及临床意义

Analysis of multidrug resistance gene locus mutations and clinical significance in children with Mycoplasma pneumoniae pneumonia

摘要:

目的 通过靶向高通量测序检测儿童肺炎支原体肺炎多重耐药基因位点突变，并探讨其临床意义。方法 回顾性分析2023年1—12月于湖北省妇幼保健院收治的2 899例呼吸道多重病原体靶向高通量测序肺炎支原体肺炎患儿的临床资料。根据是否发生肺炎支原体大环内酯类药物耐药基因23SrRNA突变，分为突变组（n=885）和未突变组（n=2 014）。采用多因素logistic回归分析探讨儿童肺炎支原体肺炎多重耐药基因位点突变的危险因素。结果 2 899例患儿中，耐药基因23SrRNA突变885例（30.53%），其中A2063G基因位点突变884例，A2064G基因位点突变1例；发生耐药基因23SrRNA突变患儿中，使用多西环素、氧氟沙星治疗疗效优于阿奇霉素、克拉霉素，且多西环素治疗疗效优于氧氟沙星（P<0.05）。肺炎支原体肺炎患儿中，耐药基因突变率随年龄增加而上升（P<0.001）。多因素logistic回归分析显示，年龄增大、肺外感染、肺实变、发热时间延长、住院时间延长及CRP水平增高是发生耐药基因23SrRNA位点突变的危险因素（P<0.05）。结论 年龄、肺外感染、肺实变、发热时间、住院时间、CRP水平与耐药基因23SrRNA位点突变密切相关。可通过检测肺炎支原体肺炎患儿体内多重耐药基因位点突变情况为患儿进行早期疾病诊断及预测治疗疗效，促进临床合理治疗。

Abstract:

Objective To detect multidrug resistance gene locus mutations in children with Mycoplasma pneumoniae pneumonia through targeted high-throughput sequencing and to explore its clinical significance.Methods A retrospective analysis was conducted on the clinical data of 2 899 children with Mycoplasma pneumoniae pneumonia, who underwent respiratory pathogen-targeted high-throughput sequencing, treated at Hubei Maternal and Child Health Care Hospital between January and December 2023. The patients were divided into a mutation group (n=885) and a non-mutation group (n=2 014) based on whether there was a mutation in the 23SrRNA macrolide-resistant gene of Mycoplasma pneumoniae. Multivariate logistic regression analysis was used to investigate the risk factors for multidrug resistance gene locus mutations in children with Mycoplasma pneumoniae pneumonia.Results Among the 2 899 children, 885 cases (30.53%) had mutations in the 23SrRNA resistance gene, including 884 cases with the A2063G mutation and 1 case with the A2064G mutation. In children with 23SrRNA resistance gene mutations, treatment with doxycycline or ofloxacin was more effective than with azithromycin or clarithromycin, and doxycycline was more effective than ofloxacin (P<0.05). The mutation rate of resistance genes in children with Mycoplasma pneumoniae pneumonia increased with age (P<0.001). Multivariate logistic regression analysis showed that increased age, extrapulmonary infection, lung consolidation, prolonged fever, prolonged hospitalization, and elevated CRP levels were risk factors for 23SrRNA gene locus mutations (P<0.05).Conclusions Age, extrapulmonary infections, lung consolidation, duration of fever, length of hospitalization, and CRP levels are closely related to 23SrRNA resistance gene locus mutations. Detecting multidrug resistance gene locus mutations in children with Mycoplasma pneumoniae pneumonia can aid in early diagnosis and prediction of treatment efficacy, promoting rational clinical treatment.