基于TLR2/MyD88/NF-κB信号通路探讨纤维支气管镜肺泡灌洗联合阿奇霉素及甲泼尼龙治疗儿童重症肺炎支原体肺炎的疗效与机制

doi:10.3969/j.issn.1006-5725.2026.11.023

Abstract

Abstract:

Objective To investigate the efficacy and mechanism of fiberoptic bronchoscopic alveolar lavage （BAL） in combination with azithromycin and methylprednisolone in the treatment of severe Mycoplasma pneumoniae pneumonia （SMPP） through the Toll-like receptor 2 （TLR2）/myeloid differentiation factor 88 （MyD88）/nuclear factor-κB （NF-κB） signaling pathway. Methods Eighty-four cases of children with SMPP caused by Mycoplasma pneumoniae （MP） infection， who were admitted to the Pediatrics Department of Wuhan First Hospital from January 2022 to January 2024， were selected as the observation group （n = 84）. All of them received BAL combined with conventional symptomatic treatment， azithromycin， and methylprednisolone treatment. Another 84 cases of children with SMPP caused by MP infection during the same period were selected as the control group. The observation group received BAL combined with conventional symptomatic treatment， azithromycin， and methylprednisolone， whereas the control group received only conventional symptomatic treatment， azithromycin， and methylprednisolone. Both groups were treated for 7 days. Therapeutic efficacy， recovery parameters， lung function， blood gas analysis， and TLR2/MyD88/NF-κB signaling pathway markers were compared between the two groups before and after treatment. Adverse reactions were also monitored during the treatment period. Results After a 7-day treatment period， the total effective rate in the observation group was significantly higher than that in the control group ［97.62% （82/84） vs. 84.52% （71/84）， P < 0.05］. The durations of cough， pulmonary rales， fever resolution， and hospitalization in the observation group were significantly shorter than those in the control group （all P < 0.05）. After treatment， the levels of arterial partial pressure of carbon dioxide （PaCO?）， along with the expression of TLR2 mRNA， MyD88 mRNA， and NF-κB mRNA in peripheral blood mononuclear cells （PBMC）， decreased in both groups compared with the baseline values. Notably， the observation group exhibited significantly lower levels （all P < 0.05）. In contrast， the time to peak tidal expiratory flow as a proportion of expiratory time （TPTEF/TE）， maximum mid-expiratory flow （MMEF）， volume to peak expiratory flow as a proportion of exhaled volume （VPTEF/VE）， oxygenation index （OI）， arterial oxygen saturation （SaO?）， and arterial partial pressure of oxygen （PaO?） increased in both groups after treatment. The observation group showed significantly higher values （all P < 0.05）. The overall incidence of adverse reactions was 5.95% （5/84） in the control group and 8.33% （7/84） in the observation group， and there was no statistically significant difference between the two groups （P = 0.549）. Conclusion BAL， when combined with azithromycin and methylprednisolone， effectively enhances lung function and blood gas parameters， downregulates the TLR2/MyD88/NF-κB signaling pathway， and facilitates clinical recovery in children with MP-induced SMPP， exhibiting favorable efficacy and safety profiles.

Key words: bronchoscopic alveolar lavage, severe mycoplasma pneumoniae pneumonia, lung function, blood gas analysis, toll receptor 2, myeloid differentiation protein 88, nuclear factor-κB

CLC Number:

R725.6

Junfeng HU,Ying NIE,Changjian CHEN,Yangcan MING,Aili WANG. Investigating the efficacy and mechanism of fiberoptic bronchoscopic alveolar lavage combined with azithromycin and methylprednisolone in the treatment of severe mycoplasma pneumoniae pneumonia in children via the TLR2/MyD88/NF-κB signaling pathway[J]. The Journal of Practical Medicine, 2026, 42(11): 2070-2076.

