目的 通过研究大环内酯类耐药肺炎支原体（macrolide-resistant mycoplasma pneumoniae，MRMP）感染与儿童难治性肺炎支原体肺炎（refractory mycoplasma pneumoniae pneumonia， RMPP）的关系，以探讨其在儿童RMPP及时诊治中的临床意义。 方法 回顾性分析714例RMPP患儿的临床资料。对患儿进行支气管镜检查和支气管肺泡灌洗液（bronchoalveolar lavage fluid， BALF）检查，提取BALF中的MP-DNA，检测其23S rRNA V区突变位点，并根据检测结果，分为大环内酯类耐药组和对照组（非大环内酯类耐药）。 结果 共计714例RMPP患儿，其中大环内酯类耐药组509例，对照组205例。男369例（54.7%），女345例（45.3%）。大环内酯类耐药组的年龄、发热时间及住院时间均高于对照组（P < 0.000 1）。大环内酯类耐药组RMPP患儿的白细胞（white blood cell count， WBC）、中性粒细胞百分比（percentage of neutrophil， NE%）、超敏C反应蛋白（high sensitive C-reactive protein， hs-CRP）、乳酸脱氢酶（lactate dehydrogenase， LDH）及白细胞介素-6（interleukin-6， IL-6）值均高于对照组（P < 0.05，P < 0.000 1）。大环内酯类耐药组RMPP患儿的肺实变、胸腔积液、坏死性肺炎、重症（severe MPP，SMPP）/危重症（fulminant MPP，FMPP）、气管内絮状及黏性分泌物、严重黏膜病变（糜烂、溃疡或坏死等）、支气管炎性狭窄、支气管内塑型痰栓及肺外并发症的发生率均高于对照组（P < 0.05，P < 0.000 1）。 结论 MRMP感染可导致进RMPP的发生。MRMP感染可能会加重RMPP患儿病情。对RMPP患儿及时地实施纤维支气管镜检查，并采集BALF样本进行检测，准确地评估RMPP患儿的呼吸道病变及判断是否存在MRMP感染等的情况，对指导临床的正确诊治有重要的参考价值。

Objective To elucidate the clinical significance in facilitating timely diagnosis and treatment of RMPP in children by investigating the association between infection caused by macrolide?resistant Mycoplasma pneumoniae （MRMP） and refractory Mycoplasma pneumoniae pneumonia （RMPP） in pediatric patients. Methods The clinical data of 714 hospitalized children with refractory Mycoplasma pneumoniae pneumonia （RMPP） were retrospectively analyzed. Bronchoscopy and bronchoalveolar lavage fluid （BALF） were performed on each subject， and the BALFs were collected to detect mutation sites in the V region of 23S rRNA for Mycoplasma pneumoniae DNA. Based on the gene detection results， children with RMPP were categorized into a macrolide?resistant group and a control group （non?macrolide?resistant group）. Results A total of 714 children diagnosed with refractory Mycoplasma pneumoniae pneumonia （RMPP） were enrolled in this study， including 509 cases in the macrolide?resistant group and 205 cases in the control group. Among them， there were 369 males （54.7%） and 345 females （45.3%）. The macrolide?resistant group exhibited higher average age， fever duration， and hospitalization days compared to the control group. Furthermore， elevated levels of white blood cell count （WBC）， neutrophil percentage （NE%）， high?sensitivity C?reactive protein （hs?CRP）， lactate dehydrogenase （LDH）， and interleukin?6 （IL?6） were observed in the macrolide?resistant group when compared to the control group （P < 0.05 or P < 0.000 1）. Compared to the control group， children with macrolide?resistant Mycoplasma pneumoniae pneumonia （RMPP） exhibited higher incidences of lung consolidation， pleural effusion， necrotic pneumonic lesions， severe MPP （SMPP）/fulminant MPP （FMPP）， flocculent and viscous tracheal secretions， severe mucosal lesions （erosion， ulceration or necrosis）， bronchial inflammatory stenosis， endo?bronchial plastic phlegm plugs and extra?pulmonary complications （P < 0.05 or P < 0.0001）. Conclusions MRMP infection can contribute to the development of RMPP， potentially exacerbating respiratory conditions in affected children. Timely bronchoscopy and collection of BALF samples for accurate evaluation of respiratory tract lesions and detection of MRMP infection have significant implications for guiding precise clinical diagnosis and treatment.