难治性肺炎支原体肺炎的中西医结合治疗研究进展

Research progress in integrated traditional Chinese and western medicine treatment of refractory Mycoplasma pneumoniae pneumonia

摘要

难治性肺炎支原体肺炎（RMPP）是儿童社区获得性肺炎中一类病程迁延、并发症多发的特殊类型。其发生既与耐药肺炎支原体持续存在和毒素作用相关，也与宿主免疫应答失衡、炎症因子风暴和气道黏液栓形成密切相关，部分患儿累及多系统器官。当前西医治疗以抗生素为基础，大环内酯类因耐药率高而疗效受限，四环素类与氟喹诺酮受年龄和安全性约束；糖皮质激素及静脉丙种免疫球蛋白在高炎症表型患儿中可改善短期结局，但用药指征、时机、剂量与长期安全性仍缺乏统一规范。纤维支气管镜肺泡灌洗可清除痰栓，改善通气，但缺少多中心随机对照证据。中医药从“风热犯肺、痰热壅肺、正虚邪恋”等病机出发，以清热解毒、宣肺化痰、益气扶正为主要治则，多靶点调节炎症及免疫反应，相关方剂与中成药在临床研究和系统评价中显示对退热、症状缓解和影像吸收具有一定优势。中西医结合方案在缩短病程、降低炎症负荷以及减少激素用量方面表现出协同效应，有望改善RMPP患儿的短期及远期预后。本文围绕RMPP的病理机制、治疗难点及西医、中医和中西医结合治疗的循证依据进行系统梳理，提出基于病程分期与表型分层的综合管理思路，为进一步优化治疗策略和设计高质量临床试验提供参考。

Abstract

Refractory Mycoplasma pneumoniae pneumonia(RMPP) represents a special type of pediatric respiratory infection, characterized by prolonged course of disease and frequent complications. Its occurrence is related to not only the persistent existence of drug-resistant Mycoplasma pneumoniae and toxic action but also imbalanced host immune response, inflammatory cytokine storm and formation of airway mucus plug, and some child patients have multiple system organs involved. Current western medicine treatment relies mainly on antibiotics; however, the effect of macrolide is limited because of high drug resistance, while tetracyclines and fluoroquinolones are restricted by age and safety. Corticosteroids and intravenous immunoglobulin(IVIG) can improve short-term outcomes in high-inflammatory phenotypes, yet there is still no unified norms for indications, timing, dosage, and long-term safety of medication. Bronchoscopic alveolar lavage facilitates mucus clearance and ventilation improvement, but there is a lack of randomized controlled multicenter evidence. Based on the pathogenesis of "wind-heat invading the lung, phlegm-heat obstructing the lung and healthy qi deficiency with lingering pathogens", and with its therapeutic principles of "clearing heat and removing toxin, ventilating the lung and resolving phlegm and tonifying qi and strengthening healthy qi", traditional Chinese medicine(TCM) exerts multi-target anti-inflammatory and immunomodulatory effects. Clinical researches and systematic evaluation have shown that related prescriptions and Chinese patent medicines have some advantages in clearing fever, relieving symptoms and imaging absorption. The protocols combining TCM and western medicine have shown synergistic effects in shortening disease course, decreasing inflammatory load and reducing hormone use, which is expected to improve the short-term and long-term prognosis of RMPP children. This review systematically collates the pathogenesis, treatment challenges and evidence-based evidence of RMPP in western medicine, traditional Chinese medicine and integrated Chinese and western medicine, and proposes the comprehensive management ideas based on stages of disease course and phenotypic stratification, aiming to provide a reference for further optimizing therapeutic strategies and designing high-quality clinical trials.

关键词

难治性肺炎支原体肺炎 / 病理机制 / 中医药 / 中西医结合 / 儿童

Key words

Refractory Mycoplasma pneumoniae pneumonia / Pathogenesis / Chinese medicine / Integrated traditional Chinese and western medicine / Child

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基金资助

国家卫生健康委能力建设和继续教育中心2025年度专项研究课题(GWJJZX20251002017)

潍坊市卫生健康委中医药科研项目(WFZYY2025-1-20)