可弯曲支气管镜对儿童重症肺炎支原体肺炎诊断及治疗的价值
The Value of Flexible Bronchoscopy in the Diagnosis and Treatment of Severe Mycoplasma Pneumoniae Pneumonia in Children
DOI: 10.12677/acm.2025.151128, PDF,    科研立项经费支持
作者: 胡国强*：内蒙古医科大学赤峰临床医学院，内蒙古 赤峰；胡景伟#：赤峰市医院儿科，内蒙古 赤峰
关键词: 支气管镜；儿童；重症肺炎支原体肺炎；诊断；治疗；Bronchoscopy； Child； Severe Mycoplasma Pneumoniae； Diagnostic； Treat
摘要: 肺炎支原体(Mycoplasma pneumoniae, MP)是儿童社区获得性肺炎(CAP)的重要致病微生物。尽管大多数肺炎支原体肺炎(MPP)患儿为自限性疾病，但部分病情恶化者可发展为重症肺炎支原体肺炎(SMPP)，并可能出现严重并发症，如塑形性支气管炎、闭塞性支气管炎等。随着2023年肺炎支原体感染的全球流行，SMPP病例显著增多，常规内科治疗在应对SMPP方面疗效有限。可弯曲支气管镜凭借其诊疗双重功能，在改善患儿预后中起到不可替代的作用。本文综述可弯曲支气管镜在SMPP诊断和治疗中的最新研究进展，为临床实践提供参考。
Abstract: Mycoplasma pneumoniae (MP) is an important causative organism of community-acquired pneumonia (CAP) in children. Although most children with Mycoplasma pneumoniae (MPP) have self-limiting disease, some children with worsening disease can progress to severe Mycoplasma pneumoniae (SMPP) and may develop serious complications such as plasmacytoid bronchitis and occlusive bronchitis. With the global epidemic of Mycoplasma pneumoniae infection in 2023, there is a significant increase in the number of SMPP cases, and conventional medical treatment has limited efficacy in dealing with SMPP. Flexible bronchoscopy (FB) has both diagnostic and therapeutic functions and plays an irreplaceable role in improving the prognosis of children. This article reviews recent advances in the use of flexible bronchoscopy for the diagnosis and treatment of SMPP, providing references for clinical practice.
文章引用：胡国强, 胡景伟. 可弯曲支气管镜对儿童重症肺炎支原体肺炎诊断及治疗的价值[J]. 临床医学进展, 2025, 15(1): 960-967. https://doi.org/10.12677/acm.2025.151128

参考文献

[1] Yan, C., Xue, G., Zhao, H., Feng, Y., Cui, J. and Yuan, J. (2024) Current Status of Mycoplasma Pneumoniae Infection in China. World Journal of Pediatrics, 20, 1-4. [Google Scholar] [CrossRef] [PubMed]
[2] Khoury, T., Sviri, S., Rmeileh, A.A., Nubani, A., Abutbul, A., Hoss, S., et al. (2016) Increased Rates of Intensive Care Unit Admission in Patients with Mycoplasma Pneumoniae: A Retrospective Study. Clinical Microbiology and Infection, 22, 711-714. [Google Scholar] [CrossRef] [PubMed]
[3] Zhang, X., He, W., Gui, Y., Lu, Q., Yin, Y., Zhang, J., et al. (2024) Current Mycoplasma Pneumoniae Epidemic among Children in Shanghai: Unusual Pneumonia Caused by Usual Pathogen. World Journal of Pediatrics, 20, 5-10. [Google Scholar] [CrossRef] [PubMed]
[4] 赵顺英, 钱素云, 陈志敏, 等. 儿童肺炎支原体肺炎诊疗指南(2023年版) [J]. 新发传染病电子杂志, 2024, 9(1): 73-79.
[5] 郭艳红, 马爱婷. 丙种球蛋白、注射用甲泼尼龙琥珀酸钠冲击联合头孢曲松钠治疗小儿重症肺炎的效果[J]. 临床医学研究与实践, 2020, 5(25): 110-112.
