儿童支原体肺炎重症化影响因素的研究进展

doi:10.19983/j.issn.2096-8493.2024013

摘要/Abstract

摘要：

肺炎支原体(Mycoplasma pneumoniae,MP)感染是一种异质性疾病。在临床中,诊断为支原体肺炎(Mycoplasma pneumoniae pneumonia,MPP)的患儿中,重症支原体肺炎(severe Mycoplasma pneumoniae pneumonia,SMPP)、难治性支原体肺炎(refractory Mycoplasma pneumoniae pneumonia,RMPP)和危重症MPP除带来治疗困难、预后差等严重影响儿童生命安全的情况外,还常遗留不同程度的后遗症。分析MPP重症化的影响因素,寻找早期识别MPP重症化的相关预警指标,对于进行早期干预,降低SMPP和RMPP的致残率和减少后遗症的发生,以及降低SMPP和RMPP的病亡率具有重要意义。在临床中,感染MPP的患儿对支原体耐药性、临床表现、实验室指标、影像学表现等,以及支气管肺泡灌洗术(bronchoalveolar lavage,BAL)的应用与MPP重症化发生相关,笔者对上述相关影响因素的研究进展予以综述。

关键词: 支原体,肺炎, 抗药性, 体征和症状, 临床实验室技术, 支气管肺泡灌洗

Abstract:

Mycoplasma pneumoniae (MP) infection is a heterogeneous disease. Clinically, in children diagnosed with Mycoplasma pneumoniae pneumonia (MPP), severe Mycoplasma pneumoniae pneumonia (SMPP), refractory Mycoplasma pneumoniae pneumonia (RMPP) and critical MPP, in addition to causing serious impacts on children’s life safety such as treatment difficulties and poor prognosis, various degrees of sequelae often exist. To explore the influencing factors and to improve the early warning indicators of MPP severity, is of great significance for early intervention, reducing the morbidity and sequelae of SMPP and RMPP, and reducing the mortality rate of SMPP and RMPP. In clinical practice, mycoplasma drug resistance, clinical manifestations, laboratory indicators, imaging manifestations, and the application of bronchoalveolar lavage (BAL) in children infected with MPP are related to the occurrence of MPP severity. This paper reviews the research progress of the above related factors.

Key words: Mycoplasma pneumoniae, Drug resistance, Signs and symptoms, Clinical laboratory techniques, Bronchoalveolar lavage

中图分类号:

R375+.2

刘力铭, 李明. 儿童支原体肺炎重症化影响因素的研究进展[J]. 结核与肺部疾病杂志, 2024, 5(1): 81-87. doi: 10.19983/j.issn.2096-8493.2024013

iu Liming, Li Ming. New progress in research on the influencing factors of the severity of Mycoplasma pneumoniae pneumonia in children[J]. Journal of Tuberculosis and Lung Disease, 2024, 5(1): 81-87. doi: 10.19983/j.issn.2096-8493.2024013

