成人肺炎支原体急性感染致社区获得性肺炎的临床特征：一项多中心横断面研究  

The clinical characteristics of adult patients with community acquired pneumonia caused by acute Mycoplasma pneumoniae infection： a multicentre cross-sectional study

作　　者：宋莉红 肖红丽[2] 辛德莉[4] 崔立建[3] 刘晓亚[3] 王艳[2] 刘春灵[5] 阴桢宏[6] 

机构地区：[1]北京广外医院急诊科,100080 [2]首都医科大学附属北京友谊医院急诊科,100050 [3]首都医科大学附属北京友谊医院感染内科,100050 [4]北京热带医学研究所,100050 [5]空军总医院感染科,北京100142 [6]首都医科大学附属北京妇产医院内科,100026

出　　处：《中华危重病急救医学》2016年第6期492-497,共6页Chinese Critical Care Medicine

基　　金：基金项目：首都医学发展科研基金（2009-1033）

摘　　要：目的分析成人肺炎支原体（MP）急性感染所致社区获得性肺炎（CAP）患者的临床特征，为临床早期识别MP感染提供依据。方法采用前瞻性多中心横断面研究方法，选择2011年8月至2015年10月北京友谊医院、北京广外医院、空军总医院收治的452例CAP患者。于初诊时取患者静脉血和咽拭子标本，联合应用双份血清抗体滴度以及MP-DNA巢氏聚合酶链反应（PCR）检测以确诊成人MP感染患者，并鉴别急性感染、既往感染、病原携带者及非MP感染者。分析非MP感染者与MP急性感染者的基线资料、临床指标及胸部影像学结果，总结MP急性感染者的临床特征。结果452例CAP患者中，MP感染患者288例（占63．7％），非MP感染者164例（占36．3％）；MP感染患者中急性感染者56例（占12．4％），既往感染者10例（占2．2％），病原携带者222例（占49．1％），说明成人容易携带MP。MP急性感染与非MP感染患者性别、年龄、体温升高程度、发热时间、咳痰、气促、肺部哕音、基础疾病等比较差异均无统计学意义，说明两组基线资料均衡可比。夏季、秋季MP急性感染率（分别为43．9％和43．5％）较春季、冬季（分别为13．3％和12．3％）多见。实验室检查结果显示，MP急性感染组血清心肌肌钙蛋白T（eTnT）水平增高患者比例较非MP感染组明显增多（30．4％比9．8％，P〈0．01），说明MP急性感染患者更易发生心肌损伤；而两组其他血常规、电解质、血糖以及心、肝、肾功能指标差异均无统计学意义。胸部影像学观察结果显示：与非MP感染患者比较，MP急性感染者肺部CT影像学表现以双肺弥漫病变（57．1％比37．2％）和纵隔淋巴结肿大（60．7％比37．8％）为主，其病变较少发生在右肺中叶（12．5％比32．9％），且差异有统计学意义（均尸〈0．01）；而两组肺部磨玻璃影、肺叶和肺段实变Objective To investigate the clinical characteristics of adult patients with community acquired pneumonia （CAP） caused by acute Mycoplasma pneumortiae （MP） infection, and provide evidence for early identification of MP infection. Methods A prospective, multicenter and cross-sectional study was conducted. 452 adult patients with CAP admitted to Beijing Fr/endship Hospital, Beijing Guangwai Hospital and Air Force General Hospital from August 2011 to October 2015 were enrolled. The diagnosis of adult MP infection was confirmed by the combined application of double serum antibody titer and MP-DNA nested polymerase chain reaction （PCR） through testing serum and throat swabsamples from patients to identify acute infections, past infections, pathogen carrying, and non-MP infection. The clinical characteristics of patients with acute MP infection were summarized by analyzing the baseline data, clinical parameters and chest imaging findings in patients with non-MP infection and acute MP infection. Results Of 452 enrolling patients with CAP, 288 patients （63.7%） suffered from MP infection, and 164 patients （36.3%） with non-MP infection. There were 56 patients （12.4%） with acute infection, 10 patients （2.2%） with past infections, 222 patients （49.1%） with pathogen carriers in MP infective patients indicating susceptible to MP in adult patients. There were no significant differences in gender, age, fever extent, duration of fever, sputum production, shortness of breath, rales, underlying diseases, etc. between non-MP infection and acute MP infection patients, which suggested that the baseline data of the two groups were equilibrium. The acute infection rates of MP in summer and autumn （43.9% and 43.5% respectively） were more than those in spring and winter （13.3% and 12.3% respectively）. It was shown by laboratory examination results that serum cardiac troponin T （cTnT） increased significantly in acute MP infectious patients more than that in non-MP infection patients （30.4% vs.

关 键 词：成人 社区获得性肺炎 肺炎支原体 临床特征 

分 类 号：R563.1[医药卫生—呼吸系统]