肺炎支原体肺炎患儿并发感染的病原菌分布耐药性分析及血清Gas6 PGE2检测的临床意义

doi:10.3969/j.issn.1006-6233.2026.01.013

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摘要 目的: 探究肺炎支原体肺炎(MPP)患儿并发感染的病原菌分布、分析其耐药性及检测血清生长停滞特异性蛋白6(Gas6)、前列腺素E2(PGE2)水平的临床意义。方法: 选取2021年4月至2024年5月收治的214例MPP并发细菌感染患儿作为感染组,同期选择210例单纯MPP患儿作为MPP组。对MPP并发细菌感染患儿的病原菌进行培养鉴定及耐药性检验,收集两组患儿一般资料,采用凝固法检测凝血功能指标,采用酶联免疫吸附法(ELISA)检测免疫功能指标、炎症因子及血清Gas6、PGE2水平,采用多因素Logistic回归分析MPP患儿并发细菌感染的影响因素,采用受试者工作特征曲线(ROC)分析血清Gas6、PGE2水平对MPP患儿并发细菌感染的诊断价值。结果: 214例MPP并发细菌感染患儿共计分离出231株病原菌,其中革兰阴性菌占比最多,MPP并发细菌感染患儿对红霉素、阿奇霉素、克拉霉素、罗红霉素及螺旋霉素耐药性较高,感染组的凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、免疫球蛋白M(IgM),免疫球蛋白G(IgG),免疫球蛋白A(IgA)水平低于MPP组,纤维蛋白原(FIB)、超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、白细胞介素-1β(IL-1β)、Gas6及PGE2水平高于MPP组(P<0.05),hs-CRP、IL-6、IL-1β、Gas6及PGE2水平是MPP患儿并发细菌感染的影响因素(P<0.05),血清Gas6、PGE2水平诊断MPP患儿并发细菌感染的AUC高于血清Gas6水平单独诊断的AUC(Z=6.814,P<0.001),高于血清PGE2水平单独诊断的AUC(Z=7.222,P<0.001)。结论: MPP并发细菌感染患儿病原菌主要为革兰阴性菌,对多种抗菌药物耐药性较高,血清Gas6、PGE2水平升高,二者联合检测对MPP并发细菌感染的诊断价值较高。

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关键词 ：肺炎支原体肺炎并发细菌感染, 病原菌分布, 耐药性, 生长停滞特异性蛋白6, 前列腺素E2

Abstract：Objective: To investigate the distribution of pathogens in children with Mycoplasma pneumoniae pneumonia (MPP) complications, to analyze their antimicrobial resistance, and to evaluate the clinical significance of detecting serum levels of growth arrest-specific protein 6 (Gas6) and prostaglandin E2 (PGE2).Methods: A total of 214 children with MPP complicated with bacterial infection admitted from April 2021 to May 2024 were selected as the infection group, while 210 children with simple MPP were selected as the MPP group during the same period. The pathogenic bacteria of children with MPP complicated with bacterial infection were cultured and identified, and were tested for drug resistance. General information of children in two groups was collected. The coagulation method was applied to detect coagulation function indicators. Enzyme linked immunosorbent assay (ELISA) was applied to detect immune function indicators, inflammatory factors, and serum levels of Gas6 and PGE2. Multivariate logistic regression was applied to analyze the influencing factors of concurrent bacterial infections in children with MPP. Receiver operating characteristic curve (ROC) was applied to analyze the diagnostic value of serum Gas6 and PGE2 levels for secondary bacterial infections in children with MPP. Results: A total of 231 strains of pathogenic bacteria were isolated from 214 children with MPP-complicated bacterial infections, with Gram negative bacteria accounting for the highest proportion. Children with MPP-complicated bacterial infections were more resistant to erythromycin, azithromycin, clarithromycin, roxithromycin, and spiramycin. The prothrombin time (PT), activated partial thromboplastin time (APTT), levels of immunoglobulin M (IgM), immunoglobulin G (IgG), and immunoglobulin A (IgA) in the infected group were lower than those in the MPP group, the levels of fibrinogen (FIB), hypersensitive C-reactive protein (hs-CRP), interleukin-6 (IL-6), interleukin-1β (IL-1β), Gas6, and PGE2 were higher than those in the MPP group (P<0.05). The levels of hs-CRP, IL-6, IL-1β, Gas6, and PGE2 were influencing factors in children with MPP with secondary bacterial infections (P<0.05). The combination of serum Gas6 and PGE2 levels for diagnosing secondary bacterial infections in children with MPP had a higher AUC than the serum Gas6 level alone (Z=6.814, P<0.001), and serum PGE2 level alone (Z=7.222, P<0.001). Conclusion: The pathogenic bacteria in children with MPP complicating bacterial infection are mainly gram-negative bacteria, which have high resistance to multiple antibiotics, serum Gas6 and PGE2 levels are elevated. The combination of the two has high diagnostic value for MPP complicating bacterial infection.

Key words： Mycoplasma pneumoniae pneumonia complicated by bacterial infection Distribution of pathogenic bacteria Drug resistance Growth arrest specific protein 6 Prostaglandin E2

基金资助:重庆市科卫联合医学科研项目,(编号:2023MSXM042)

通讯作者: 文义

引用本文:

刘西平, 文义. 肺炎支原体肺炎患儿并发感染的病原菌分布耐药性分析及血清Gas6 PGE2检测的临床意义[J]. 河北医学, 2026, 32(1): 79-85.
LIU Xiping, WEN Yi. Analysis of Pathogenic Bacteria Distribution and Drug Resistance in Children with Mycoplasma Pneumoniae Pneumonia Complicated by Secondary Infections and Clinical Significance of Serum Gas6 and PGE2 Assays. HeBei Med, 2026, 32(1): 79-85.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2026.01.013 或 http://www.hbyxzzs.cn/CN/Y2026/V32/I1/79

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