参考文献 60

[1]	Yamazaki T, Kenri T. Epidemiology of Mycoplasma pneumoniae Infections in Japan and Therapeutic Strategies for Macrolide-Resistant M.pneumoniae. Front Microbiol, 2016, 7: 693. doi:10.3389/fmicb.2016.00693. pmid: 27242718
[2]	Pereyre S, Touati A, Petitjean-Lecherbonnier J, et al. The increased incidence of Mycoplasma pneumoniae in France in 2011 was polyclonal, mainly involving M.pneumoniae type 1 strains. Clin Microbiol Infect, 2013, 19(4): E212-E217. doi:10.1111/1469-0691.12107.
[3]	Yan C, Sun H, Zhao H. Latest Surveillance Data on Mycoplasma pneumoniae Infections in Children, Suggesting a New Epidemic Occurring in Beijing. J Clin Microbiol, 2016, 54(5): 1400-1401. doi:10.1128/JCM.00184-16.
[4]	Gao LW, Yin J, Hu YH, et al. The epidemiology of paediatric Mycoplasma pneumoniae pneumonia in North China: 2006 to 2016. Epidemiol Infect, 2019, 147: e192. doi:10.1017/S0950268819000839.
[5]	李少丽, 刘立雍, 黄乐乐, 等. 健康体检儿童肺炎支原体检出情况研究. 中华微生物学和免疫学杂志, 2023, 43(7): 555-558. doi:10.3760/cma.j.cn112309-20230615-00172.
[6]	Guo Z, Liu L, Gong J, et al. Molecular features and antimicrobial susceptibility of Mycoplasma pneumoniae isolates from paediatric inpatients in Weihai, China: Characteristics of M.pneumoniae In Weihai. J Glob Antimicrob Resist, 2022, 28: 180-184. doi:10.1016/j.jgar.2022.01.002.
[7]	Jiang FC, Wang RF, Chen P, et al. Genotype and mutation patterns of macrolide resistance genes of Mycoplasma pneumoniae from children with pneumonia in Qingdao, China, in 2019. J Glob Antimicrob Resist, 2021, 27: 273-278. doi:10.1016/j.jgar.2021.10.003.
[8]	Li L, Ma J, Guo P, et al. Molecular beacon based real-time PCR p 1 gene genotyping, macrolide resistance mutation detection and clinical characteristics analysis of Mycoplasma pneumoniae infections in children. BMC Infect Dis, 2022, 22(1): 724. doi:10.1186/s12879-022-07715-6.
[9]	史大伟, 刘玲, 赵萌萌, 等. 肺炎支原体肺炎患儿支气管肺泡灌洗液中肺炎支原体耐药基因和13种病原检测结果分析. 中华实用儿科临床杂志, 2022, 37(12): 893-896. doi:10.3760/cma.j.cn101070-20210716-00833.
[10]	Xu C, Deng H, Zhang J, et al. Mutations in domain V of Mycoplasma pneumoniae 23S rRNA and clinical characteristics of pediatric M.pneumoniae pneumonia in Nanjing, China. J Int Med Res, 2021, 49(6): 3000605211016376. doi:10.1177/03000605211016376.
[11]	中华人民共和国国家卫生健康委员会. 儿童肺炎支原体肺炎诊疗指南(2023年版). 国卫办医政函〔2023〕27号. 2023-02-15.
[12]	费文祎, 罗健. 儿童坏死性肺炎诊治进展. 临床儿科杂志, 2018, 36(4): 306-310. doi:10.3969/j.issn.1000-3606.2018.04.016.
[13]	Bakshi M, Khemani C, Vishwanathan V, et al. Mycoplasma pneumonia with antiphospholipid antibodies and a cardiac thrombus. Lupus, 2006, 15(2): 105-106. doi:10.1191/0961203306lu2258cr. pmid: 16539282
[14]	Nagashima M, Higaki T, Satoh H, et al. Cardiac thrombus associated with Mycoplasma pneumoniae infection. Interact Cardiovasc Thorac Surg, 2010, 11(6): 849-851. doi:10.1510/icvts.2010.242115.
