肺炎支原体肺炎发病机制及相关临床问题_王菲.pdfVIP

·184 · ChineseJournalofPracticalPediatricsMar.2015Vol.30No.3 讲 座 文章编号：1005-2224（2015）03-0184-06 DOI：10.7504/ek2015030608 肺炎支原体肺炎发病机制及相关临床问题 王 菲，尚云晓 摘要：肺炎支原体（MP）是社区获得性肺炎的常见病原，致病机制主要包括对气道上皮的细胞黏附作用，产生氧化 应激；释放CARDS TX ，导致细胞代谢异常；引起免疫反应，导致免疫损伤；侵入白细胞内直接致病。难治性MP 肺 炎通常指正规应用大环内酯类抗生素临床症状未见明显好转的MP 肺炎；C-反应蛋白（CRP）明显升高、肺部大面 积实变及呼吸道纤毛超微结构异常等可能提示RMPP。通常应用大环内酯类抗生素及四环素、喹诺酮类、氨基糖 苷类抗生素通过干扰和抑制蛋白质合成而治疗MP 感染。RMPP 患儿行支气管镜治疗对改善预后有积极作用。 关键词：肺炎支原体；支气管镜；难治性肺炎支原体肺炎 中图分类号：Ｒ72 文献标志码：A Researchprogressofthepathogenesisofmycoplasmapneumoniaepneumoniaanditsrelatedclinicalproblems. WANG Fei，SHANG Yun-xiao. Shengjing Hospital of China Medical University ，Shenyang 110004 ，China Abstracts：Mycoplasma pneumoniae(MP) is a common cause of community-acquired pneumonias. The airway epithelial cell adhesion effect of MP can lead to oxidative stress; CARDS TX is released disturbing the cell metabolism; MP also causes direct pathogenic immune response, leading to immune damage and invades into the white blood cells causing la⁃ tent or chronic infections. RMPP usually refers to mycoplasma pneumonia deterioration despite the appropriate macro⁃ lides treatment.Arised CRP, large area consolidation of lung and ciliary ultrastructural abnormalities may prompt RMPP. Macrolide antibiotics tetracyclines, quinolones and aminoglycosides are used in Mycoplasma pneumoniae infection by in⁃ hibiting and interfering the protein synthesis. Bronchoscopic treatment of RMPP has a positive effect in improving the prognosis. Keywords：mycoplasma pneumoniae; bronchoscope; refractory mycoplasma pneumoniae pneumonia 尽管对MP 肺炎发病机制的研究已有40 余年 床相关问题。 历史，但有关MP 与宿主细胞相互作用、对免疫系 1 MP 肺炎发病机制 统的影响及如何导致肺外系统受累至今尚不十分 ［1-3 ］ 清楚 。近年来，难治性MP 肺炎（refractory myco⁃ 1 . 1 MP 直接毒性作用 MP 在呼吸道致病，主要 plasma pneumoniae pneumonia ，RMPP ）的比例也