Figures/Tables 7

Tab.1

Tab.2

Tab.3

Tab.4

Tab.5

Tab.6

Tab.7

References 27

[1]	徐炎，孙丽平，田野，等.小儿肺炎8368例住院病例回顾性分析［J］. 中华中医药杂志， 2020， 35（6）： 3078-3080. doi： 10. 13193/j.issn.1673-7717.2020.06.056 . doi: 10. 13193/j.issn.1673-7717.2020.06.056
[2]	张宙，赖来清，郭惠娴，等. 2012-2019年广州市越秀区急性呼吸道感染住院患儿肺炎支原体、肺炎衣原体及嗜肺军团菌分布特点［J］. 实用医学杂志， 2021， 37（15）： 2017-2021. doi： 10.3969/j.issn.1006-5725.2021.15.022 . doi: 10.3969/j.issn.1006-5725.2021.15.022
[3]	ZHANG X， SUN R， JIA W， et al. Clinical characteristics of lung consolidation with mycoplasma pneumoniae pneumonia and risk factors for mycoplasma pneumoniae necrotizing pneumonia in children［J］. Infect Dis Ther， 2024， 13（2）： 329-343. doi： 10.1007/s40121-023-00808-6 . doi: 10.1007/s40121-023-00808-6
[4]	王潜，杨菊华，陈乡，等. 基于宏基因组二代测序的儿童肺炎支原体耐药基因位点分析［J］. 中华儿科杂志， 2024， 62（5）： 457-461. DOI： 10.3760/cma.j.cn112140-20240105-00019 . doi: 10.3760/cma.j.cn112140-20240105-00019
[5]	FAN F， LV J， YANG Q， et al. Clinical characteristics and serum inflammatory markers of community-acquired mycoplasma pneumonia in children［J］. Clin Respir J， 2023， 17（7）： 607-617. doi： 10.1111/crj.13620 . doi: 10.1111/crj.13620
[6]	LAI M， AI T， YANG S， et al. The value of high-sensitivity c-reactive protein in evaluating myocardial damage and the prognosis in children with mycoplasmal pneumonia［J］. Ann Clin Lab Sci， 2021， 51（5）： 721-725. doi： 10.1093/acls/acab034 . doi: 10.1093/acls/acab034
[7]	YU H， CHEN L， YUE C J， et al. Effects of propofol and sevoflurane on t-cell immune function and th cell differentiation in children with smpp undergoing fibreoptic bronchoscopy［J］. Ann Med， 2022， 54（1）： 2574-2580. doi： 10.1080/07853890.2022. 2035102 . doi: 10.1080/07853890.2022. 2035102
[8]	SHI L， WU Q G， ZHANG J C， et al. Mechanism of shuang-huang-lian oral liquid for treatment of mycoplasmal pneumonia in children on network pharmacology［J］. Comb Chem High Throughput Screen， 2020， 23（9）： 955-971. doi： 10.2174/1386207323666200520112507 . doi: 10.2174/1386207323666200520112507
[9]	CHEN J， YIN Y， ZHAO L， et al. Mycoplasma pneumoniae infection prediction model for hospitalized community-acquired pneumonia children［J］. Pediatr Pulmonol， 2021， 56（12）： 4020-4028. doi： 10.1002/ppul.25664 . doi: 10.1002/ppul.25664
[10]	XU J， LIU L Y， ZHI F J， et al. DDX5 inhibits inflammation by modulating m6A levels of TLR2/4 transcripts during bacterial infection［J］. EMBO Rep， 2024， 25（2）： 770-795. doi： 10.15252/embr.202357696 . doi: 10.15252/embr.202357696
[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）［J］. 国际流行病学传染病学杂志， 2023， 50（2）： 79-85. doi： 10.3760/cma.j.cn331340-20230315-00050 . doi: 10.3760/cma.j.cn331340-20230315-00050
[12]	于跑，朱峰，葛争，等. 重症肺炎支原体肺炎患儿早期淋巴细胞亚群表型特征及支气管镜检查表现［J］. 实用医学杂志， 2025， 41（7）： 1062-1069. doi： 10.3969/j.issn.1006-5725.2025. 07.020 . doi: 10.3969/j.issn.1006-5725.2025. 07.020
[13]	韩林梅，任盈丽，李依蔓，等. 深度学习重建算法联合轴扫的低剂量胸部CT在儿童肺炎支原体肺炎中的诊断价值［J］. 实用医学杂志， 2025， 41（21）： 3428-3434. doi： 10.3969/j.issn. 1006-5725.2025.21.019 . doi: 10.3969/j.issn. 1006-5725.2025.21.019
[14]	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［J］. Emerg Microbes Infect， 2022， 11（1）： 1508-1517. doi： 10.1080/22221751.2022.2080664 . doi: 10.1080/22221751.2022.2080664
[15]	MEYER SAUTEUR P M， BERGER C. Proadrenomedullin in mycoplasma pneumoniae community-acquired pneumonia in children［J］. Clin Infect Dis， 2021， 73（7）： e1769-e1771. doi： 10.1093/cid/ciab207 . doi: 10.1093/cid/ciab207