[15]	Flateau C, Asfalou I, Deman AL, et al. Aortic thrombus and multiple embolisms during a Mycoplasma pneumoniae infection. Infection, 2013, 41(4): 867-873. doi:10.1007/s15010-013-0475-2. pmid: 23696110
[16]	Matsumoto N, Takahashi S, Toriumi N, et al. Acute disseminated encephalomyelitis in an infant with incontinentia pigmenti. Brain Dev, 2009, 31(8): 625-628. doi:10.1016/j.braindev.2008.08.010.
[17]	Al-Zaidy SA, MacGregor D, Mahant S, et al. Neurological Complications of PCR-Proven M.pneumoniae Infections in Children: Prodromal Illness Duration May Reflect Pathogenetic Mechanism. Clin Infect Dis, 2015, 61(7): 1092-1098. doi:10.1093/cid/civ473. pmid: 26084846
[18]	Chen X, Xu W, Du J, et al. Acute postinfectious glomerulonephritis with a large number of crescents caused by Mycoplasma pneumoniae. Indian J Pathol Microbiol, 2015, 58(3): 374-376. doi:10.4103/0377-4929.162907.
[19]	Hu J, Ye Y, Chen X, et al. Insight into the Pathogenic Mechanism of Mycoplasma pneumoniae. Curr Microbiol, 2022, 80(1): 14. doi:10.1007/s00284-022-03103-0.
[20]	鲁靖, 赵顺英, 宋蕾, 等. 不同影像学表现的儿童肺炎支原体肺炎临床特征. 中华实用儿科临床杂志, 2017, 32(4): 284-288. doi:10.3760/cma.j.issn.2095-428X.2017.04.011.
[21]	杜景林, 周丽琴, 唱丽敏. C反应蛋白、白细胞与降钙素原联合检测在儿童呼吸道感染中的诊断价值. 中国临床医生杂志, 2022, 50(1): 116-117. doi:10.3969/j.issn.2095-8552.2022.01.036.
[22]	张月明. 血清降钙素原和C反应蛋白水平改变在支原体肺炎患儿中的临床意义. 临床和实验医学杂志, 2014, 13(9):746-748. doi:10.3969/j.issn.1671-4695.2014.09.021.
[23]	刘峰. 肺炎支原体肺炎与预后相关的临床指标. 临床儿科杂志, 2022, 40(4):247-251. doi:10.12372/jcp.2022.22e0170.
[24]	Zhang Y, Zhou Y, Li S, et al. The Clinical Characteristics and Predictors of Refractory Mycoplasma pneumoniae Pneumonia in Children. PLoS One, 2016, 11(5): e0156465. doi:10.1371/journal.pone.0156465.
[25]	Cao X. Monitoring Mycoplasma pneumoniae-Specific Antibody, C-Reactive Protein, and Procalcitonin Levels in Children with Mycoplasma Pneumonia Is Important. Comput Math Methods Med, 2022, 2022: 7976858. doi:10.1155/2022/7976858.
[26]	Neeser OL, Vukajlovic T, Felder L, et al. A high C-reactive protein/procalcitonin ratio predicts Mycoplasma pneumoniae infection. Clin Chem Lab Med, 2019, 57(10): 1638-1646. doi:10.1515/cclm-2019-0194.
[27]	Jiang Y, Wang W, Zhang Z, et al. Serum amyloid a, C-reactive protein, and procalcitonin levels in children with Mycoplasma pneumoniae infection. J Clin Lab Anal, 2022, 36(3): e24265. doi:10.1002/jcla.24265.
[28]	Meyer Sauteur PM, Krautter S, Ambroggio L, et al. Improved Diagnostics Help to Identify Clinical Features and Biomarkers That Predict Mycoplasma pneumoniae Community-acquired Pneumonia in Children. Clin Infect Dis, 2020, 71(7): 1645-1654. doi:10.1093/cid/ciz1059.
[29]	Lee E, Lee YY. Predictive Factors of the Responses to Treatment of Mycoplasma pneumoniae Pneumonia. J Clin Med, 2021, 10(6): 1154. doi:10.3390/jcm10061154.
[30]	Choi YJ, Jeon JH, Oh JW. Critical combination of initial markers for predicting refractory Mycoplasma pneumoniae pneumonia in children: a case control study. Respir Res, 2019, 20(1): 193. doi:10.1186/s12931-019-1152-5.
