摘要
目的探讨高龄(≥80岁)老年人社区获得性肺炎(CAP)的不同病原体感染的特点及危险因素分析。方法回顾性分析94例高龄老年人CAP的临床资料。结果高龄老年人CAP的病原体阳性率为69.15%,其中,最常见致病菌为肺炎链球菌,病毒感染以甲型流感病毒为主,二者混合感染以肺炎链球菌合并甲型流感病毒感染最常见。根据病原体不同,将患者分为细菌阳性组(Ⅰ组)、病毒阳性组(Ⅱ组)、二者混合阳性组(Ⅲ组)、病原体阴性组(Ⅳ组),发现Ⅰ组较Ⅱ组、Ⅳ组有更多吸烟史;与Ⅰ组、Ⅳ组相比,Ⅲ组合并脑血管病史、胸腔积液者更多,降钙素原也更高;与Ⅳ组相比,Ⅱ组、Ⅲ组的C-反应蛋白更高;Ⅰ组、Ⅲ组的CURB-65评分比Ⅱ组高,Ⅲ组的重症肺炎者比Ⅱ组、Ⅳ组多。危险因素分析显示吸烟史是细菌感染的独立危险因素,贫血病史是病毒感染的独立危险因素,脑血管病史、贫血病史是细菌混合病毒感染的独立危险因素。结论高龄老年人CAP的不同病原体感染的特点不一,吸烟史、脑血管病史分别是细菌感染、混合感染的危险因素;贫血病史是病毒感染、混合感染的危险因素。
Objective To investigate the characteristics and risk factors of different pathogens in elderly patients with community-acquired pneumonia(CAP)(≥80 years old).Methods The clinical data of 94 elderly patients with CAP were retrospectively analyzed.Results The pathogen-positive rate of elderly patients with CAP was 69.15%.The most common pathogen was Streptococcus pneumonia.Viral infection was mainly caused by influenza A virus.Bacterial mixed virus infection was mainly caused by Streptococcus pneumonia and influenza A virus infection.According to the different pathogens,they were divided into the bacterial positive group(the groupⅠ),the virus positive group(the groupⅡ),the mixed positive group of both(the groupⅢ),and the pathogen negative group(the groupⅣ).There were more patients with smoking history in the groupⅠthan in the groupⅡandⅣ.Compared with the groupⅠandⅣ,there were more patients with a history of cerebrovascular disease and pleural effusion,and a more pronounced elevation of procalcitonin in the groupⅢ.C-reactive protein in the groupⅡand the groupⅢincreased more significantly than in the groupⅣ.The CURB-65 scores in the groupⅠandⅢwere higher than those in the groupⅡ.The patients with severe pneumonia in the groupⅢwere more severe than those in the groupⅡandⅣ.The analysis of risk factors showed that smoking history was an independent risk factor for bacterial infection alone.The history of anemia was an independent risk factor for viral infection alone.The history of cerebrovascular disease and the history of anemia were independent risk factors for the bacterial-mixed viral infection group.Conclusion The characteristics of different pathogens infection of CAP in the elderly are different.Smoking history is a risk factor for bacterial infection.History of cerebrovascular disease is risk factors for mixed infection.History of anemia is a risk factor for viral infection and mixed infection.
作者
俞婷
余小丽
李鸿茹
陈愉生
YU Ting;YU Xiao-li;LI Hong-ru;CHEN Yu-sheng(the First Department of Cadre Special Diagnosis,,Fujian Provincial Hospital,Fuzhou,Fujian 350001,China;Department of Respiratory and Critical Care Medicine,Fujian Provincial Hospital,Fuzhou,Fujian 350001,China)
出处
《临床肺科杂志》
2023年第4期590-593,599,共5页
Journal of Clinical Pulmonary Medicine
基金
福建省卫生计生青年科研课题(No.2018-1-2)。
