| 摘要: |
| ［摘要］ 肺炎支原体（MP）是儿童和青少年社区获得性肺炎的重要病原体，近年来其感染率呈上升趋势，且耐大环内酯类药物肺炎支原体（MRMP）检出率不断升高，增加了临床诊疗难度。MP感染临床表现多样，部分患儿可进展为重症肺炎，或伴有肺外系统受累。当前诊断方法主要包括聚合酶链反应（PCR）、血清学检测、多重PCR及宏基因组二代测序（mNGS）等，均有助于早期识别MP感染并完成病原学确认。治疗方面，大环内酯类仍为首选药物；对于核酸检测提示耐药突变并伴有大环内酯治疗反应不佳的患者，可根据病情权衡启用四环素类或氟喹诺酮类等替代药物。部分难治性MP肺炎患儿对糖皮质激素及免疫球蛋白治疗反应良好。该文结合最新循证指南与专家共识，系统总结MP感染的流行病学特征、发病机制、临床表现、诊断技术、耐药机制及治疗策略，为临床诊疗与研究提供参考依据。 |
| 关键词: 肺炎支原体 社区获得性肺炎 耐药性 儿童肺炎 |
| DOI：10.3969/j.issn.1674-3806.2025.08.02 |
| 分类号:R 725.6 |
| 基金项目:国家自然科学基金项目（编号：81972991） |
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| Clinical characteristics, diagnosis and treatment strategies of Mycoplasma pneumoniae infection in children |
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SHANG Ziru, DING Guodong
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Department of Paediatric Respiratory Medicine, Xinhua Hospital Affiliate to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
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| Abstract: |
| ［Abstract］ Mycoplasma pneumoniae(MP) is a major pathogen responsible for community-acquired pneumonia(CAP) in children and adolescents. In recent years, the incidence of MP infection has been on the rise, and the detection rate of macrolide-resistant Mycoplasma pneumoniae(MRMP) has been continuously increasing, making the clinical diagnosis and treatment of MP infection more challenging. The clinical manifestations of MP infection are diverse. Some pediatric patients with MP infection may progress to severe pneumonia or be accompanied by extrapulmonary system involvement. At present, the diagnostic methods for MP infection mainly include polymerase chain reaction(PCR), serological testing, multiplex PCR and metagenomic next-generation sequencing(mNGS), all of which facilitate early detection of MP infection and confirmation of its etiology. Macrolides remain the first-line treatment of MP infection. However, for the patients with drug-resistant gene mutations indicated by nucleic acid testing and poor response to macrolide treatment, alternative drugs such as tetracyclines or fluoroquinolones can be initiated according to the patients′ conditions. Some pediatric patients with refractory MP pneumonia respond well to the treatments of glucocorticoids and immunoglobulins. This paper, in combination with the latest evidence-based guidelines and expert consensuses, systematically summarizes the epidemiological features, pathogenesis, clinical manifestations, diagnostic techniques, drug-resistant mechanisms and treatment strategies of MP infection, providing a reference basis for clinical diagnosis, treatment and research of MP infection. |
| Key words: Mycoplasma pneumoniae(MP) Community-acquired pneumonia(CAP) Drug resistance Pediatric pneumonia |