[31]	Wang S, Jiang Z, Li X, et al. Diagnostic value of serum LDH in children with refractory Mycoplasma pneumoniae pneumoniae: A systematic review and meta-analysis. Front Pediatr, 2023, 11: 1094118. doi:10.3389/fped.2023.1094118.
[32]	Yan Y, Wei Y, Jiang W, et al. The clinical characteristics of corticosteroid-resistant refractory Mycoplasma pneumoniae pneumonia in children. Sci Rep, 2016, 6: 39929. doi:10.1038/srep39929.
[33]	刘建华, 刘金荣, 唐晓蕾, 等. 难治性肺炎支原体肺炎患儿遗留闭塞性支气管炎的预测因素分析. 中华儿科杂志, 2023, 61(4): 317-321. doi:10.3760/cma.j.cn112140-20220902-00775.
[34]	Li T, Yu H, Hou W, et al. Evaluation of variation in coagulation among children with Mycoplasma pneumoniae pneumonia: a case-control study. J Int Med Res, 2017, 45(6): 2110-2118. doi:10.1177/0300060517709613.
[35]	Fumarola D. Intravascular coagulation and Mycoplasma pneumoniae infection. Pediatr Infect Dis J, 1997, 16(10): 1012-1013. doi:10.1097/00006454-199710000-00029. pmid: 9380463
[36]	刘莉萍, 杨泽玉, 王玉, 等. 儿童重症肺炎支原体肺炎的临床特征及相关危险因素分析. 中国小儿急救医学, 2023, 30(6): 451-456. doi:10.3760/cma.j.issn.1673-4912.2023.06.010.
[37]	Huang X, Li D, Liu F, et al. Clinical significance of D-dimer levels in refractory Mycoplasma pneumoniae pneumonia. BMC Infect Dis, 2021, 21(1): 14. doi:10.1186/s12879-020-05700-5. pmid: 33407216
[38]	Fu Y, Zhang TQ, Dong CJ, et al. Clinical characteristics of 14 pediatric Mycoplasma pneumoniae pneumonia associated thrombosis: a retrospective study. BMC Cardiovasc Disord, 2023, 23(1): 1. doi:10.1186/s12872-022-03030-9.
[39]	Song S, Xu Y. A retrospective study of the clinical characteris-tics of 9 children with pulmonary embolism associated with Mycoplasma pneumoniae pneumonia. BMC Pediatr, 2023, 23(1): 370. doi:10.1186/s12887-023-04188-7.
[40]	Narita M. Classification of Extrapulmonary Manifestations Due to Mycoplasma pneumoniae Infection on the Basis of Possible Pathogenesis. Front Microbiol, 2016, 7: 23. doi:10.3389/fmicb.2016.00023.
[41]	Liu J, He R, Wu R, et al. Mycoplasma pneumoniae pneumonia associated thrombosis at Beijing Children’s hospital. BMC Infect Dis, 2020, 20 (1): 51. doi:10.1186/s12879-020-4774-9.
[42]	Qiu J, Ge J, Cao L. D-dimer: The Risk Factor of Children’s Severe Mycoplasma pneumoniae Pneumonia. Front Pediatr, 2022, 10: 828437. doi:10.3389/fped.2022.828437.
[43]	彭丹, 何秋水. 肺炎支原体感染呼吸道菌群和细胞因子的研究进展. 国际呼吸杂志, 2020, 40(21): 1654-1659. doi:10.3760/cma.j.cn131368-20200405-00255
[44]	Rodman Berlot J, Dolenc Š, Krivec U, et al. Clinical, Laboratory, and Radiographic Features Can Help Predict Mycoplasma pneumoniae Lower Respiratory Tract Infection in Children. Microorganisms, 2023, 11(5): 1358. doi:10.3390/microorganisms11051358.
[45]	方柯南, 王晶, 倪婧雯. 重症肺炎支原体肺炎患儿肺炎支原体DNA复制水平与病情的相关性. 中国当代儿科杂志, 2019, 21(9): 876-880. doi:10.7499/j.issn.1008-8830.2019.09.006.
