摘要
目的通过对住院社区获得性肺炎(CAP)病例的临床及病原学特点进行分析,为临床上治疗CAP提供参考依据。方法收集2016年8月至2017年1月在中国医科大学附属第一医院呼吸与危重症医学科住院治疗的CAP病例的临床资料,进行病原学检测,肺炎严重度指数(PSI)分级及CURB-65评分。结果51例CAP病例中,病原学检测阳性31例(60.8%),单纯肺炎支原体阳性20例(39.2%),单纯嗜肺军团菌阳性4例(7.8%),单纯细菌检测阳性2例(4.0%),检出肺炎克雷伯杆菌1例(2.0%),肺炎链球菌1例(2.0%),混合感染5例(9.8%),嗜肺军团菌合并肺炎支原体4例(7.8%),柯萨奇病毒合并腺病毒1例(2.0%)。CAP患者入院第1日及第3~5日PSI分级及CURB-65评分均以低危为主,随着病情不同转归,PSI分级及CURB-65评分发生改变。结论非典型病原体是成人CAP最常见的病原体,其中肺炎支原体占首位,且多发于14~45岁组,嗜肺军团菌在各年龄组检出率无明显差异。PSI分级及CURB-65评分具有相关性,动态观察有助于评价疗效及判定疾病转归。
Objective To provide a reference for the clinician's initial empirical treatment of community-acquired pneumonia(CAP)by analysis of clinical and pathogenic characteristics of hospitalized CAP cases.Methods Information about CAP cases was provided by the Department of Respiratory Medicine,The First Hospital of China Medical University for the period of August 2016 to January 2017.Patients with CAP were tested for pathogens,and relevant clinical data were collected.The severity of pneumonia was quantitated in terms of pneumonia severity index(PSI)grades and CURB-65 scores.Results Among the 51 cases of CAP studied,31(60.8%)were positive for pathogen detection.Of these 31 cases,20(39.2%),4(7.8%),and 2(4.0%)were positive only for Mycoplasma pneumoniae,Legionella pneumophila,and bacteria(1 case of Klebsiella pneumoniae and 1 case of Streptococcus pneumoniae),respectively.Mixed infection was observed in 5 cases(9.8%),among which there were 4 cases(7.8%)of L.pneumophila infection with M.pneumoniae and 1 case(2.0%)of coxsackievirus co-infection with adenovirus.The PSI grades and CURB-65 scores of patients with CAP on the day of their admission and on days 3-5 were mainly low-risk.However,these PSI grades and CURB-65 scores changed with different clinical outcomes.Conclusion Atypical pathogens were the most common in adult patients with CAP.Among them,M.pneumoniae ranked first in abundance and occurred most frequently in the 14-to 45-year age group.There was no significant difference in the distribution of L.pneumophila across the age groups.PSI grades and CURB-65 scores can provide relevant insights,and dynamic observations may be helpful in evaluating efficacy and subsequent outcomes.
作者
马江伟
毕钰
何丽艳
王秋月
王玮
康健
李尔然
MA Jiangwei;BI Yu;HE Liyan;WANG Qiuyue;WANG Wei;KANG Jian;LI Erran(Department of Respiratory and Critical Care Medicine,The First Hospital,China Medical University,Shenyang 110001,China;Shenyang Central Blood Station,Shenyang 110044,China;Department of Respiratory Medicine,Shenyang Chest Hospital,Shenyang 110044,China)
出处
《中国医科大学学报》
CAS
CSCD
北大核心
2020年第1期1-5,共5页
Journal of China Medical University
基金
国家自然科学基金（30470766）
高等学校博士学科点专项科研基金（20040159011）
教育部留学归国启动基金（教外司留[2004]527号）
辽宁省重点实验室资助项目（2009S105）
辽宁省创新团队项目（LT 2013015）