[6] 王亚玲. 丙种球蛋白对重症支原体肺炎患儿炎症反应、用药安全性的影响[J]. 黑龙江医药科学, 2024, 47(4): 148-149.
[7] Lu, J., Zhang, J., Wang, G., Zhang, X. and Li, Z. (2023) Effects of Bronchoalveolar Lavage on Mycoplasma Pneumoniae pneumonia: A Propensity Score Matched-Cohort Study. Frontiers in Pediatrics, 10, Article No. 1066640. [Google Scholar] [CrossRef] [PubMed]
[8] 王丽萍, 陈守平, 黄玉瑛, 等. 软式支气管镜在儿童呼吸系统疾病中的应用[J]. 中国当代儿科杂志, 2017, 19(11): 1174-1179.
[9] Ikeda, S., Yanai, N. and Ishikawa, S. (1968) Flexible Bronchofiberscope. The Keio Journal of Medicine, 17, 1-16. [Google Scholar] [CrossRef] [PubMed]
[10] 凌耀政. 支气管镜诊疗术对大叶性肺炎治疗作用的研究[D]: [硕士学位论文]. 长春: 吉林大学, 2023.
[11] Izumikawa, K. (2016) Clinical Features of Severe or Fatal Mycoplasma Pneumoniae Pneumonia. Frontiers in Microbiology, 7, Article No. 800. [Google Scholar] [CrossRef] [PubMed]
[12] 吴振起, 齐兆东, 张天宇, 等. 高载量肺炎支原体感染小鼠重症肺炎模型的建立和评价[J]. 中华中医药学刊, 2023, 41(1): 9-12, 259.
[13] Xu, X., Wu, L., Sheng, Y., Liu, J., Xu, Z., Kong, W., et al. (2020) Airway Microbiota in Children with Bronchial Mucus Plugs Caused by Mycoplasma Pneumoniae Pneumonia. Respiratory Medicine, 170, Article No. 105902. [Google Scholar] [CrossRef] [PubMed]
[14] Wang, Y., Yu, X., Liu, F., Tian, X., Quan, S., Jiao, A., et al. (2023) Respiratory Microbiota Imbalance in Children with Mycoplasma Pneumoniae Pneumonia. Emerging Microbes & Infections, 12, Article No. 2202272. [Google Scholar] [CrossRef] [PubMed]
[15] 董庆华, 尹建运, 苏杭, 等. 中性粒细胞胞外诱捕网在儿童重症肺炎支原体肺炎中的意义[J]. 新医学, 2024, 55(7): 520-526.
[16] 惠秦. 磷脂对儿童重症肺炎支原体肺炎的预测价值及代谢组学研究[D]: [博士学位论文]. 北京: 北京协和医学院, 2021.
[17] 陈艳, 姚欢迎, 林健楠, 等. 儿童肺炎支原体肺炎伴气道阻塞的免疫机制研究进展[J]. 中国当代医药, 2023, 30(25): 23-26.
[18] 路素坤. 肺炎支原体致儿童肺炎伴气道阻塞的原因分析及牛乳铁蛋白对MALP-2致急性肺损伤的作用与机制研究[D]: [硕士学位论文]. 石家庄: 河北医科大学, 2020.
[19] 王文磊, 李芳. 纤维支气管镜在儿童塑形性支气管炎诊治中的价值研究[J]. 重庆医学, 2016, 45(32): 4490-4492.
[20] 程序. 儿童塑形性支气管炎的临床特点及影响因素[D]: [硕士学位论文]. 济南: 山东大学, 2019.
