台州地区儿童肺炎支原体感染及23S rRNA突变情况的多中心调查
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摘要
目的了解台州地区儿童急性呼吸道感染中肺炎支原体(MP)的感染情况及其对大环内酯类药物耐药情况。方法在台州市第一人民医院、台州医院、温岭市第一人民医院和玉环人民医院4家医院儿科2016年1月～2017年12月进行多中心调查,共收集4395例0～14岁急性呼吸道感染患儿的呼吸道标本,采用Real-time PCR法检测MP阳性率及耐药基因(23S rRNA)的突变情况,并对临床资料进行统计分析。结果 Real-time PCR结果显示,在4395例急性呼吸道感染患儿中,MP感染742例,感染率为16.88%,其中有422例23S rRNA突变,突变率为56.87%。不同季节MP感染率比较,差异有统计学意义(P <0.05),夏季最高为23.56%;不同年龄组间MP感染率比较,差异有统计学意义(P <0.05),且随着年龄的增长而升高;不同性别患儿MP阳性率比较,差异无统计学意义(P> 0.05);不同季节、不同性别患儿23S rRNA突变率比较差异无统计学意义(P> 0.05);不同年龄患儿23S r RNA突变率比较,差异有统计学意义(P <0.05)。结论多中心联合研究结果显示,MP感染可能与气候、年龄相关,MP感染夏季多发,大龄儿童多见,同时,MP对大环内酯类药物的耐药率较高。
Objective To know about the infection conditions of Mycoplasma pneumonia(MP) and conditions of drug resistance to macrolides of children with acute respiratory infection in Taizhou region. Methods Through multicenter investigation of pediatric departments in the 4 hospitals of Taizhou First People′s Hospital, Taizhou Hospital of Zhejiang Province, the First People′s Hospital of Wenling and the People′s Hospital of Yuhuan, the respiratory tract samples of 4395 cases of children with acute respiratory infection were collected from January 2016 to December 2017. Real-time PCR was used to detect the positive rates of MP and the mutations of its drug resistance gene(23 S rRNA).Then the clinical data was analyzed. Results The results of Real-time PCR showed that among 4395 children with acute respiratory infection, 742 cases were MP positive, the infection rate was 16.88%, among whom, there were 422 cases of mutation of 23 S r RNA, the mutation rate was 56.87%. There was statistically significant difference of the positive rates of MP among different seasons(P < 0.05), among which, summer(23.56%) was the highest. There was statistically significant difference in the positive rates of MP among different age groups(P < 0.05), and it increased with age. There was no significant difference in infection rate of MP between children of different sexes(P > 0.05); there was no significant difference in mutation rate of 23 S rRNA among children of different seasons and sexes(P> 0.05); and there was statistically significant difference in mutation rate of 23 S r RNA among children of different ages(P < 0.05). Conclusion This multicenter combining research shows that MP infection may have correlation with climate and age. MP infection is more common in summer and older children. At the same time, MP has higher drug resistance rates for macrolides.
Objective To know about the infection conditions of Mycoplasma pneumonia(MP) and conditions of drug resistance to macrolides of children with acute respiratory infection in Taizhou region. Methods Through multicenter investigation of pediatric departments in the 4 hospitals of Taizhou First People′s Hospital, Taizhou Hospital of Zhejiang Province, the First People′s Hospital of Wenling and the People′s Hospital of Yuhuan, the respiratory tract samples of 4395 cases of children with acute respiratory infection were collected from January 2016 to December 2017. Real-time PCR was used to detect the positive rates of MP and the mutations of its drug resistance gene(23 S rRNA).Then the clinical data was analyzed. Results The results of Real-time PCR showed that among 4395 children with acute respiratory infection, 742 cases were MP positive, the infection rate was 16.88%, among whom, there were 422 cases of mutation of 23 S r RNA, the mutation rate was 56.87%. There was statistically significant difference of the positive rates of MP among different seasons(P < 0.05), among which, summer(23.56%) was the highest. There was statistically significant difference in the positive rates of MP among different age groups(P < 0.05), and it increased with age. There was no significant difference in infection rate of MP between children of different sexes(P > 0.05); there was no significant difference in mutation rate of 23 S rRNA among children of different seasons and sexes(P> 0.05); and there was statistically significant difference in mutation rate of 23 S r RNA among children of different ages(P < 0.05). Conclusion This multicenter combining research shows that MP infection may have correlation with climate and age. MP infection is more common in summer and older children. At the same time, MP has higher drug resistance rates for macrolides.
引文
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[12]魏升云,汤淑斌,李武军,等.宝鸡地区小儿急性下呼吸道感染病毒和肺炎支原体病原学的多中心研究分析[J].中国儿童保健杂志,2012,20(6):550-552.
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[14]张淑艳,刘杰,赵满仓.北京地区儿童肺炎支原体感染的流行病学分析[J].标记免疫分析与临床,2015,22(7):620-623.
[15]张新星,季伟,顾文婧,等.2005年至2014年苏州地区儿童呼吸道肺炎支原体感染流行病学分析[J].中华传染病杂志,2015,33(10):594-598.
[16]黄海樱,陈波,周强.广州地区肺炎支原体感染儿童血清流行病学调查分析[J].中国儿童保健杂志,2014,22(1):83-85.
