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目的探讨MP 23S rRNA耐药基因2 063位点阳性的MPP患儿临床特征及BALF中IL-8表达。方法回顾性分析2014年2月-2016年2月住院MPP患儿170例,根据BALF中MP 23S rRNA耐药基因2 063位点分为阳性和阴性组各85例,比较两组临床症状和体征、并发症、影像学及实验室检查。结果耐药基因阳性组与耐药基因阴性组咳嗽、发热、气促、寒战比较,差异无统计学意义(P>0.05),而呼吸音减弱比较,耐药基因阳性组显著多于耐药基因阴性组,差异有统计学意义(χ~2=11.56,P<0.01)。耐药基因阳性组肺不张、胸腔积液、肺实变低于耐药基因阴性组,差异均有统计学意义(χ~2值分别为23.80、12.24、8.84,P<0.01);支气管镜下表现比较,耐药基因阳性组痰栓多于耐药基因阴性组,差异有统计学意义(χ~2=7.65,P<0.01)。MPP患儿BALF IL-8水平比较,耐药基因阳性组高于耐药基因阴性组,差异有统计学意义(t=6.70,P<0.01)。结论肺部呼吸音减低、肺外并发症、肺部影像学及BALF中性粒细胞比例和IL-8水平升高对早期识别MPP对大环内酯类药物耐药具有一定参考价值。
Objective To investigate the clinical features of MPP in children with MP 23S rRNA gene resistance at locus 2 063 and the expression of IL-8 in BALF. Methods A retrospective analysis of 170 hospitalized children with MPP between February 2014 and February 2016 was performed. According to the MRP-23S rRNA gene 2 063 locus in BALF, 85 cases were divided into positive and negative groups. The clinical symptoms and signs Complications, imaging and laboratory tests. Results There was no significant difference in cough, fever, shortness of breath and cold between the positive drug resistance group and the negative drug resistance group (P> 0.05). However, in the negative respiratory group, the resistance gene positive group was significantly more than the drug resistance gene positive group Negative group, the difference was statistically significant (χ ~ 2 = 11.56, P <0.01). The positive rates of atelectasis, pleural effusion and lung consolidation were lower in drug-resistant gene group than in drug-resistant gene group (χ ~ 2 = 23.80,12.24,8.84, P <0.01, respectively); bronchoscopy The results showed that there were more sputum suppositories than drug-resistant gene negative group (χ ~ 2 = 7.65, P <0.01). The level of BALF IL-8 in MPP children was higher than that in drug-resistant group (P <0.01), the difference was statistically significant (t = 6.70, P <0.01). Conclusions The reduction of pulmonary breath sounds, extrapulmonary complication, pulmonary imaging and the increase of BALF neutrophil ratio and IL-8 level may be useful for early identification of MPP resistance to macrolides.