目的 分析23S rRNA V区A2063G基因突变肺炎支原体肺炎（mycoplasma pneumoniae pneumonia,MPP）患儿的临床特征,探索大环内酯类药物疗效的预测因素。方法 纳入194例该基因突变MPP住院患儿,根据对大环内酯类药物治疗反应分为大环内酯类无反应性肺炎支原体肺炎（macrolide-unresponsive MPP,MUMPP）组（137例）及大环内酯类有反应性肺炎支原体肺炎（macrolide-responsive MPP,MRMPP）组（57例）,比较两组临床资料及实验室数据。结果 MUMPP组热程、CRP（C-reactive protein,CRP）、LDH（lactate dehydrogenase,LDH）、NLR（neutrophil-to-lymphocyte ratio,NLR）及大叶实变与支气管镜下严重病变比例均高于MRMPP组,而大叶实变中存在充气支气管征的比例显著较低。Logistic回归显示,热程、CRP、NLR为MUMPP的独立危险因素,充气支气管征为其保护因素。ROC曲线分析表明,热程+CRP+NLR联合预测疗效的AUC为0.923（95%CI：0.862~0.956,P<0.005）。结论 热程、CRP与NLR联合指标对A2063G突变MPP患儿的大环内酯类药物疗效具有良好预测价值,有助于早期干预。
Abstract
Objective To analyze the clinical characteristics of children with Mycoplasma pneumoniae pneumonia (MPP) carrying the 23S rRNA V region A2063G mutation and to explore predictive factors for macrolide treatment efficacy. Methods A total of 194 hospitalized children with MPP harboring this mutation were enrolled. Based on their response to macrolide treatment, they were divided into a macrolide-unresponsive MPP (MUMPP) group (n=137) and a macrolide-responsive MPP (MRMPP) group (n=57). Clinical data and laboratory findings were compared between the two groups. Results Compared to the MRMPP group, the MUMPP group had significantly longer duration of fever, higher levels of C-reactive protein (CRP), lactate dehydrogenase (LDH), neutrophil-to-lymphocyte ratio (NLR), and higher incidences of lobar consolidation and severe bronchoscopic lesions (erosions, plastic bronchitis, mucus plugs). However, the presence of an air bronchogram within lobar consolidation was significantly less frequent in the MUMPP group. Logistic regression analysis identified duration of fever, CRP, and NLR as independent risk factors for MUMPP, while the presence of an air bronchogram was a protective factor. ROC curve analysis showed that the combination of fever duration, CRP, and NLR had an AUC of 0.923 (95% CI: 0.862-0.956, P<0.05) for predicting clinical efficacy. Conclusion The combination of fever duration, CRP, and NLR serves as a valuable predictor of macrolide treatment efficacy in children with A2063G-mutated MPP, facilitating early clinical intervention.
关键词
儿童 /
23S rRNA V区A2063G基因突变 /
肺炎支原体肺炎 /
大环内酯类药物无反应性 /
早期预测
Key words
children /
23S rRNA V region A2063G /
mycoplasma pneumoniae pneumonia /
macrolide-unresponsive /
early prediction
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基金
湖南省自然科学基金“中性粒细胞胞外陷阱在肺炎支原体所致黏液栓形成中的作用及机制研究”(2024JJ9152); 湖南省卫生健康委科研项目一般课题“IFN-λ1通过抑制NETs生成缓解肺炎支原体粘液栓形成及机制研究”（20253577）; 湖南省儿童呼吸疾病重点实验室项目（2019TP1043）; 芙蓉计划卫生健康高层次人才青年骨干人才项目（20260224-1007）
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