中国生化药物杂志
中國生化藥物雜誌
중국생화약물잡지
CHINESE JOURNAL OF BIOCHEMICAL PHARMACEUTICS
2014年
3期
84-87,90
,共5页
大环内酯类抗生素%二甲胺四环素%妥舒沙星%大环内酯类抗药性儿童肺炎支原体肺炎%疗效%抑菌效果
大環內酯類抗生素%二甲胺四環素%妥舒沙星%大環內酯類抗藥性兒童肺炎支原體肺炎%療效%抑菌效果
대배내지류항생소%이갑알사배소%타서사성%대배내지류항약성인동폐염지원체폐염%료효%억균효과
macrolides%minocycline%tofufloxacin%macrolide-resistant mycoplasma pneumonia pneumonia%treatment efficacy%antimicrobial efficacy
目的：观察3种不同抗生素-大环内酯类、二甲胺四环素、妥舒沙星-对大环内酯类抗药性肺炎支原体肺炎（macrolide-resistant Mycoplasma pneumoniae，MRMP）的疗效。方法选取海南省第三人民医院收治的188例确诊为肺炎支原体肺炎（mycoplasma pneumoniae，MP）患儿为研究对象。PCR检测患儿是否有大环内脂耐药基因，对检测为MRMR的患儿分成4组，分别采用阿奇霉素、克拉霉素、妥舒沙星、二甲胺四环素4种药物进行治疗，观察各组退热情况。将检测结果中显示为大环内酯类敏感性肺炎支原体肺炎（macrolide-sensitive mycoplasma pneumoniae，MSMP）的患儿分为阿奇霉素组与克拉霉素组，观察MRMP与MSMP在相同治疗方法下的疗效差异。结果共检测出150例MRMR患儿，其中134例为23S rRNA 2063位点A→G突变；38例MSMP患儿。MRMR患儿4组4抗生素治疗后8 h退热患儿比例分别为阿奇霉素41％，克拉霉素48％，妥舒沙星69％，二甲胺四环素87％。其中两大环内酯类抗生素组（阿奇霉素组、克拉霉素组）用药后平均发热天数明显多于妥舒沙星组和二甲胺四环素组（P＜0.01）。通过DNA拷贝数测算，发现经过48～96小时治疗，二甲胺四环素组患者肺炎支原体下降明显（P＝0.016）高于妥舒沙星组（P＝0.049）、阿奇霉素组（P＝0.273）、克拉霉素组（P＝0.107）。结论大环内酯类抗生素对MRMP的抑菌及治疗作用不强。对于年龄≥8岁的MRMP患儿，适合选用二甲胺四环素作为治疗药物。
目的：觀察3種不同抗生素-大環內酯類、二甲胺四環素、妥舒沙星-對大環內酯類抗藥性肺炎支原體肺炎（macrolide-resistant Mycoplasma pneumoniae，MRMP）的療效。方法選取海南省第三人民醫院收治的188例確診為肺炎支原體肺炎（mycoplasma pneumoniae，MP）患兒為研究對象。PCR檢測患兒是否有大環內脂耐藥基因，對檢測為MRMR的患兒分成4組，分彆採用阿奇黴素、剋拉黴素、妥舒沙星、二甲胺四環素4種藥物進行治療，觀察各組退熱情況。將檢測結果中顯示為大環內酯類敏感性肺炎支原體肺炎（macrolide-sensitive mycoplasma pneumoniae，MSMP）的患兒分為阿奇黴素組與剋拉黴素組，觀察MRMP與MSMP在相同治療方法下的療效差異。結果共檢測齣150例MRMR患兒，其中134例為23S rRNA 2063位點A→G突變；38例MSMP患兒。MRMR患兒4組4抗生素治療後8 h退熱患兒比例分彆為阿奇黴素41％，剋拉黴素48％，妥舒沙星69％，二甲胺四環素87％。其中兩大環內酯類抗生素組（阿奇黴素組、剋拉黴素組）用藥後平均髮熱天數明顯多于妥舒沙星組和二甲胺四環素組（P＜0.01）。通過DNA拷貝數測算，髮現經過48～96小時治療，二甲胺四環素組患者肺炎支原體下降明顯（P＝0.016）高于妥舒沙星組（P＝0.049）、阿奇黴素組（P＝0.273）、剋拉黴素組（P＝0.107）。結論大環內酯類抗生素對MRMP的抑菌及治療作用不彊。對于年齡≥8歲的MRMP患兒，適閤選用二甲胺四環素作為治療藥物。
목적：관찰3충불동항생소-대배내지류、이갑알사배소、타서사성-대대배내지류항약성폐염지원체폐염（macrolide-resistant Mycoplasma pneumoniae，MRMP）적료효。방법선취해남성제삼인민의원수치적188례학진위폐염지원체폐염（mycoplasma pneumoniae，MP）환인위연구대상。PCR검측환인시부유대배내지내약기인，대검측위MRMR적환인분성4조，분별채용아기매소、극랍매소、타서사성、이갑알사배소4충약물진행치료，관찰각조퇴열정황。장검측결과중현시위대배내지류민감성폐염지원체폐염（macrolide-sensitive mycoplasma pneumoniae，MSMP）적환인분위아기매소조여극랍매소조，관찰MRMP여MSMP재상동치료방법하적료효차이。결과공검측출150례MRMR환인，기중134례위23S rRNA 2063위점A→G돌변；38례MSMP환인。MRMR환인4조4항생소치료후8 h퇴열환인비례분별위아기매소41％，극랍매소48％，타서사성69％，이갑알사배소87％。기중량대배내지류항생소조（아기매소조、극랍매소조）용약후평균발열천수명현다우타서사성조화이갑알사배소조（P＜0.01）。통과DNA고패수측산，발현경과48～96소시치료，이갑알사배소조환자폐염지원체하강명현（P＝0.016）고우타서사성조（P＝0.049）、아기매소조（P＝0.273）、극랍매소조（P＝0.107）。결론대배내지류항생소대MRMP적억균급치료작용불강。대우년령≥8세적MRMP환인，괄합선용이갑알사배소작위치료약물。
