肺炎支原体23S rRNA突变与患儿临床特征及耐药性的相关性

吴超雄; 王爱敏; 蔡振荡

doi:10.16766/j.cnki.issn.1674-4152.001872

肺炎支原体23S rRNA突变与患儿临床特征及耐药性的相关性

doi: 10.16766/j.cnki.issn.1674-4152.001872

温州市中西医结合医院儿科，浙江温州 325000

基金项目:

浙江省中医药科技计划项目 2015ZA237

详细信息

通讯作者:
吴超雄, E-mail: zjyzyycd@126.com

中图分类号: R725.6 R563.15
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- 被引次数: 0
出版历程
- 收稿日期: 2020-06-10
- 网络出版日期: 2022-02-16

Correlation between 23S rRNA mutation of Mycoplasma pneumoniae and clinical characteristics and drug resistance in children

Department of Pediatrics, Wenzhou Integrated Traditional Chinese and Western Medicine Hospital, Wenzhou, Zhejiang 325000, China

摘要

摘要: 目的观察肺炎支原体(Mycoplasma pneumoniae，MP)肺炎患儿23S rRNA基因突变特征，探讨该基因突变与患儿临床特征及耐药性的相关性。方法对2016年1月—2019年1月于温州市中西医结合医院住院治疗的214例小儿肺炎支原体肺炎病例MP菌株进行23S rRNA基因突变检测，并分别纳入无突变组(36例)和突变组(178例)，通过病历收集患儿的一般信息、临床资料和药敏试验结果，分析23S rRNA基因突变与患儿临床特征及耐药性的相关性。结果共检测到23S rRNA基因突变178例(83.18%)。与无突变组相比，突变组患儿的重症肺炎比例(83.18%)更高，平均发热时间[(7.22±2.13)d]、住院时间[(8.30±3.25)d]及体温恢复正常的时间[(6.45±2.33)d]更长，差异均有统计学意义(均P < 0.05)。药敏试验结果显示突变组阿奇霉素、罗红霉素的耐药率(38.20%、25.84%)显著高于无突变组(13.89%、8.33%，均P < 0.05)。多因素logistic回归分析显示肺炎严重程度、体温恢复正常时间和23S rRNA基因突变是MP耐药性的独立相关因素(OR=1.693、1.285、3.338，均P < 0.05)。结论 23S rRNA的A2063G基因突变是MP的主要突变类型，对大环内酯类抗生素具有明显耐药性，可导致重症肺炎患儿比例增高，并可显著延长患儿的临床治疗时间。
- 肺炎支原体 /
- 23S rRNA /
- 耐药性 /
- 基因突变
Abstract: Objective This study aimed to observe the mutation characteristics of 23S rRNA gene in children with Mycoplasma pneumoniae (MP) and explore the correlation amongst the mutation, clinical characteristics and drug resistance in children. Methods A total of 214 cases of infantile MP with 23S rRNA gene mutation treated with the combination of traditional Chinese and Western medicine in a hospital in Wenzhou from January 2016 to January 2019 were collected and divided into the non-mutated group (36 cases) and mutated group (178 cases). Patient's general information, clinical data and drug susceptibility test results were collected on the basis of medical records to analyse the correlation between 23S rRNA gene mutation with the clinical characteristic and drug resistance of the patients. Results A total of 178 cases (83.18%) of 23S rRNA gene mutations were detected. Compared with the non-mutated group, the proportion of severe pneumonia in the mutated group was higher (83.18%); the mean fever time was longer (7.22±2.13) d; the hospital stay was longer (8.30±3.25) d, and the time to normal body temperature was longer (6.45±2.33) d. The differences were statistically significant (all P < 0.05). The drug susceptibility test results showed that the drug resistance rates of azithromycin and roxithromycin in the mutated group (38.20% vs. 25.84%) were significantly higher than those in non-mutated group (13.89% vs. 8.33%), all P < 0.05. Multivariate logistic regression analysis showed that the severity of pneumonia, the time to return to normal body temperature and 23S rRNA gene mutation were independent related factors of MP resistance (OR=1.693, 1.285, 3.338, all P < 0.05). Conclusion The mutation of A2603G gene in 23S rRNA is the main type of MP mutation, which has evident resistance to macrolide antibiotics, which can increase the proportion of children with severe pneumonia and significantly prolong the clinical treatment time of children.
- Mycoplasma pneumoniae /
- 23S rRNA /
- Drug resistance /
- Gene mutation

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表 1 2组MPP患儿一般资料比较[例(%)]

组别	例数	性别		年龄(岁)				起病至入院时间(x±s, d)
组别	例数	男	女	< 1	1~2	3~6	> 7	起病至入院时间(x±s, d)
无突变组	36	22(61.11)	14(38.89)	4(11.11)	6(16.67)	18(50.00)	8(22.22)	7.22±3.24
突变组	178	97(54.50)	81(45.50)	11(6.18)	33(18.54)	91(51.12)	43(24.16)	6.53±3.55
统计量		0.531^a		0.494^b				1.079^c
P值		0.466		0.622				0.282
注：^a为χ²值，^b为Z值，^c为t值。

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表 2 2组MPP患儿临床资料对比[例(%)]

组别	例数	咳嗽	发热	重症肺炎	叶或段实变	并发症	混合细菌感染	混合病毒感染	平均发热时间(d，x±s)	住院时间(d，x±s)	体温恢复正常时间(d，x±s)
无突变组	36	31(86.11)	32(88.89)	23(63.89)	19(52.78)	21(58.33)	9(25.00)	11(30.56)	6.37±2.61	7.10±2.73	5.21±1.95
突变组	178	158(88.76)	162(91.01)	148(83.18)	102(57.30)	125(70.22)	25(14.04)	31(17.42)	7.22±2.13	8.30±3.25	6.45±2.33
统计量		0.204^a	0.159^a	6.917^a	0.250^a	1.953^a	2.689^a	3.277^a	-2.099^b	-2.123^b	-2.987^b
P值		0.651	0.690	0.009	0.617	0.162	0.101	0.070	0.037	0.035	0.003
注：^a为χ²值，^b为t值。

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表 3 2组MPP患儿MP菌株耐药性对比[例(%)]

组别	例数	阿奇霉素	红霉素	克拉霉素	罗红霉素	螺旋霉素	吉他霉素	克林霉素
无突变组	36	5(13.89)	3(8.33)	1(2.78)	1(2.78)	0(0.00)	0(0.00)	0(0.00)
突变组	178	68(38.20)	46(25.84)	24(13.48)	30(16.85)	20(11.24)	4(2.25)	2(1.12)
χ²值		7.876	5.200	2.369	4.790	3.234
P值		0.005	0.023	0.124	0.029	0.072	1.000^a	1.000^a
注：^a为采用Fisher精确检验。

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表 4 MP耐药影响因素的赋值表

项目	赋值
MP耐药性	1=耐药，2=敏感
23S rRNA突变	1=突变，2=无突变
重症肺炎	1=是，2=否
平均发热时间	实测值
住院时间	实测值
体温恢复正常时间	实测值

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表 5 MP耐药性的多因素logistic回归分析

项目	B	SE	Wald χ²	P值	OR值	95% CI
23S rRNA突变	1.205	0.317	14.494	< 0.001	3.338	1.795~6.208
重症肺炎	0.527	0.184	8.233	0.004	1.693	1.182~2.426
体温恢复正常时间	0.251	0.082	9.271	0.002	1.285	1.093~1.510

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