PDF(1276 KB)
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
陈煜, 田维敏, 陈琪, 赵红缨, 黄萍, 林志青, 陈凌
中国当代儿科杂志 ›› 2018, Vol. 20 ›› Issue (8) : 629-634.
PDF(1276 KB)
PDF(1276 KB)
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
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。
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.
耐大环内酯类肺炎支原体 / 肺炎支原体肺炎 / 临床特征 / 激素 / 儿童
Macrolide-resistant Mycoplasma pneumoniae / Mycoplasma pneumoniae pneumonia / Clinical feature / Glucocorticoid / Child
[1] 中华医学会儿科学分会呼吸学组. 儿童社区获得性肺炎管理指南(2013修订)(上)[J]. 中华儿科杂志, 2013, 51(10):745-752.
[2] Yamazaki T, Kenri T. Epidemiology of Mycoplasma pneumoniae infections in Japan and therapeutic strategies for macrolide-resistant M. pneumoniae[J]. Front Microbiol, 2016, 7:693.
[3] Lucier TS, Heitzman K, Liu SK, et al. Transition mutations in the 23S rRNA of erythromycin-resistant isolates of Mycoplasma pneumoniae[J]. Antimicrob Agents Chemother, 1995, 39(12):2770-2773.
[4] Okazaki N, Narita M, Yamada S, et al. Characteristics of macrolide-resistant Mycoplasma pneumoniae strains isolated from patients and induced with erythromycin in vitro[J]. Microbiol Immunol, 2001, 45(8):617-620.
[5] 辛德莉, 韩旭, 糜祖煌, 等. 肺炎支原体对大环内酯类抗生素耐药性及耐药机制研究[J]. 中华检验医学杂志, 2008, 31(5):543-546.
[6] 胡亚美, 江载芳. 诸福棠实用儿科学[M]. 第8版. 北京:人民卫生出版社, 2015:1280-1282.
[7] 中华医学会儿科学分会呼吸学组. 儿童肺炎支原体肺炎诊治专家共识(2015年版)[J]. 中华实用儿科临床杂志, 2015, 30(17):1304-1308.
[8] 温顺航, 张海邻, 李昌崇. 儿童肺炎支原体肺炎的影像学表现[J]. 中华实用儿科临床杂志, 2016, 31(16):1272-1274.
[9] 柯莉芹, 王凤美, 李银洁, 等. 儿童肺炎支原体肺炎流行病学特征[J]. 中国当代儿科杂志, 2013, 15(1):33-36.
[10] 郑宝英, 闫超, 薛冠华, 等. 耐药肺炎支原体肺炎患儿的临床特点及流行基因型特征分析[J]. 中华实用儿科临床杂志, 2017, 32(10):735-739.
[11] Zheng X, Lee S, Selvarangan R, et al. Macrolide-resistant Mycoplasma pneumoniae, United States[J]. Emerg Infect Dis, 2015, 21(8):1470-1472.
[12] Ferguson GD, Gadsby NJ, Henderson SS, et al. Clinical outcomes and macrolide resistance in Mycoplasma pneumoniae infection in Scotland, UK[J]. J Med Microbiol, 2013, 62(Pt 12):1876-1882.
[13] 辛德莉, 王斯, 韩旭, 等. 耐药肺炎支原体肺炎患儿的临床特点[J]. 中华实用儿科临床杂志, 2010, 25(16):1213-1215.
[14] Ma Z, Zheng Y, Deng J, et al. Characterization of macrolide resistance of Mycoplasma pneumoniae in children in Shenzhen, China[J]. Pediatr Pulmonol, 2014, 49(7):695-700.
[15] Zhou Y, Zhang Y, Sheng Y, et al. More complications occur in macrolide-resistant than in macrolide-sensitive Mycoplasma pneumoniae pneumonia[J]. Antimicrob Agents Chemother, 2014, 58(2):1034-1038.
[16] Kim YJ, Shin KS, Lee KH, et al. Clinical characteristics of macrolide-resistant Mycoplasma pneumoniae from children in Jeju[J]. J Korean Med Sci, 2017, 32(10):1642-1646.
[17] Lee E, Cho HJ, Hong SJ, et al. Prevalence and clinical manifestations of macrolide resistant Mycoplasma pneumoniae pneumonia in Korean children[J]. Korean J Pediatr, 2017, 60(5):151-157.
[18] Yoon IA, Hong KB, Lee HJ, et al. Radiologic findings as a determinant and no effect of macrolide resistance on clinical course of Mycoplasma pneumoniae pneumonia[J]. BMC Infect Dis, 2017, 17(1):402.
[19] Komatsu H, Tsunoda T, Inui A, et al. Characteristics of hospitalized children infected with macrolide-resistant Mycoplasma pneumoniae[J]. Braz J Infect Dis, 2014, 18(3):294-299.
[20] Matsubara K, Morozumi M, Okada T, et al. A comparative clinical study of macrolide-sensitive and macrolide-resistant Mycoplasma pneumoniae infections in pediatric patients[J]. J Infect Chemother, 2009, 15(6):380-383.
[21] Narita M, Tanaka H. Late increase of interleukin-18 levels in blood during Mycoplasma pneumoniae pneumonia[J]. Cytokine, 2012, 59(1):18-19.
[22] 陈莉莉, 刘金荣, 赵顺英, 等. 常规剂量甲泼尼龙治疗无效的儿童难治性肺炎支原体肺炎的临床特征和治疗探讨[J]. 中华儿科杂志, 2014, 52(3):172-176.
[23] Spuesens EB, Meyer Sauteur PM, Vink C, et al. Mycoplasma pneumoniae infections-does treatment help?[J]. J Infect, 2014, 69 Suppl 1:S42-S46.
[24] Narita M. Classification of extrapulmonary manifestations due to Mycoplasma pneumoniae Infection on the Basis of Possible Pathogenesis[J]. Front Microbiol, 2016, 7:23.
[25] Yang D, Chen L, Chen Z. The timing of azithromycin treatment is not associated with the clinical prognosis of childhood Mycoplasma pneumoniae pneumonia in high macrolide-resistant prevalence settings[J]. PLoS One, 2018, 13(1):e0191951.
[26] Luo Z, Luo J, Liu E, et al. Effects of prednisolone on refractory mycoplasma pneumoniae pneumonia in children[J]. Pediatr Pulmonol, 2014, 49(4):377-380.
[27] Lee KY, Lee HS, Hong JH, et al. Role of prednisolone treatment in severe Mycoplasma pneumoniae pneumonia in children[J]. Pediatr Pulmonol, 2006, 41(3):263-268.
[28] 王菲, 张晗, 王植嘉, 等. 难治性肺炎支原体肺炎支气管镜肺泡灌洗术治疗时机研究[J]. 中国实用儿科杂志, 2015, 30(11):855-858.
[29] 陈志敏. 合理治疗难治性肺炎支原体肺炎[J]. 中华儿科杂志, 2013, 51(10):724-728.
[30] Ahluwalia J, Wan J, Lee DH, et al. Mycoplasma-associated Stevens-johnson syndrome in children:retrospective review of patients managed with or without intravenous immunoglobulin, systemic corticosteroids, or a combination of therapies[J]. Pediatr Dermatol, 2014, 31(6):664-669.