[16]	LEE E， CHOI I. Clinical usefulness of serum lactate dehydrogenase levels in mycoplasma pneumoniae pneumonia in children［J］. Indian J Pediatr， 2022， 89（10）： 1003-1009. doi： 10.1007/s12098-021-03868-6 . doi: 10.1007/s12098-021-03868-6
[17]	HEYMANN W R. More than Mycoplasma-induced rash and mucositis： The potential role of Mycoplasma pneumoniae in Stevens-Johnson syndrome/toxic epidermal necrolysis［J］. J Am Acad Dermatol， 2022， 86（4）： 746-747. doi： 10.1016/j.jaad.2021.12.014 . doi: 10.1016/j.jaad.2021.12.014
[18]	LIU Y N， ZHANG Y F， XU Q， et al. Infection and co-infection patterns of community-acquired pneumonia in patients of different ages in China from 2009 to 2020： A national surveillance study［J］. Lancet Microbe， 2023， 4（5）： e330-e339. doi： 10.1016/S2666-5247（23）00067-4 . doi: 10.1016/S2666-5247（23）00067-4
[19]	MARQUES I R， CALVI I P， CRUZ S A， et al. Shorter versus longer duration of amoxicillin-based treatment for pediatric patients with community-acquired pneumonia： A systematic review and meta-analysis［J］. Eur J Pediatr， 2022， 181（11）： 3795-3804. doi： 10.1007/s00431-022-04568-6 . doi: 10.1007/s00431-022-04568-6
[20]	WU Y， YAO J， ZHANG Y. Effects of acetylcysteine combined with bronchoalveolar lavage under fiberoptic bronchoscopy on blood oxygenation and inflammation in elderly severe pneumonia patients［J］. Am J Transl Res， 2025， 17（12）： 9317-9326. doi： 10.12998/ajtr.v17i12.9317 . doi: 10.12998/ajtr.v17i12.9317
[21]	史洁，汲蕊，管志玉，等. 基于HMGB1-TLR2/TLR4-NF-κB通路探索氧化苦参碱对小鼠微小隐孢子虫感染的影响［J］. 中国血吸虫病防治杂志， 2024， 36（3）： 286-293. doi： 10.16250/j.32.1374.2024019 . doi: 10.16250/j.32.1374.2024019
[22]	BONO C， GUERRERO P， ERADES A， et al. Direct tlr2 signaling through mtor and tbk1 induces c/ebpβ and irf7-dependent macrophage differentiation in hematopoietic stem and progenitor cells［J］. Stem Cells， 2022， 40（10）： 949-962. doi： 10.1002/stem.3640 . doi: 10.1002/stem.3640
[23]	WANG L， XIE Q， XU S， et al. The role of flexible bronchoscopy in children with Mycoplasma pneumoniae pneumonia［J］. Pediatr Res， 2023， 93（1）： 198-206. doi： 10.1038/s41390-022-02088-4 . doi: 10.1038/s41390-022-02088-4
[24]	FLORIN T A， RAMILO O， BANKS R K， et al. Radiographic pneumonia in young febrile infants presenting to the emergency department： Secondary analysis of a prospective cohort study［J］. Emerg Med J， 2023， 41（1）： 13-19. doi： 10.1136/emermed-2022-212664 . doi: 10.1136/emermed-2022-212664
[25]	TIAN J， ZHENG B， YANG L， et al. Effectiveness of 13-valent pneumococcal conjugate vaccine on all-cause pneumonia in children under 5 years in shanghai， China： An observational study［J］. Vaccine， 2023， 41（41）： 5979-5986. doi： 10.1016/j.vaccine.2023.08.011 . doi: 10.1016/j.vaccine.2023.08.011
[26]	HAYASHI T， FUJIWARA Y， KAWANO O， et al. Incidence and risk factors of pneumonia following acute traumatic cervical spinal cord injury［J］. J Spinal Cord Med， 2023， 46（5）： 725-731. doi： 10.1080/10790268.2022.2161024 . doi: 10.1080/10790268.2022.2161024
[27]	MIYASHITA N， NAKAMORI Y， OGATA M， et al. Validation of jrs atypical pneumonia score in patients with community-acquired chlamydia psittaci pneumonia［J］. J Infect Chemother， 2023， 29（9）： 863-868. doi： 10.1016/j.jiac.2023.05.009 . doi: 10.1016/j.jiac.2023.05.009

