儿童大环内酯类耐药的重症肺炎支原体肺炎早期识别与治疗  

Early identification and treatment of macrolide-resistant severe Mycoplasmal pneumoniae pneumonia in children

作　　者：于曼 叶乐平 YU Man;YE Leping(Department of Pediatric Respiratory Medicine,Children's Medical Center,Peking University First Hospital,Beijing 102627,China;Department of Pediatrics,Beijing Pinggu Hospital,Beijing 101200,China)

机构地区：[1]北京大学第一医院儿童医学中心儿童呼吸内科,北京102627 [2]北京市平谷区医院儿科,北京101200

出　　处：《医学新知》2025年第4期461-468,共8页New Medicine

基　　金：国家自然科学基金面上项目(82371708);北京大学第一医院跨学科交叉研究专项(2023IR03)。

摘　　要：儿童肺炎支原体肺炎是儿童常见的呼吸系统疾病,受群体免疫下降、大环内酯类抗生素耐药、延误诊疗、混合感染等多种因素影响,重症肺炎支原体肺炎(severe Mycoplasmal pneumoniae pneumonia,SMPP)的发病率呈增长趋势,形势严峻。大部分SMPP患儿临床症状重,病程长,易合并肺实变、肺不张、塑形性支气管炎、肺坏死、肺外表现等严重并发症,遗留支气管扩张、闭塞性细支气管炎等慢性肺疾病,影响患儿生活质量。对于有可能发展为SMPP的患儿,需引起高度重视。通过临床表现、相关实验室检查、肺部影像学、支气管镜下改变等,可以早期识别大环内酯类耐药的SMPP,及时调整个体化治疗方案。尽早诊断并进行有效治疗,可减轻患儿痛苦,缩短病程,减少重症发生率。本文对儿童大环内酯类耐药的SMPP的早期识别及治疗方案进行综述。Mycoplasmal pneumoniae pneumonia(MPP)is a common respiratory disease in children.The incidence of severe MPP(SMPP)has increased and the situation is critical due to a variety of factors such as declining herd immunity,macrolide antibiotic resistance,delayed diagnosis and treatment,and mixed infection.Most children with SMPP have severe clinical symptoms and a long course of disease.SMPP is prone to serious complications such as lung consolidation,atelectasis,plastic bronchitis,necrotizing pneumonia,and extrapulmonary manifestations,leaving behind chronic lung diseases such as bronchiectasis and bronchiolitis obliterans,which affect the quality of children’s life.Children who are likely to develop SMPP should be given high attention.Early identification of SMPP with macrolide-resistant can be achieved by clinical manifestations,relevant laboratory tests,lung imaging,and bronchoscopic changes,and individualized treatment plan can be adjusted in time.Early diagnosis and effective treatment can alleviate the pain of children,shorten the course of disease,and reduce the incidence of severe diseases.This article reviews the early identification and treatment of severe macrolide-resistant MPP in children.

关 键 词：肺炎支原体 大环内酯类抗生素 耐药 重症肺炎 早期识别 治疗 

分 类 号：R725.6[医药卫生—儿科]