Narita Mitsuo
Department of Pediatrics, Sapporo Tetsudo Hospital, N 3 E 1 Chuo-ku, Sapporo 060-0033, Japan.
Pediatr Neurol. 2009 Sep;41(3):159-66. doi: 10.1016/j.pediatrneurol.2009.04.012.
Mycoplasma pneumoniae has been associated with various neurologic manifestations, but exactly how the organism can cause such a wide variety of diseases is a long-standing mystery. In this respect, although pneumonia has been considered the hallmark of Mycoplasma pneumoniae infection, emerging accumulations of data have revealed that the infection can cause a number of extrapulmonary manifestations even in the absence of pneumonia. The importance of host immune response in the pathomechanism of pneumonia has been established, but the pathomechanisms of extrapulmonary manifestations remain largely unknown. For this review, extrapulmonary manifestations due to M. pneumoniae infection were classified into three categories: a direct type, in which locally induced cytokines must play a role; an indirect type, in which immune modulation such as autoimmunity must play a role; and a vascular occlusion type, in which vasculitis or thrombosis (either or both, and with or without systemic hypercoagulable state) must play a role. This classification was then applied within a literature review for neurologic manifestations. Most neurologic manifestations due to M. pneumoniae infection could be reasonably classified into and explained by one of the three types of pathomechanisms.
肺炎支原体与多种神经系统表现有关，但该生物体究竟如何引发如此多种疾病仍是一个长期存在的谜团。在这方面，尽管肺炎一直被视为肺炎支原体感染的标志，但越来越多的数据表明，即使没有肺炎，该感染也可导致多种肺外表现。宿主免疫反应在肺炎发病机制中的重要性已得到证实，但肺外表现的发病机制仍 largely unknown。在本综述中，肺炎支原体感染所致的肺外表现分为三类：直接型，即局部诱导的细胞因子必定起作用；间接型，即自身免疫等免疫调节必定起作用；血管阻塞型，即血管炎或血栓形成（单独或两者兼有，伴有或不伴有全身高凝状态）必定起作用。然后将这种分类应用于神经系统表现的文献综述中。大多数肺炎支原体感染所致的神经系统表现可合理地归类为这三种发病机制之一并由其解释。
