成人鼻病毒肺炎临床特征和混合感染病原学特点分析  

Clinical features and etiological characteristics of co-infections in adult patients with rhinovirus pneumonia

作　　者：李丽娟[1] 刘思危 孙凌霄 王一民[1] 刘颖梅[1] 王金祥[3] 任亚莉 刘波[5] 潘建亮 刘菲菲[7] 宋丽斯 王传[9] 曹彬[1] LI Lijuan;LIU Siwei;SUN Lingxiao;WANG Yimin;LIU Yingmei;WANG Jinxiang;REN Yali;LIU Bo;PAN Jianliang;LIU Feifei;SONG Lisi;WANG Chuan;CAO Bin(Department of Respiratory And Critical Care Medicine,National Center for Clinical Research on Respiratory Diseases,China-Japan Friendship Hospital,Beijing 100029,P.R.China;School of Science and Engineering,The Chinese University of Hong Kong(Shenzhen),Shenzhen,Guangdong 518172,P.R.China;Beijing Luhe Hospital of Capital Medical University,Beijing 101149,P.R.China;Second Hospital of Hebei Medical University,Shijiazhuang,Hebei 050052,P.R.China;Linzi District People's Hospital ofZibo,Zibo,Shandong 255400,P.R.China;Second People's Hospital of Weifang,Weifang,Shandong 261041,P.R.China;First Hospital of Qin Huang Dao,Qin Huang Dao,Hebei 066001,P.R.China;Beijing Shijingshan Hospital,Beijing 100043,P.R.China;First Hospital of Shijiazhuang,Shijiazhuang,Hebei 050011,P.R.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]香港中文大学(深圳)理工学院,广东深圳518172 [3]北京潞河医院,北京101149 [4]河北医科大学第二医院,河北石家庄050052 [5]淄博市临淄区人民医院,山东淄博255400 [6]潍坊市第二人民医院,山东潍坊261041 [7]秦皇岛市第一医院,河北秦皇岛066001 [8]北京市石景山医院,北京100043 [9]石家庄市第一医院,河北石家庄050011

出　　处：《中国呼吸与危重监护杂志》2020年第5期451-456,共6页Chinese Journal of Respiratory and Critical Care Medicine

基　　金：国家科技支撑计划(2015BAI12B11);北京市科技计划课题(D151100002115004)。

摘　　要：目的探讨成人鼻病毒肺炎的临床特征及预后。方法从2016年8月至2018年8月入住全国8家二级或三级医院呼吸科或重症监护病房的49例鼻病毒肺炎患者为研究对象,患者均行支气管镜和支气管肺泡灌洗液鼻病毒核酸检测,根据是否合并其他病原学感染,分为单纯鼻病毒肺炎组(24例)和混合感染组(25例)。收集患者的一般资料,包括年龄、性别、基础疾病、是否合并免疫功能低下、症状、疾病严重程度、影像学表现、病原学特征、是否合并呼吸衰竭、机械通气、是否应用血管活性药物、抗菌药物应用情况、住院病死率等。结果 13例(26.5%)鼻病毒肺炎患者没有任何基础疾病,8例(16.3%)患者合并慢性基础肺疾病,6例(12.2%)患者合并糖尿病,10例(20.4%)患者合并免疫功能低下,16例(32.7%)患者合并呼吸衰竭,住院病死率8.2%(4/49)。混合感染组患者合并脑血管病和意识障碍的比例、PSI评分、CURB-65评分>1分的比例、呼吸衰竭的比例和住院病死率明显高于单纯鼻病毒肺炎组(P<0.05)。鼻病毒肺炎中合并混合感染25例(51.0%),其中细菌检出18株(36.7%),其他病毒12株(24.5%),真菌(肺孢子菌、曲霉)12株(24.5%),细菌感染中以肠杆菌属和铜绿假单胞菌为主。死亡的4例患者均为混合感染。结论成人鼻病毒肺炎多合并基础疾病,且易合并混合感染,住院病死率高。Objective To explore the clinical features, etiological characteristics of co-infections in adult patients with rhinovirus pneumonia. Methods Fourty-nine patients admitted to hospitals for rhinovirus pneumonia were enrolled from 8 medical centers in China's Mainland between August 2016 and August 2018. Multiplex real-time polymerase chain reaction assays for viral detection were implemented to all bronchoalveolar lavage fluid specimens obtained from the patients. The patients were divided into two groups depending on the status of other etiology coinfection(simple rhinovirus pneumonia group, n=24;coinfections group, n=25). The general data were collected, age,gender, underlying diseases, corticosteroids, symptoms, disease severity, imaging manifestations, etiology, whether patients with respiratory failure, mechanical ventilation, whether the application of vasoactive drugs, antibiotics application, hospital mortality rate of the two groups were reviewed and compared in detail. Results Thirteen patients(26.5%) with rhinovirus pneumonia had no underlying diseases, 8 patients(16.3%) with chronic underlying lung diseases,6 patients(12.2%) with diabetes mellitus, 10 patients(20.4%) were immunocompromised patients, 16 patients(32.7%)with respiratory failure, and the hospital mortality rate was 8.2%(4/49). Cases with coinfection were remarkably correlated with more cerebrovascular diseases and disturbance of consciousness, higher PSI score and higher ratio of CURB-65 score>1, more respiratory failure and hospital mortality than those of simple rhinovirus pneumonia group(P< 0.05). There were 25 cases(51.0%) with mixed infection, including 18 bacteria(36.7%), 12 viruses(24.5%), 12(24.5%) fungi(pneumocystis, aspergillus). Enterobacter and Pseudomonas aeruginosa were most frequently identified bacteria in the viral-bacterial group. Four patients with coinfections died. Conclusions Rhinovirus pneumonia in adult patients often has underlying diseases, and is prone to coinfections(bacteria, fungi, and other viruses). The outc

关 键 词：鼻病毒 肺炎 混合感染 预后 

分 类 号：R563.1[医药卫生—呼吸系统]