Objective To observe the differences in the therapeutic efficacies of macrolides,minocycline,and tosufloxacin against macrolide-resistant Mycoplasma pneumoniae(MRMP).Methods A total of 188 children with M.pneumoniae pneumonia confirmed by culture and PCR were analyzed.Of these,150 patients had a strain with an MR gene and 134 had one with an A-to-G mutation at position 2063 of M.pneumoniae 23S rRNA domain V.Azithromycin(n=27),clarithromycin(n=23),tosufloxacin(n=62),or minocycline(n=38)was used for definitive treatment of patients with MR M.pneumoniae.Among the 188 patients,the other 38 patients with macrolide-sensitive Mycoplasma pneumonia (MSMP)were grouped into azithromycin(n =16)and clarithromycin groups(n =22)for observing whether there is differences with respect to efficacy under parallel treatment between patients with MRMP and MSMP. Results Defervescence within 48 h after the initiation of antibiotic therapy was observed in 41%of the patients in the azithromycin group,48% of those in the clarithromycin group,69% of those in the tosufloxacin group,and 87% of those in the minocycline group.The average number of days of fever after the administration of antibiotic treatment was lower in the minocycline and tosufloxacin groups than in the macrolide groups(azithromycin and clarithromycin groups).The decrease in the M.pneumoniae burden,as estimated by the number of DNA copies,after 48 to 96 h of treatment was more rapid in patients receiving minocycline(P=0.016)than in those receiving tosufloxacin(P=0.049),azithromycin(P=0.273),or clarithromycin(P=0.107).Conclusion We found that the clinical and bacteriological efficacies of macrolides against MR M.pneumoniae pneumonia was low.Our results indicated that minocycline rather than tosufloxacin can be considered the first-choice drug for the treatment of M.pneumoniae pneumonia in children aged >8 years.
