Abstract: 　Objective　To investigate the clinical characteristics of children with Mycoplasma pneumoniae pneumonia (MPP) who had detected A2063G mutation (A-to-G transition at position 2063 in domain V on the 23S rRNA domain) in bronchoalveolar lavage fluid (BALF). Methods　A foral of  297 hospitalized children diagnosed with MPP in the pediatric ward of the First Affiliated Hospital of Hunan Normal University from April 2016 to October 2017, were enrolled. All children were underwent fiberoptic bronchoscopy treatment and A2063G mutation test in 23S rRNA V domain in BALF specimen. The patients were divided into mutant group and non-mutant group according to genetic test, and clinical features between the two groups were compared. Results　Among the 297 cases, 155 cases were detected with A2063G mutation in the 23S rRNA V domain in the BALF, with a positive rate of 52.1%. Clinical features, such as gender, age, C-reactive protein  level, white blood cell count, pleural effusion and thoracic thickening percentage, the ratio of severe lesions found under fiberoptic bronchoscopy (erosion, plastic or yellowish-white phlegm plug), co-infection rate, the percentage of severe pneumonia and refractory MPP in the two groups of patients showed no significant difference （P>0.05）. The admission duration and fever duration in the mutant group were longer than those in the non-mutant group. The MP-DNA load in the BALF was higher than that in the non-mutant group. The MP-DNA load decreased slower and duration of fever was longer after the use of macrolide antibiotics in the mutant group, without statistical significance between the two groups (P<0.05). Logistic regression analysis revealed that the MP-DNA load and febrile days after the use of macrolide antibiotics were correlated with A2063G mutation in the 23S rRNA V domain. Conclusions　The MP-DNA load in BALF and the febrile days after using macrolide antibiotics may have certain reference value for identifying the A2063G mutation in 23S rRNA V domain in children with MPP.