摘要
肺炎支原体(Mycoplasma pneumoniae,Mp)是儿童和青少年社区获得性肺炎的主要病原体之一。近年来,由于大环内酯类抗生素耐药Mp的出现以及针对Mp的有效疫苗缺乏,以持续发热和/或临床恶化为主要表现的重症肺炎支原体肺炎及难治性肺炎支原体肺炎比例逐年上升。Mp致病机制比较复杂,主要包括肺内损伤和肺外多系统损伤。肺内损伤机制通常表现为Mp通过黏附素、毒素、代谢产物等对宿主细胞造成直接损伤;通过诱导促炎因子释放,激活NLR家族蛋白3炎症小体和核因子κB等信号通路造成免疫炎性损伤;通过免疫逃逸策略实现持续定植造成长期潜伏和慢性感染性损伤。肺外损伤则是由Mp直接侵袭和宿主免疫介导共同驱动,常累及多器官多系统,需格外警惕并及时诊断和治疗,以改善患者预后。本文重点概述Mp感染的肺内/外致病机制,为未来聚焦多靶点联合治疗、疫苗研发,以优化诊疗策略并控制重症风险提供理论依据。
Mycoplasma pneumoniae(Mp)is one of the primary pathogens causing community-acquired pneumonia in children and adolescents.In recent years,the emergence of macrolide-resistant Mp strains and the lack of effective vaccines against Mp have led to an increasing proportion of severe Mycoplasma pneumoniae pneumonia and refractory Mycoplasma pneumoniae pneumonia,which are characterized by persistent fever and/or clinical deterioration.The pathogenic mechanisms of Mp are complex,primarily involving intrapulmonary and extrapulmonary multi-system damage.Intrapulmonary damage mechanisms typically include:direct injury to host cells by Mp via adhesins,toxins,and metabolites;immune-inflammatory damage induced by the release of pro-inflammatory factor and the activation of signaling pathways such as the NLR family pyrin domain containing 3(NLRP3)inflammasome and nuclear factor kappa B(NF-κB).Long-term latent and chronic infectious damage resulting from persistent colonization through immune evasion strategies.Extrapulmonary damage is driven by both direct Mp invasion and host immune mediation,often affecting multiple organs and systems.Thus,heightened vigilance and timely diagnosis and treatment are essential to improve patient prognosis.This review focuses on summarizing the intrapulmonary and extrapulmonary pathogenic mechanisms of Mp infection,providing a theoretical basis for future multi-target combination therapies,vaccine development,and the optimizing of diagnostic and treatment strategies to control the risk of severe disease.
作者
陶宇煊
王军
蔡秦真
陈添
伍墨
庹文彬
姚聪
商宇
袁纯辉
向贇
Tao Yuxuan;Wang Jun;Cai Qinzhen;Chen Tian;Wu Mo;Tuo Wenbin;Yao Cong;Shang Yu;Yuan Chunhui;Xiang Yun(Department of Laboratory Medicine,Wuhan Children's Hospital,Tongji Medical College Huazhong University of Science&Technology,Wuhan 430016,China;School of Laboratory Medicine,Hubei University of Chinese Medicine,Wuhan 430065,China;Children's Health Section,Wuhan Children's Hospital,Tongji Medical College Huazhong University of Science&Technology,Wuhan 430016,China)
出处
《中华微生物学和免疫学杂志》
北大核心
2025年第12期1066-1073,共8页
Chinese Journal of Microbiology and Immunology
基金
国家自然科学基金(82202536)
武汉市卫生健康委员会自然基金(WX21M03)。
关键词
肺炎支原体
致病机制
肺内感染
肺外损伤
免疫逃逸
Mycoplasma pneumoniae
Pathogenic mechanisms
Pulmonary infection
Extrapulmonary injury
Immune evasion