[46]	Jiang Y, Bao C, Zhao X, et al. Intestinal bacteria flora changes in patients with Mycoplasma pneumoniae pneumonia with or without wheezing. Sci Rep, 2022, 12(1): 5683. doi:10.1038/s41598-022-09700-0.
[47]	Zhang X, Chen Z, Gu W, et al. Viral and bacterial co-infection in hospitalised children with refractory Mycoplasma pneumoniae pneumonia. Epidemiol Infect, 2018, 146(11): 1384-1388. doi:10.1017/S0950268818000778.
[48]	Song Q, Xu BP, Shen KL. Effects of bacterial and viral co-infections of Mycoplasma pneumoniae pneumonia in children: analysis report from Beijing Children’s Hospital between 2010 and 2014. Int J Clin Exp Med, 2015, 8(9): 15666-15674.
[49]	Wang X, Li M, Luo M, et al. Mycoplasma pneumoniae triggers pneumonia epidemic in autumn and winter in Beijing: a multicentre, population-based epidemiological study between 2015 and 2020. Emerg Microbes Infect, 2022, 11(1): 1508-1517. doi:10.1080/22221751.2022.2078228.
[50]	Gao J, Xu L, Xu B, et al. Human adenovirus Coinfection aggravates the severity of Mycoplasma pneumoniae pneumonia in children. BMC Infect Dis, 2020, 20(1): 420. doi:10.1186/s12879-020-05152-x.
[51]	Ryu JS, Kim HJ, Sung IY, et al. Posterior cerebral artery occlusion after Mycoplasma pneumoniae infection associated with genetic defect of MTHFR C677T. J Child Neurol, 2009, 24(7): 891-894. doi:10.1177/0883073808331081.
[52]	中华医学会儿科学分会神经学组. 儿童中枢神经系统感染治疗疗程与腰椎穿刺检查系列建议之四——支原体脑炎治疗疗程与腰椎穿刺检查建议. 中国实用儿科杂志, 2020, 35(1): 9-12. doi:10.19538/j.ek2020010604.
[53]	李默晗, 陶晓娟, 杨双风, 等. 儿童肺炎支原体脑炎MRI征象分析. 中华放射学杂志, 2023, 57(9):1006-1009. doi:10.3760/cma.j.cn112149-20230117-00044.
[54]	Fan G, Guo Y, Tang F, et al. Determining the Clinical Charac-teristics, Treatment Strategies, and Prognostic Factors for Mycoplasma pneumoniae Encephalitis in Children: A Multicenter Study in China. J Clin Neurol, 2023, 19(4): 402-409. doi:10.3988/jcn.2022.0328.
[55]	王琦, 靳蓉, 陈敏, 等. 儿童塑型性支气管炎早期预警分析及可弯曲支气管镜治疗的临床研究. 中华实用儿科临床杂志, 2022, 37(23): 1786-1792. doi:10.3760/cma.j.cn101070-20220617-00732
[56]	Yang B, Zhang W, Gu W, et al. Differences of clinical features and prognosis between Mycoplasma pneumoniae necrotizing pneumonia and non-Mycoplasma pneumoniae necrotizing pneumonia in children. BMC Infect Dis, 2021, 21(1): 797. doi:10.1186/s12879-021-06469-x.
[57]	白新凤, 徐梅先. 儿童肺炎支原体坏死性肺炎预测指标. 国际呼吸杂志, 2023, 43(9): 1083-1088. doi:10.3760/cma.j.cn131368-20230413-00239.
[58]	国家卫生健康委员会人才交流服务中心儿科呼吸内镜诊疗技术专家组, 中国医师协会儿科医师分会内镜专业委员会, 中国医师协会内镜医师分会儿科呼吸内镜专业委员会, 等. 中国儿科可弯曲支气管镜术指南(2018年版). 中华实用儿科临床杂志, 2018, 33(13): 983-989. doi:10.3760/cma.j.issn.2095-428X.2018.13.006.
[59]	Xu X, Li H, Sheng Y, et al. Nomogram for Prediction of Bronchial Mucus Plugs in Children with Mycoplasma pneumoniae Pneumonia. Sci Rep, 2020, 10(1): 4579. doi:10.1038/s41598-020-61348-w.
[60]	Lu J, Zhang J, Wang G, et al. Effects of bronchoalveolar lavage on Mycoplasma pneumoniae pneumonia: A propensity score matched-cohort study. Front Pediatr, 2023, 10: 1066640. doi:10.3389/fped.2022.1066640.