肺炎患者支气管肺泡灌洗液病原阳性率影响因素：多中心回顾性研究  

Influencing factors of positive rate of bronchoalveolar lavage fluid in patients with pneumonia：a multicenter retrospective study

作　　者：李丽娟[1] 刘颖梅[2] 邢西迁 韩秀迪 陈亮[5] 张春晓 王蕾[7] 索立俊[8] 王金祥 于国华 刘波[8] 曹彬[1] Li Lijuan;Liu Yingmei;Xing Xiqian;Han Xiudi;Chen Liang;Zhang Chunxiao;Wang Lei;Suo Lijun;Wang Jinxiang;Yu Guohua;Liu Bo;Cao Bin(Second Department of Respiratory and Critical Care Medicine,Center of Respiratory Medicine,National Clinical Center for Respiratory Diseases,China-Japan Friendship Hospital,Beijing 100029,China)

机构地区：[1]中日友好医院呼吸中心呼吸与危重症医学科二部、国家呼吸疾病临床研究中心,北京100029 [2]首都医科大学附属北京朝阳医院感染和临床微生物科,100020 [3]昆明市延安医院呼吸与危重症医学科,650051 [4]青岛市立医院呼吸与危重症医学科,266071 [5]北京积水潭医院感染性疾病科,100096 [6]北京回民医院呼吸与危重症医学科,100053 [7]日照市中医医院呼吸与危重症医学科,276800 [8]山东临淄区人民医院呼吸与危重症医学科,255400 [9]北京市潞河医院呼吸与危重症医学科,101149 [10]潍坊市第二人民医院呼吸与危重症医学科,261041

出　　处：《国际呼吸杂志》2018年第17期1281-1286,共6页International Journal of Respiration

基　　金：国家科技部科技支撑计划（2015BA112811）;北京市科委重点项目（D151100002115004）

摘　　要：目的研究社区获得性肺炎（CAP）、医疗机构相关性肺炎（HcAP）及免疫低下宿主（ICH）肺炎中支气管肺泡灌洗液（BALF）病原诊断阳性率影响因素。方法采用回顾性研究方法，调查2014年13家医院所有CAP、HCAP及ICH肺炎患者，并且在1周内行BALF病原学检查的住院患者。收集患者的一般资料包括年龄、性别、基础疾病、症状、抗菌药物应用情况，疾病严重程度，影像学表现，住院病死率，住ICU时间等，支气管肺泡灌洗（BAL）检查时间，BALF细菌、真菌培养，病毒和不典型的病原体核酸结果。结果共入选肺炎6056例，其中CAP4869例，HCAP848例，ICH肺炎338例，1周内行BALF检查616例（10．2％），50例重症肺炎，95％在BALF检查前使用过抗菌药物；发病到BALF检查的时间为14（10，24）d；住院到BALF检查的时间为4（2，6）d；未应用抗菌药物BALF细菌阳性率为30．4％，高于应用抗菌药物组（14．8％，P=0．041）；重症CAP和HcAP肺炎BAL细菌和真菌培养阳性率高于非重症患者（P〈0．05）。ICH肺炎BALF细菌和真菌培养阳性率为32．3％，高于HCAP（17．1％）和CAP（13．8％）（P〈0．05）。明确BALF细菌病原学82例肺炎患者中31例（37．8％）根据培养和药敏结果调整了抗菌药物；明确真菌和病毒病原学的全部17例肺炎患者加用针对性抗感染药物。结论重症肺炎和ICH肺炎BALF病原学检查阳性率最高；明确病原学可以指导抗感染药物治疗。Objective To explore bronchoalveolar lavage fluid （BALF） positive rate in the etiological diagnosis of community-acquired pneumonia （CAP）, healthcare associated pneumonia （HCAP） and immunocompromised hosts （ICH） in the real world of China, and to investigate influencing factors of the positive rate. Methods A retrospective study of 13 hospitals in 2014 hospitalized with pulmonary infection, all patients with community acquired pneumonia （CAP）, HCAP or immunocompromised host pulmonary infection, and BALF examination was adopted within 1 weeks after admitted. The general data were collected including age, gender, underlying diseases, symptoms, the use of antibiotics, the severity of the disease, imaging manifestations, hospital mortality, length of stay in ICU, with the results of sputum culture were collected, and bronchoalveolar lavage （BAL） inspection time, BALF bacterial culture, fungal culture, nucleic acids of respiratory viruses, atypical pathogens （mycoplasma, chlamydia）, Legionella and Pneumocystis jiroveci. Results 6 056 cases of pneumonia were collected, including 4 869 cases of CAP, 848 cases of HCAP, 338 cases of ICH pneumonia, 616 cases （10.2%） underwent BALF examination 1 week within admitting, 50 cases had severe pneumonia, 95% had used antibacterial drugs before BALF examination ; 95 % BALF were performed during antimicrobial treatment of the patient. The mean duration from the onset of the symptoms to the performance of BAL was 14（10,24） d and the mean duration of the hospitalization before BAL was 4 （2,6） d. Untreated patients exhibited positive quantitative bacterial cultures （30.4%）, as compared to patients with prior antimicrobial therapy having positive cultures （14.8%, P〈0. 041）. The bacterial and fungal culture positive rates in severe patients were higher than the non-severe patients with CAP, HCAP （ P〈0.05）. The positive rate of BALF bacterial and fungal culture was 32.3% in immunocompromised host （ICH）, it was higher than that o

关 键 词：肺炎 支气管肺泡灌洗液 病原学 

分 类 号：R563.1[医药卫生—呼吸系统]