中文摘要：

目的了解肺炎支原体（mycoplasma pneumoniae，MP）对大环内酯类抗生素的耐药情况及耐药机制。方法对370份咽拭子标本进行MP分离培养，应用套式PCR扩增MP种特异16S核蛋白体RNA（16SrRNA）基因对临床分离株进行分子鉴定；通过药物敏感实验测定MP分离株对大环内酯类药物的MIC并筛选出耐药株；设计套式PCR扩增红霉素作用靶位23S核蛋白体RNA（23SrRNA）基因，扩增产物进行全自动DNA测序，测得序列与NCBI已登录的MP标准株M129（登录号）（68422）23SrRNA基因作比对。结果370份临床标本中分离MP50株，分离阳性率为13．5％。50株中敏感株4株，耐药株46株（占92％）。耐药菌株的红霉素、阿奇霉素、交沙霉素MIC值均升高。4株敏感株和肺炎支原体国际标准株FH的23SrRNA基因序列与基因库的MP基因序列相同，46株耐药株的23SrRNA基因发生点突变，41株突变位点在23SrRNAV区中心环的2063位，其中40株发生了A—G的点突变，1株发生了A—c的点突变；另5株突变位点在2064位，A→G。结论MP对大环内酯类抗生素耐药率高，耐药性的分子基础是23SrRNA基因的点突变，其中2063位点突变占主导地位。23SrRNA基因发生点突变的肺炎支原体对红霉素、阿奇霉素及交沙霉素的MIC值均升高。

英文摘要：

Objective To investigate status of macrolide resistance and determine molecular mechanisms in Mycoplasma pneumoniae. Methods All of 370 throat swab specimens were cultured to isolate Mycoplasma pneumoniae. Mycoplasma pneumoniae isolates were identified by nested PCR for specific 16SrRNA gene. Antibiotic susceptibility test was done to identify macrolide resistant strains. 23SrRNA gene was amplified by nested PCR followed by direct automatic sequencing method. The DNA sequences were compared to the sequence of Mycoplasma pneumoniae M129 （ accession no. X68422 ） to find molecular mechanisms of drug resistance. Results Fifty clinical strains were isolated from 370 specimens. Of 50 strains, 4 strains were susceptible to macrolide, 46 strains were macrolide resistant with the percentage of 92%. MICs of resistant strains to erythromycin, azithromycin and josamycin were elevated. The sequence of 23SrRNA gene in 4 susceptible strains and the reference strain FH was identical to Mycoplasma pneumoniae gene in GenBank. 46 resistant strains harbored a point mutation respectively, among them, 40 strains had an A to G transition at position 2063, 1 strain had an A to C transition at position 2063, the other five strains showed an A to G transition at position 206d. Conclusions Macrolide resistance in Mycoplasma pneumoniae is very serious health concern. The point mutation in 23SrRNA, expecailly predominant position 2063 mutation contributed to the macrolide resistance in Mycoplasma pneumoniae. The MICs of resistant strains to erythromycin, azithromycin and josamycin are much higher than Mycoplasma pneumoniae reference strain FH.