不同23S rRNA基因型肺炎支原体感染患儿的临床特征与预后比较

Comparison of clinical characteristics and prognosis in children with Mycoplasma pneumoniae infection harboring different 23S rRNA genotypes

摘要

目的 系统比较不同23S rRNA基因型肺炎支原体感染患儿的临床特征、实验室指标、治疗反应及预后差异,为临床精准诊疗提供依据。方法 采用回顾性队列研究,选取2024年6月—2025年5月在河南中医药大学第五临床医学院（郑州人民医院）就诊并经核酸检测确诊为肺炎支原体感染的患儿131例。对呼吸道标本23S rRNA V区进行测序以明确基因型,并收集人口学特征、发热时长、住院时长、肺部影像学表现、炎症指标、治疗用药及预后资料。依据基因型将患儿分组比较,并采用多因素Logistic回归分析预后不良的独立危险因素。结果 在131例入组患儿中,共检测到大环内酯类耐药相关突变89例,其中A2063G突变组（G1组）75例,A2064G突变组（G2组）10例,A2063G+A2064G双突变组（D组）4例,大环内酯类抗生素敏感组（S组）42例。与S组及G2组相比,G1组的发热持续时间显著延长,住院时间也明显增加（均P<0.05）;炎症指标方面,G1组中性粒细胞比例、血清淀粉样蛋白A（serum amyloid A,SAA）、C反应蛋白（C-reactive protein,CRP）、乳酸脱氢酶（lactate dehydrogenase,LDH）、降钙素原（procalcitonin,PCT）、红细胞沉降率（erythrocyte sedimentation rate,ESR）及免疫球蛋白E（immunoglobulin E,IgE）水平均显著高于S组（均P<0.05）,且G1组中性粒细胞比例（P=0.031）、SAA（P=0.008）、CRP（P=0.014）及ESR（P=0.002）水平均显著高于G2组。耐药突变组（R组,G1+G2组）与S组相比,发热发生率更高,发热持续时间及住院时间更长;中性粒细胞比例、SAA、CRP、LDH、PCT、ESR及IgE水平均显著升高,初始治疗失败率及二线药物使用率亦显著增加（均P<0.05）。治疗方面,G1组大环内酯类抗生素初始治疗失败率显著高于S组和G2组,其二线药物使用率（86.67% vs. 57.14%）显著高于S组（P<0.001）,预后良好率更低。4例双突变组均表现出严重的临床症状和初始治疗失败。多因素Logistic回归分析显示,A2063G突变是预后不良的独立危险因素（OR=2.127,95%CI：1.242~3.644,P=0.006）。结论 A2063G突变与儿童肺炎支原体感染更严重的临床表现、更强的炎症反应、更差的初始治疗反应及不良预后密切相关。临床检测中区分具体突变位点,尤其是A2063G突变,对评估病情和指导治疗具有重要价值。

Abstract

Objective To systematically compare the clinical characteristics, laboratory parameters, treatment responses, and prognostic outcomes among children with Mycoplasma pneumoniae （MP） infection harboring different 23S rRNA genotypes, and to provide evidence for precision diagnosis and treatment. Methods This retrospective cohort study included 131 children diagnosed with MP infection by nucleic acid testing at Zhengzhou People′s Hospital between June 2024 and May 2025. The V region of 23S rRNA in respiratory specimens was sequenced to determine genotypes. Demographic characteristics, duration of fever, length of hospital stay, pulmonary imaging findings, inflammatory markers, treatment regimens, and prognostic data were collected. Patients were grouped according to genotype for comparative analysis, and multivariable logistic regression was used to identify independent risk factors for poor prognosis. Results Among the 131 enrolled children, 89 macrolide-resistance mutations were detected, including 75 patients with the A2063G mutation （group G1）, 10 patients with the A2064G mutation （group G2）, 4 patients with the combined A2063G+A2064G mutation （group D）, and 42 patients infected with macrolide-sensitive strains （group S）. Compared with groups S and G2, children in group G1 had a significantly longer duration of fever and a longer hospital stay （both P<0.05）. Regarding inflammatory markers, neutrophil percentage （NEUT%）, serum amyloid A （SAA）, C-reactive protein （CRP）, lactate dehydrogenase （LDH）, procalcitonin （PCT）, erythrocyte sedimentation rate （ESR）, and immunoglobulin E （IgE） levels were all significantly higher in group G1 than in group S （all P<0.05）. In addition, NEUT% （P=0.031）, SAA （P=0.008）, CRP （P=0.014）, and ESR （P=0.002） were significantly higher in group G1 than in group G2. Compared with group S, group D showed a higher incidence of fever, longer fever duration and hospital stay, significantly elevated NEUT%, SAA, CRP, LDH, PCT, ESR, and IgE levels, and significantly higher rates of initial treatment failure and second-line antibiotic use rate （all P<0.05）. In terms of treatment, the initial macrolide treatment failure rate was significantly higher in group G1 than in groups S and G2, and the second-line antibiotic use rate was significantly higher in group G1 than in group S （86.67% vs. 57.14%, P<0.001）, with a lower rate of favorable prognosis. All four children with dual mutations presented with severe clinical manifestations and initial treatment failure. Multivariable logistic regression analysis showed that the A2063G mutation was an independent risk factor for poor prognosis （OR=2.127, 95%CI： 1.242―3.644, P=0.006）. Conclusion The A2063G mutation is closely associated with more severe clinical manifestations, stronger inflammatory responses, poorer initial treatment response, and unfavorable prognosis in children with MP infection. Distinguishing specific mutation sites, particularly the A2063G mutation, is of important clinical value for disease assessment and treatment guidance.

关键词

肺炎支原体 / 儿童 / 大环内酯类 / 23S rRNA

Key words

Mycoplasma pneumoniae / children / macrolides / 23S rRNA