儿童肺炎支原体肺炎的耐大环内酯类药物情况及其与重症发生的临床特征和危险因素分析

Analysis of Macrocyclic Ester-Resistant Drugs for Mycoplasma pneumoniae in Children and Its Clinical Characteristics and Risk Factors in the Occurrence of Severe Cases

摘要: 目的：分析2024年1月1日至2024年2月29日间，在青岛大学附属医院儿童医学中心首次收治的儿童肺炎支原体肺炎(Mycoplasma pneumoniae pneumonia, MPP)患者中，重症肺炎支原体肺炎(severe Mycoplasma pneumoniae pneumonia, SMPP)的耐药情况，以及耐药SMPP的临床特征和相关危险因素。方法：本研究回顾性收集68例诊断为MPP的儿童患者的临床资料，分为重症组(SMPP)和非重症组(non-SMPP)。所有患者均进行MP DNA检测及耐药基因检测，采用Real-Time PCR法检测MP DNA，并对临床数据(如血液指标、影像学表现等)进行分析。统计学分析使用SPSS 27.0软件，采用t检验、卡方检验和多因素Logistic回归分析等方法。结果：重症组25例，占36.76%，非重症组43例，占63.24%。重症组患者住院天数、C反应蛋白(CRP)、乳酸脱氢酶(LDH)、D-二聚体及热程明显高于非重症组。多因素Logistic回归分析发现，CRP、LDH、D-二聚体和淋巴细胞计数是预测重症发生的独立危险因素。耐药组和非耐药组在临床特征上的差异不显著，耐药率未显著影响重症的发生(P > 0.05)。结论：CRP、LDH、D-二聚体和淋巴细胞计数是预测SMPP发生的独立危险因素，耐药性对临床特征影响较小，但MP耐药性在SMPP中的发生依然需要引起足够重视。进一步研究和监测MP的耐药情况，尤其在季节性流行期间，对于早期识别和治疗具有重要意义。

Abstract: Objective: To analyze from January 1, 2024 to February 29, 2024, among the patients with Mycoplasma pneumoniae pneumonia (MPP) who were first admitted to the Children’s Medical Centre of Qingdao University Affiliated Hospital, the severe cases Drug resistance of severe Mycoplasma pneumoniae pneumonia (SMPP), as well as the clinical characteristics and related risk factors of drug-resistant SMPP. Methods: This study retrospectively collected the clinical data of 68 paediatric patients diagnosed with MPP, which was divided into severe group (SMPP) and non-SMPP. All patients undergo MP DNA testing and drug resistance gene testing, use Real-Time PCR to detect MP DNA, and analyse clinical data (such as blood indicators, imaging performance, etc.). Statistical analysis uses SPSS 27.0 software, and adopts methods such as t-test, card square test and multi-factor Logistic regression analysis. Results: 25 cases in the severe group, accounting for 36.76%, and 43 cases in the non-severe group, accounting for 63.24%. The number of days of hospitalisation, C-reactive protein (CRP), dehydrogenase of lactate (LDH), D-dimer and heat range of patients in the critically ill group were significantly higher than those in the non-critically ill group. Multifactorial Logistic regression analysis found that CRP, LDH, D-dimer and lymphocyte counts are independent risk factors for predicting the occurrence of severe illness. The difference in clinical characteristics between the drug-resistant group and the non-drug-resistant group was not significant, and the drug resistance rate did not significantly affect the occurrence of severe illness (P > 0.05). Conclusion: CRP, LDH, D-dimer and lymphocyte counts are independent risk factors for predicting the occurrence of SMPP. Drug resistance has little impact on clinical characteristics, but the occurrence of MP resistance in SMPP still needs to be given sufficient attention. Further research and monitoring of MP’s drug resistance, especially during seasonal epidemics, is important for early identification and treatment.