不同类型病原体感染社区获得性肺炎临床与影像特征及转归  

Clinical characteristics,imaging features and outcomes of patients with community-acquired pneumonia caused by different pathogens

作　　者：赵登峰[1] 徐慧[2] 陈恒[1] 李静[1] 杨东明 汪茂胜[3] ZHAO Deng-feng;XU Hui;CHEN Heng;LI Jing;YANG Dong-ming;WANG Mao-sheng(The First Affiliated Hospital of Nanyang Medical College,Nanyang,Henan 473000,China;不详)

机构地区：[1]南阳医学高等专科学校第一附属医院呼吸与危重症医学科,河南南阳473000 [2]南阳医学高等专科学校第一附属医院感染管理科,河南南阳473000 [3]南阳医学高等专科学校临床医学系,河南南阳473000

出　　处：《中华医院感染学杂志》2021年第18期2768-2772,共5页Chinese Journal of Nosocomiology

基　　金：河南省高等学校青年骨干教师基金资助项目(2014GGJS-187)。

摘　　要：目的探讨不同病原体感染社区获得性肺炎(CAP)临床特点、影像特征及转归。方法收集2017年1月-2019年6月南阳医学高等专科学校第一附属医院收治的678例CAP患者临床资料。了解患者病原学分布情况,评估不同类型肺炎患者临床特点、胸部计算机断层扫描(CT)影像学表现、炎症指标[C-反应蛋白(CRP)、降钙素原(PCT)、白细胞(WBC)、白介素-6(IL-6)]水平及转归情况。结果678例CAP患者中病原体检测阳性420例,阳性率61.95%,细菌性肺炎、病毒性肺炎、肺炎支原体肺炎及混合型感染肺炎的比例分别为44.29%、30.00%、11.90%和13.81%。不同类型CAP患者性别、病情严重程度比较差异无统计学意义。细菌性肺炎胸痛症状比例最高,病毒性肺炎喘鸣音比例最高,支原体肺炎咳嗽比例最高,混合型感染肺炎咳痰比例最高。不同病原体感染病变部位、CT特点比较差异有统计学意义(P<0.05)。不同类型病原体感染CAP患者炎症指标CRP、PCT、WBC、IL-6比较差异有统计学意义(P<0.05),混合型感染CAP各指标水平最高,细菌性CAP次之。混合型感染CAP患者转归不良率(34.48%)最高。结论不同病原体感染CAP临床特点、影像学表现及转归均存在差异,混合型感染炎症指标水平最高,预后转归最差。OBJECTIVE To explore the clinical characteristics,imaging features and outcomes of patients with community-acquired pneumonia(CAP)caused by different species of pathogens.METHODS The clinical data were collected from 678patients with CAP who were treated in the First Affiliated Hospital of Nanyang Medical College from Jan 2017to Jun 2019.The distribution of pathogens was observed,the clinical characteristics,chest computed tomography(CT)imaging features,inflammatory factors[C-reactive protein(CRP),procalcitonin(PCT),white blood cell(WBC),interleukin-6(IL-6)]and treatment outcomes were observed and compared among the patients with different types of pneumonia.RESULTS Among the 678CAP patients,420were tested positive for pathogens,with the positive rate 61.95%;the patients with bacterial pneumonia accounted for 44.29%,the patients with viral pneumonia 30.00%,the patients with Mycoplasma pneumoniae pneumonia 11.90%,the patients with mixed types of pneumonia 13.81%.There were no significant differences in the gender and severity of disease among the patients with different types of CAP.The proportion of the bacterial pneumonia patients and chest pain symptom was the highest,the proportion of the viral pneumonia patients with wheezing rales was the highest,the proportion of the M.pneumoniae pneumonia patients with cough was highest,and the proportion of the mixed types of pneumonia patients with expectoration was the highest.As compared with sites of lesions and CT characteristics,the rate of adverse outcomes of the patients with mixed types of pneumonia was the highest(34.48%).CONCLUSION There are significant differences in the clinical characteristics,imaging features and outcomes among the patients with CAP caused by different pathogens,the levels of inflammatory factors of the patients with mixed types of pneumonia are the highest,and the treatment outcomes are the poorest.

关 键 词：社区获得性肺炎 细菌 病毒 肺炎支原体 临床特点 影像学表现 转归 

分 类 号：R563.1[医药卫生—呼吸系统]