目的 分析8岁前后儿童肺炎支原体肺炎(MPP)的临床特征、病原学构成及治疗策略差异,为分龄个体化诊疗提供参考。方法 回顾性分析2023-11至2024-04北京市海淀医院儿科收治的经靶向二代测序(tNGS)确诊的167例MPP住院患儿的资料,按年龄分为<8岁组(n=71例)和≥8岁组(n=96例),比较两组临床表现、实验室指标、病原学特征及治疗方案的差异。结果 两组大环内酯类耐药肺炎支原体检出率均超过88%,组间差异无统计学意义(P=0.702)。<8岁组难治性MPP发生率39.4%,高于≥8岁组的20.8%,差异有统计学意义(P=0.014);<8岁组合并病毒感染率27%,高于≥8岁组的16.7%,差异有统计学意义(P=0.003)。≥8岁组C反应蛋白、D-二聚体水平高于<8岁组,差异有统计学意义(P<0.05),而<8岁组乳酸脱氢酶水平高于≥8岁组,差异有统计学意义(P=0.009)。≥8岁组多西环素/米诺环素使用率为79.2%,高于<8岁组的33.8%,差异有统计学意义(P<0.001)。结论 2023-2024年流行期儿童MPP以大环内酯类高耐药率为核心特征,且该特征不存在年龄组间显著差异。<8岁儿童更易出现难治性病程及病毒混合感染,应强化早期检测,≥8岁儿童炎症反应更剧烈,抗凝监测需加强。

Objective To analyze the differences in clinical features, etiological distribution and treatment strategies of mycoplasma pneumoniae pneumonia (MPP) in children around the age of 8, so as to provide evidence for age-stratified individualized diagnosis and treatment. Methods A retrospective analysis was conducted on the data of 167 hospitalized children with MPP diagnosed by targeted next-generation sequencing (tNGS) in the pediatric department of Beijing Haidian Hospital from November 2023 to April 2024. The patients were divided into the <8-year-old group (n=71) and the ≥8-year-old group (n=96). The two groups were compared in terms of clinical manifestations, laboratory parameters, etiological features and treatment strategies. Results The detection rate of macrolide-resistant MPP exceeded 88%, and there was no statistically significant difference between the groups (P=0.702). The incidence of refractory MPP was 39.4% in the group aged <8 years, which was higher than 20.8% in the group aged ≥8 years, and the difference was statistically significant (P=0.014). The co-infection rate of viruses was 26.7% in the <8-year-old group, also higher than 14.6% in the ≥8-year-old group, with statistically significant difference (P=0.003). The levels of C-reactive protein and D-dimer were significantly higher in the ≥8-year-old group than in the <8-year-old group (P<0.05), and the difference was statistically significant (P<0.05), while the level of lactate dehydrogenase was higher in the <8-year-old group than that in the ≥8-year-old group, and the difference was statistically significant (P=0.009).The utilization rate of doxycycline/minocycline was 79.2% in the ≥8-year-old group, notably higher than 33.8% in the <8-year-old group, and the difference was statistically significant (P<0.001). Conclusions During the 2023-2024 epidemic period, childhood MPP is characterized by a high rate of macrolide resistance, with no significant difference among age groups. Children under 8 years are more likely to have a refractory course and viral co-infections, highlighting the need for enhanced early detection. Children aged 8 and above have a more severe inflammatory responses, requiring intensified anticoagulation monitoring.