[17]Kong LC,Gao D,Jia BY,et al.Antimicrobial susceptibility and molecular characterization of macrolide resistance ofMycoplasma bovisisolates from multiple provinces in China[J].J Vet Med Sci,2016,78(2):293-296.
[18]王翠玲,杨丽君.44例儿童难治性肺炎支原体肺炎的并发症及胸部CT特点[J].中国现代医生,2018,56(18):12-15.
[19]陈玲,覃军,胡荆江.儿童肺炎支原体突变体对大环内酯类药物耐药的研究[J].国际呼吸杂志,2015,35(19):1465-1467.
[20]王良玉,辛德莉.肺炎支原体感染实验室诊断的研究进展[J].传染病信息,2017,30(1):51-55.
[21]王文,吴小军.大环内酯类抗生素在慢性气道炎症疾病治疗中的进展[J].临床肺科杂志,2016,21(7):1338-1341.
[22]高璐,洪倩,许英,等.阿奇霉素两种给药方案治疗小儿支原体肺炎的疗效及经济学评价[J].中国医院用药评价与分析,2018,18(4):458-460.
[23]赵贺华,杨丽君.儿童重症肺炎支原体肺炎40例临床分析[J].中国现代医生,2018,56(16):47-49.
[24]姚凤莉,常凤媛,于雅彬,等.肺炎支原体的耐药状况及中医药研究进展[J].国际儿科学杂志,2011,38(2):191-194.
[2]牛波,池跃朋,帅金凤,等.儿童难治性肺炎支原体肺炎免疫机制探讨[J].中国医药导报,2016,13(6):107-110.
[3]林艳,马微,李桂艳,等.医院儿童肺炎支原体的耐药性变迁分析[J].中国病原生物学杂志,2017,12(6):570-573.
[4]吕建海,唐兰芳.儿童肺炎支原体肺炎临床特征分析[J].浙江预防医学,2016,28(3):310-312.
[5]Morozumi M,Okada T,Tajima T,et al.Killing kinetics of minocycline,doxycycline and tosufloxacin against macrolideresistant Mycoplasma pneumoniae[J].Int J Antimicrob A-gents,2017,50(2):255-257.
[6]潘芬,张泓.肺炎支原体耐药性及分子流行病学研究进展[J].上海交通大学学报:医学版,2014,34(8):1248-1253.
[7]骆文龙,杨雨.肺炎支原体大环内酯类药物耐药机制研究[J].中国卫生检验杂志,2018,28(12):1457-1459.
[8]胡亚美.诸福棠实用儿科学[M].7版.北京:人民卫生出版社,2005:42-45.
[9]杨一华,张艺,黄先玫,等.儿童大环内酯类抗生素耐药肺炎支原体肺炎的临床分析[J].中华全科医学,2018,16(3):434-436.
[10]阳爱梅,宋建辉,黄榕,等.1026例儿童肺炎支原体感染及耐药情况分析[J].中国当代儿科杂志,2013,15(7):522-525.
[11]骆文龙,杨雨,韩徐芳,等.富阳区儿童肺炎支原体感染及耐药分析[J].预防医学,2018,30(3):257-259.
[12]魏升云,汤淑斌,李武军,等.宝鸡地区小儿急性下呼吸道感染病毒和肺炎支原体病原学的多中心研究分析[J].中国儿童保健杂志,2012,20(6):550-552.
[13]陈正荣,严永东.小儿肺炎支原体感染流行病学特征[J].中国实用儿科杂志,2015,30(3):180-183.
[14]张淑艳,刘杰,赵满仓.北京地区儿童肺炎支原体感染的流行病学分析[J].标记免疫分析与临床,2015,22(7):620-623.
[15]张新星,季伟,顾文婧,等.2005年至2014年苏州地区儿童呼吸道肺炎支原体感染流行病学分析[J].中华传染病杂志,2015,33(10):594-598.
[16]黄海樱,陈波,周强.广州地区肺炎支原体感染儿童血清流行病学调查分析[J].中国儿童保健杂志,2014,22(1):83-85.
[17]Kong LC,Gao D,Jia BY,et al.Antimicrobial susceptibility and molecular characterization of macrolide resistance ofMycoplasma bovisisolates from multiple provinces in China[J].J Vet Med Sci,2016,78(2):293-296.
[18]王翠玲,杨丽君.44例儿童难治性肺炎支原体肺炎的并发症及胸部CT特点[J].中国现代医生,2018,56(18):12-15.
[19]陈玲,覃军,胡荆江.儿童肺炎支原体突变体对大环内酯类药物耐药的研究[J].国际呼吸杂志,2015,35(19):1465-1467.
[20]王良玉,辛德莉.肺炎支原体感染实验室诊断的研究进展[J].传染病信息,2017,30(1):51-55.
[21]王文,吴小军.大环内酯类抗生素在慢性气道炎症疾病治疗中的进展[J].临床肺科杂志,2016,21(7):1338-1341.
[22]高璐,洪倩,许英,等.阿奇霉素两种给药方案治疗小儿支原体肺炎的疗效及经济学评价[J].中国医院用药评价与分析,2018,18(4):458-460.
[23]赵贺华,杨丽君.儿童重症肺炎支原体肺炎40例临床分析[J].中国现代医生,2018,56(16):47-49.
[24]姚凤莉,常凤媛,于雅彬,等.肺炎支原体的耐药状况及中医药研究进展[J].国际儿科学杂志,2011,38(2):191-194.