甲泼尼龙在耐大环内酯肺炎支原体患儿的应用研究现状

Current Research Status on the Application of Methylprednisolone in Pediatric Patients with Macrolide-Resistant Mycoplasma pneumoniae Pneumonia

摘要: 肺炎支原体肺炎(MPP)是我国儿童社区获得性肺炎的主要病因，其高发的耐药性问题，尤其是大环内酯类药物耐药(MRMP)，已成为当前临床诊疗的核心挑战。MRMP导致传统一线治疗效果不彰，显著增加了患儿发展为重症及难治性肺炎的风险。在此背景下，糖皮质激素作为重要的免疫调节剂，其合理应用对于控制过度炎症反应、改善预后至关重要。甲泼尼龙作为一种中效合成糖皮质激素，因其较强的抗炎效力与相对温和的盐皮质激素作用，在重症及难治性MPP的治疗中占据关键地位。本文旨在系统综述耐大环内酯肺炎支原体的流行病学与临床困境，深入阐述甲泼尼龙的分子药理学机制，并基于最新临床研究及指南，详细探讨其在MRMP患儿中的应用策略、疗效证据及优化方向。

Abstract: Mycoplasma pneumoniae pneumonia (MPP) is a leading cause of community-acquired pneumonia in children in China. The high prevalence of drug resistance, especially to macrolides (Macrolide-Resistant M. pneumoniae, MRMP), has become a core challenge in current clinical diagnosis and treatment. MRMP leads to poor efficacy of conventional first-line therapies and significantly increases the risk of children developing severe and refractory pneumonia. In this context, glucocorticoids, as important immunomodulators, play a crucial role in controlling excessive inflammatory responses and improving prognosis through rational application. Methylprednisolone, a moderately potent synthetic glucocorticoid, holds a key position in the treatment of severe and refractory MPP due to its strong anti-inflammatory potency and relatively mild mineralocorticoid activity. This article aims to systematically review the epidemiology and clinical challenges of macrolide-resistant M. pneumoniae, elaborate on the molecular pharmacological mechanisms of methylprednisolone, and based on the latest clinical research and guidelines, discuss in detail its application strategies, efficacy evidence, and optimization directions in children with MRMP.