儿童重症肺炎支原体肺炎感染的研究进展

Research Progress on Severe Mycoplasma pneumoniae Pneumonia Infection in Children

摘要: 肺炎支原体肺炎(Mycoplasma pneumoniae Pneumonia, MPP)是儿童呼吸道感染的常见病原体之一，同时也是我国5岁及以上儿童最主要的社区获得性肺炎(Community Acquired Pneumonia, CAP)。随着大环内酯类抗生素的使用，越来越多的耐药菌出现，以及免疫紊乱、混合感染、血液高凝等因素的影响下，使得儿童重症肺炎支原体肺炎(Sever Mycoplasma pneumoniae Pneumonia, SMPP)的发病率逐年上升。其病情进展迅速，常出现坏死性肺炎、胸腔积液、肺不张、肺脓肿、肺栓塞等并发症，少数病重患儿可发生急性呼吸窘迫综合征及全身炎症反应综合征，引起多器官功能衰竭，甚至危及患儿的生命。Miyashita等定义SMPP为出现急性呼吸衰竭或进入重症监护室治疗的MPP。因此，早期发现重症和危重症病例、合理救治、避免死亡和后遗症的发生是MPP诊治的核心和关键问题。本文就SMPP的发病机制、临床表现、治疗进展进行综述。

Abstract: Mycoplasma pneumoniae Pneumonia (MPP) is one of the most common pathogens causing respiratory infections in children and the leading cause of Community-Acquired Pneumonia (CAP) in children aged 5 years and older in China. With the widespread use of macrolide antibiotics, the emergence of drug-resistant strains, and the influence of factors such as immune dysregulation, co-infections, and hypercoagulability, the incidence of severe Mycoplasma pneumoniae Pneumonia (SMPP) in children has been rising year by year. SMPP progresses rapidly and often leads to complications such as necrotizing pneumonia, pleural effusion, atelectasis, lung abscess, and pulmonary embolism. In severe cases, it may cause Acute Respiratory Distress Syndrome (ARDS) and Systemic Inflammatory Response Syndrome (SIRS), resulting in multiple organ dysfunction and even life-threatening conditions. Miyashita et al. defined SMPP as MPP that presents with acute respiratory failure or requires treatment in an intensive care unit. Therefore, early identification of severe and critical cases, appropriate treatment, and prevention of mortality and long-term sequelae are the core and key issues in the diagnosis and treatment of MPP. This article reviews the pathogenesis, clinical manifestations, and recent advances in the treatment of SMPP.