[21] Ma, Y., Gu, Y., Zhang, X., Gu, W., Wang, T., Sun, H., et al. (2022) High Expression of MUC5AC, MUC5B, and Layilin Plays an Essential Role in Prediction in the Development of Plastic Bronchitis Caused by MPP. Frontiers in Microbiology, 13, Article No. 911228. [Google Scholar] [CrossRef] [PubMed]
[22] Zhang, H., Yang, J., Zhao, W., Zhou, J., He, S., Shang, Y., et al. (2023) Clinical Features and Risk Factors of Plastic Bronchitis Caused by Refractory Mycoplasma Pneumoniae Pneumonia in Children: A Practical Nomogram Prediction Model. European Journal of Pediatrics, 182, 1239-1249. [Google Scholar] [CrossRef] [PubMed]
[23] Huang, L.L., Li, R.H., Li, J., Chen, H.J. and Peng, S.M. (2019) Association of YKL-40 in Bronchoalveolar Lavage Fluid with Airway Damage in Children with Mycoplasma Pneumoniae Pneumonia. Chinese Journal of Contemporary Pediatrics, 21, 1188-1192.
[24] 刘初, 代继宏, 耿刚, 等. 闭塞性支气管炎与闭塞性细支气管炎临床特征对比分析[J]. 中国实用儿科杂志, 2023, 38(6): 470-476.
[25] 刘霞, 李渠北. 儿童感染后闭塞性细支气管炎诊疗进展[J]. 儿科药学杂志, 2022, 28(6): 63-65.
[26] 颉雅苹, 曾强, 陶建平, 等. 67例儿童感染后闭塞性细支气管炎的临床特征与随访研究[J]. 临床肺科杂志, 2023, 28(5): 689-693.
[27] 张立霞, 朱峰, 李传景, 等. 重症肺炎支原体肺炎患儿CRP、LDH等实验室指标的预警价值及支气管镜下特点[J]. 中华全科医学, 2024, 22(7): 1098-1101, 1107.
[28] 杨红, 和石圣, 龚卉, 等. 电子支气管镜治疗儿童重症支原体肺炎对气道粘膜状态、免疫功能和炎症指标的影响[J]. 中外医学研究, 2024, 22(21): 57-61.
[29] 张琪, 许崇玉, 毕良学. 支气管镜在早期识别重症肺炎支原体肺炎中的价值[J]. 临床肺科杂志, 2019, 24(4): 684-687.
[30] 李丹丹, 刘新锋, 马铮, 等. 肺泡灌洗液在病毒混合感染儿童重症肺炎支原体肺炎中的诊断价值[J]. 中国消毒学杂志, 2022, 39(8): 606-609.
[31] Wang, L., Xie, Q., Xu, S., Li, H., Zhang, L., Ai, J., et al. (2022) The Role of Flexible Bronchoscopy in Children with Mycoplasma Pneumoniae Pneumonia. Pediatric Research, 93, 198-206. [Google Scholar] [CrossRef] [PubMed]
[32] 郭亚琳, 杨玉霞, 董芃芃. 下呼吸道感染患儿支气管肺泡灌洗液的病原学研究[J]. 中国当代儿科杂志, 2019, 21(2): 144-149.
[33] Lin, Q., Yao, Y., Li, X., Zhang, S., Guo, H., Ma, X., et al. (2023) The Application of Nanopore Targeted Sequencing for Pathogen Diagnosis in Bronchoalveolar Lavage Fluid of Patients with Pneumonia: A Prospective Multicenter Study. Infectious Diseases, 56, 128-137. [Google Scholar] [CrossRef] [PubMed]
[34] Huang, X., Luo, Y., Wang, J., Zhang, X., Chen, L., Wu, R., et al. (2024) Integrative Study of Pulmonary Microbiome, Transcriptome and Clinical Outcomes in Mycoplasma pneumoniae Pneumonia. Respiratory Research, 25, Article No. 35. [Google Scholar] [CrossRef] [PubMed]
[35] 胡祖霞, 杨中桥. 肺炎支原体药物敏感性和难治性肺炎支原体肺炎患儿发病的关系分析[J]. 中国医学工程, 2023, 31(7): 64-68.
