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目的分析肺炎支原体(MP)感染患儿对大环内酯类药物(ML)的耐药率以及发病期血清炎症指标白细胞计数(WBC)、C-反应蛋白(CRP)和血沉(ESR)的表达与临床意义。方法纳入2015年11月-2016年12月在该院小儿科住院,经荧光定量PCR法确诊的5岁以下MP感染患儿250例,同时对其抗大环内酯类抗生素耐药突变位点进行定性检测,分为耐药组与非耐药组,计算ML耐药率。患儿入院时抽血检测血WBC、ESR、CRP水平,并比较两组患儿入院前应用ML情况、病程、治疗反应、并发症发生率、炎症因子WBC、ESR和CRP表达有无差异。结果 250例MP患儿中,140例存在MP DNA 23S rRNA2063(A∶G)和2064(A∶G)点突变,即耐药基因阳性(耐药组),耐药率为45.0%。耐药组患儿平均热程长于非耐药组;肺不张发生率高于非耐药组;入院时WBC、CRP异常发生率高于非耐药组(P<0.05);两组患儿性别、年龄、咳嗽持续时间、肺不张发生率、总住院时间、住院前是否应用ML、住院期间ML使用天数及预后比较,差异均无统计学意义(均P>0.05)。结论该院5岁以下患儿MP的耐药发生率高,耐药患儿炎症指标WBC、CRP可有不同程度的表达升高,但并非接受ML治疗后疗效及预后的主要影响因素。
Objective To analyze the drug resistance rate of macrolide (ML) and the expression of serum inflammatory markers WBC, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) in children with Mycoplasma pneumoniae infection And clinical significance. Methods Two hundred and fifty children with MP infection under 5 years of age who were hospitalized in pediatrics department from November 2015 to December 2016 in our hospital were included in the study. Fluorescent quantitative polymerase chain reaction (PCR) was used to determine the resistance to macrolide antibiotic resistance in 250 children with MP infection. Qualitative detection, divided into drug-resistant group and non-drug-resistant group, calculated ML drug resistance. WBC, ESR and CRP levels in children with blood were collected during admission. The application of ML, course of disease, treatment response, incidence of complications, WBC, ESR and CRP expression in both groups were compared. Results Among 250 cases of MP, 140 cases had MP DNA 23S rRNA2063 (A:G) and 2064 (A:G) point mutations, ie, the resistance gene was positive (resistance group). The resistance rate was 45.0%. The average heat history of drug-resistant children was longer than that of non-drug-resistant children. The incidence of atelectasis was higher than that of non-drug-resistant children. The incidence of abnormal WBC and CRP was higher in admission-resistant children than in non-drug-resistant children (P <0.05) Gender, age, duration of cough, incidence of atelectasis, total length of hospital stay, ML before hospitalization, days of hospitalization using ML and prognosis were not significantly different (all P> 0.05). Conclusion The prevalence of MP in children under 5 years of age in this hospital is high. However, WBC and CRP in infants with drug resistance may have different levels of expression. However, they are not the main factors that influence the efficacy and prognosis of ML patients.