指标	正向引物	反向引物	引物长度/bp
TLR2 mRNA	5'-TTTGCTGGACTTACCTTCCTTG-3'	5'-CAGTATCTCGCAGTTCCAAACA-3'	218
MyD88 mRNA	5'-GCCTCCTCCTTTCGGTTGTAG-3'	5'-TTCCATGCAGGACATGAAAT-3'	119
NF-κB mRNA	5'-TTTGCTGGACTTACCTTCCTTG-3'	5'-CAGTATCTCGCAGTTCCAAACA-3'	128
内参β-肌动蛋白	5'-CATCTTCTTTTGCGTCGCCA-3'	5'-TAAAAGCAGCCCTGGTGACC-3'	115

项目	对照组（n = 84）	观察组（n = 84）	t/χ²值	P值
年龄/岁	7.85 ± 1.03	8.01 ± 0.89	1.077	0.283
性别/例			0.214	0.643
男	43	40
女	41	44
体质量/kg	17.25 ± 2.57	16.93 ± 2.96	0.748	0.455
症状开始至入院时间/d	4.91 ± 0.78	5.12 ± 0.82	1.701	0.091

疗效	对照组（n = 84）	观察组（n = 84）	χ²值	P值
显效	25（29.76）	34（40.48）	-	-
有效	46（54.76）	48（57.14）	-	-
无效	13（15.48）	2（2.38）	-	-
总有效率/%	84.52	97.62	8.858	0.003

康复情况	对照组（n = 84）	观察组（n = 84）	t值	P值
咳嗽时间	6.94 ± 0.74	6.16 ± 0.87	6.259	< 0.001
肺部啰音消失时间	10.06 ± 1.75	7.49 ± 1.66	9.765	< 0.001
退热时间	4.86 ± 0.64	4.07 ± 0.68	7.754	< 0.001
住院时间	14.81 ± 1.64	11.95 ± 1.71	11.063	< 0.001

指标	例数	对照组				观察组
指标	例数	治疗前	治疗后	t值	P值	治疗前	治疗后	t值	P值
MMEF/（L/s）	48	1.24 ± 0.24	1.54 ± 0.31	5.302	< 0.001	1.27 ± 0.23	1.70 ± 0.28^b	4.150	< 0.001
TPTEF/TE/%	36	22.62 ± 3.23	26.87 ± 3.26	5.557	< 0.001	23.09 ± 3.40	32.81 ± 4.63^b	10.153	< 0.001
VPTEF/VE/%	36	19.96 ± 3.23	24.27 ± 4.78	4.483	< 0.001	20.09 ± 3.62	28.89 ± 4.23^b	9.484	< 0.001

Investigating the efficacy and mechanism of fiberoptic bronchoscopic alveolar lavage combined with azithromycin and methylprednisolone in the treatment of severe mycoplasma pneumoniae pneumonia in children via the TLR2/MyD88/NF-κB signaling pathway