[36] Yan, C., Xue, G., Zhao, H., Feng, Y., Li, S., Cui, J., et al. (2019) Molecular and Clinical Characteristics of Severe Mycoplasma pneumoniae Pneumonia in Children. Pediatric Pulmonology, 54, 1012-1021. [Google Scholar] [CrossRef] [PubMed]
[37] 杨丽微, 仇有喜, 杨松. 支气管肺泡灌洗液中细胞分类及炎症因子水平与MPP合并气道黏液栓患儿预后的关联性分析[J]. 中国临床新医学, 2023, 16(10): 1065-1070.
[38] 赵青, 许银辉, 贾建伟. 急性肺炎支原体肺炎患儿支气管肺泡灌洗液中乳酸水平及意义[J]. 检验医学与临床, 2024, 21(19): 2824-2829.
[39] 马莹莹, 彭韶, 储卫红, 等. 儿童难治性肺炎支原体肺炎血清和肺泡灌洗液中CARDS TX、TNF-α、SAA的表达水平及意义[J]. 河南医学研究, 2023, 32(20): 3685-3689.
[40] 王洁, 王丹丹, 张薇, 等. 儿童重症肺炎支原体肺炎支气管肺泡灌洗液中炎症细胞因子变化及临床意义分析[J]. 中国实用医药, 2022, 17(16): 1-5.
[41] 徐素玲, 李政, 张成. 肺炎支原体肺炎患儿血清和支气管肺泡灌洗液中肺表面活性蛋白A、肺表面活性蛋白D和Toll样受体2水平变化及临床意义[J]. 新乡医学院学, 2018, 35(7): 605-607, 611.
[42] Wang, M., Ren, R., Xu, Y., Wang, T., Liang, X. and Li, S. (2024) Oxidative Stress in the Alveolar Lavage Fluid of Children with mycoplasma Pneumoniae Pneumonia. Pediatric Pulmonology, 59, 2772-2782. [Google Scholar] [CrossRef] [PubMed]
[43] 李静, 刘长山, 王雪艳, 等. 儿童肺炎支原体肺炎肺功能改变及临床意义的探讨[J]. 天津医科大学学报, 2018, 24(3): 229-231.
[44] 巴荷霞, 李静, 余永生, 等. 可弯曲支气管镜术对小儿重症支原体肺炎的治疗作用[J]. 中南医学科学杂志, 2024, 52(4): 635-637.
[45] 赵越真, 郑敬阳, 赖辉添. 电子支气管镜下治疗儿童塑型性支气管炎疗效[J]. 中国城乡企业卫生, 2024, 39(9): 121-123.
[46] 储芳芳, 梁磊, 许崇玉. 早期应用软式支气管镜治疗对小儿肺炎支原体肺炎合并支气管黏液栓的疗效[J]. 临床和实验医学杂志, 2023, 22(4): 410-414.
[47] 黄蓉, 刘玉玲. 不同支气管镜支气管肺泡灌洗时机治疗难治性肺炎支原体肺炎患儿的临床效果[J]. 内科, 2022, 17(5): 514-518.
[48] 辛静, 彭建萍, 万文利. 支气管镜肺泡灌洗乙酰半胱氨酸治疗支气管扩张伴感染的临床疗效观察[J]. 现代医学与健康研究电子杂志, 2024, 8(18): 17-19.
[49] 陈俊先, 林民豪, 吴桂清, 等. 乙酰半胱氨酸、布地奈德、纤维支气管镜下肺泡灌洗三者联合治疗重症肺炎的应用研究[J]. 中国医药科学, 2023, 13(16): 17-20.
[50] 王跃, 高永平, 荆蕾, 等. 激光治疗过度动态气道塌陷的疗效分析(附13例报告) [J]. 中国内镜杂志, 2024, 30(3): 73-80.
[51] 何成, 廖冬菊, 刘阳, 等. 冷冻在电子支气管镜下肉芽组织清除术中的疗效观察[J]. 中国内镜杂志, 2024, 30(7): 1-8.

为你推荐