四川地区社区获得性肺炎的病原学调查  

The Prevalence of Pathogens in Adult Patients with Community-acquired Pneumonia in Sichuan

作　　者：李群[1] 李为民[2] 高属生[1] 唐风鸣[3] 颜浩[4] 马兵[5] 石平[5] 高培会 张新高[7] 代中全 王开禄[9] 

机构地区：[1]成都市第三人民医院,四川成都610031 [2]四川大学华西医院 [3]宜宾市第一人民医院 [4]成都市第二人民医院 [5]广元市人民医院 [6]雅安市人民医院 [7]自贡市第一人医院 [8]遂宁市人民医院 [9]绵阳市第三人民医院

出　　处：《华西医学》2008年第2期275-277,共3页West China Medical Journal

基　　金：CROTC社区获得性下呼吸道感染科研基金资助

摘　　要：目的：了解四川地区社区获得性肺炎的致病原分布情况及影响CAP致病原分布的因素,为四川地区CAP的经验治疗提供依据。方法：在四川地区采取多中心前瞻性的临床研究,收集2004年4月-2005年3月期间的≥15岁的CAP患者共380例,用PORT评分标准[1]对CAP患者进行危险分级,取患者急性期痰标本进行细菌培养,高热患者（体温〉39℃）行血培养,应用常规方法分离鉴定细菌,用酶联免疫吸附试验（ELISA）检测患者急性期及恢复期肺炎支原体、嗜肺军团菌、肺炎衣原体血清抗体。结果：380例CAP患者的痰或血培养结果显示,细菌感染率为39.74%,其中革兰氏阴性杆菌占66.89%,常见致病菌主要为嗜血杆菌属（8.73%）、肺炎链球菌（7.67%）及肺炎克雷伯菌（7.41%）。行血清学检测的273例CAP患者中非典型病原体69例（25.27%）,其中肺炎支原体感染为50例（18.32%）,13例（4.76%）为肺炎衣原体,6例（2.19%）为嗜肺军团菌。细菌和非典型病原体的混合感染22例（8.06%）。病原体的分布与季节无关（P〉0.05）。肺炎支原体、嗜血杆菌属在≤30岁组的阳性率较高（P〈0.05）;肺炎按PORT分级,肺炎支原体、嗜血杆菌属在Ⅰ、Ⅱ级组的阳性检出率高于Ⅲ~Ⅳ级的患者;军团菌在≥Ⅲ级的患者中多见（5/6）（P〈0.05）。结论：肺炎支原体已为首要的致病原;流感嗜血杆菌和肺炎链球菌是CAP最重要的病原菌;CAP的混合感染不容忽视;革兰阴性杆菌感染增多。在不同年龄和不同PORT分级的患者中CAP病原体构成不同。Objective：To investigate the etiology of community-acquired pneumonia（CAP）in Sichuan and analyse factors that may influence the distribution of common pathogens.Methods：A multicentre prospective study was performed on 380 consecutive adult patients（≥15 years old） with CAP from April 2004 to March 2005 in Sichuan.Sputum samples in all patients and blood samples in patients with high fever（T〉39℃） were collected for bacteria culture.Bacteria were isolated and identified by using conventional methods.Antibodies of the paired serum samples to Mycoplasma pneumoniae,Chlamydia pneumoniae and Legionella pneumophilia were detected.Results：Three hundred and eighty patients（15 to 82 years）were evaluated.Bacteria were isolated from 151 cases（yield,39.74%）,in which Gram-negtive bacilli were up to 66.89%.Haemophilus influenzae,the most common pathogen,was isolated in 33 cases（8.73%）,while Streptococcus pneumoniae presented in 29 cases（7.67%）,Klebsiella pneumonia accounting for 7.41% of the isolates.Specific antibodies were detected in paired serum from 273 cases.The results showed Mycoplasma pneumoniae in 18.32%,Chlamydia pneumoniae in 4.76%and Legionella pneumophilia in 2.19%.Mixed infection of bacteria and atypical pathogens were found in 22 patients（8.06%）.There was no correlation between season and distribution of common pathogens（P〉0.05）.Mycoplasma pneumoniae and Haemophilus species were more frequent among patients aged below 30.According to the criteria conducted by Fine（PORT）,the percent of Mycoplasma pneumoniae and Haemophilus species infections in the low-risk groups（Ⅰ～Ⅱ）was higher than patients in the high-risk groups（Ⅲ～Ⅳ）,while Legionella pneumophilia was the common pathogen in patients in the high-risk groups（≥Ⅲ）（P〈0.05）.Conclusion：Mycoplasma pneumoniae have an important role in CAP,while Haemophilus influenzae and Streptococcus pneumoniae remain the major bacteria.Mixed infection shoud not only be ignored,but infection with G

关 键 词：社区获得性肺炎 病原学 细菌 非典型病原体 

分 类 号：R563.1[医药卫生—呼吸系统]