RichHTML

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 7

References 27

Related Articles 8

Recommended Articles

Metrics

Comments

[1]	Neng HU,Jianghua SHEN,Mei YAO,Xinqian ZHAO. The assessment value of nomogram prediction model based on lung ultrasound and clinical indicators for children with severe mycoplasma pneumoniae pneumoniae prognosis [J]. The Journal of Practical Medicine, 2026, 42(5): 869-877.
[2]	Biao LENG,Dequan HONG,Ming TAN,Ming TIAN,Shanliang XIE,Yaoran. TU. Value of serum TFPI-1 combined with NF-κB in prognostic analysis of severe traumatic brain injury [J]. The Journal of Practical Medicine, 2025, 41(16): 2455-2460.
[3]	Xi LI,Xueling LIU,Xiangling TAN,Daoqi. ZHU. Optimizing postoperative recovery efficiency through early⁃stage phased pulmonary rehabilitation in thoracoscopic surgery [J]. The Journal of Practical Medicine, 2025, 41(14): 2237-2242.
[4]	Chi ZHANG,Sai HU,Jing WANG,Fengqiang XIA,Xiaoying CHENG,Zeying. GAN. Involvement of RNF99 in potential link between ubiquitination and septic shock via TAK1/NF⁃κB signaling pathway [J]. The Journal of Practical Medicine, 2024, 40(5): 615-620.
[5]	ZHANG Lisha, YANG Xianmiao, QIAN Fenhong. The significance of differential methylation expression of Cathepsin Z gene promoter in adult asthma [J]. The Journal of Practical Medicine, 2021, 37(7): 874-878.
[6]	. Effect of bio master virtual scene interactive rehabilitation combined with combined breathing training on pulmonary function recovery in elderly patients with COPD [J]. The Journal of Practical Medicine, 2021, 37(5): 681-685.
[7]	WANG Ning, YANG Jiajia, WANG Dandan, MA Pei.. The combined application value of ulinastatin and bronchoscopy in mechanical ventilation of respiratory failure caused by pulmonary infection [J]. The Journal of Practical Medicine, 2021, 37(22): 2914-2918.
[8]	HUANG Jinhua, DENG Guosheng, ZHANG Tingting, QIN Yinyin. . Association between expression of secretory leukocyte proteinase inhibitor in airway and lung function in patients with COPD [J]. The Journal of Practical Medicine, 2021, 37(15): 1953-1957.

指标	对照组（n = 84）				观察组（n = 84）
指标	治疗前	治疗后	t值	P值	治疗前	治疗后	t值	P值
OI/mmHg	278.11 ± 26.28	294.10 ± 28.19	3.803	< 0.001	275.95 ± 28.44	315.76 ± 32.18^b	4.640	< 0.001
SaO₂/%	93.08 ± 1.21	97.34 ± 0.42	30.483	< 0.001	92.84 ± 1.18	98.55 ± 0.35^b	42.519	< 0.001
PaO₂/mmHg	51.34 ± 4.18	67.71 ± 6.19	20.087	< 0.001	50.80 ± 4.33	73.22 ± 7.07^b	24.785	< 0.001
PaCO₂/mmHg	50.98 ± 6.26	38.65 ± 3.21	16.063	< 0.001	52.05 ± 6.23	29.36 ± 3.25^b	29.595	< 0.001

指标	对照组（n = 84）				观察组（n = 84）
指标	治疗前	治疗后	t值	P值	治疗前	治疗后	t值	P值
TLR2 mRNA	1.07 ± 0.26	0.61 ± 0.20	12.853	< 0.001	1.11 ± 0.28	0.43 ± 0.11^b	20.717	< 0.001
MyD88 mRNA	0.91 ± 0.23	0.75 ± 0.17	5.127	< 0.001	0.95 ± 0.26	0.48 ± 0.15^b	14.351	< 0.001
NF-κB mRNA	1.23 ± 0.38	0.54 ± 0.12	15.870	< 0.001	1.30 ± 0.37	0.42 ± 0.11^b	20.894	< 0.001