2015至2019年北京某医院住院患者成人社区获得性肺炎病原学特点及防控研究  

Study on the etiological characteristics and prevention and control of adult community-acquired pneumonia in hospitalized patients in a hospital in Beijing from 2015 to 2019

作　　者：王玫[1] 赵建玉 李雪 吴丽媛 周倩倩 黄艳飞[1] 隋文君[1] 张韶娅 胥杰[5] 金建敏[6] 顾海彤[1] 鲁辛辛[1] Wang Mei;Zhao Jianyu;Li Xue;Wu Liyuan;Zhou Qianqian;Huang Yanfei;Sui Wenjun;Zhang Shaoya;Xu Jie;Jin Jianmin;Gu Haitong;Lu Xinxin(Department of Laboratory Medicine,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China;Department of Laboratory Medicine,Beijing Shunyi Hospital,Beijing 101300,China;Department of Laboratory Medicine,Beijing Anding Hospital,Capital Medical University,Beijing 100029,China;Department of Laboratory Medicine,Guangzhou Women and Childrens Medical Center,Guangzhou 510623,China;Department of Respiratory Medicine,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China;Department of Infectious Disease,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院检验科,北京100730 [2]北京市顺义区医院检验科,北京101300 [3]首都医科大学附属北京安定医院检验科,北京100029 [4]广州市妇女儿童医疗中心检验科,广州510623 [5]首都医科大学附属北京同仁医院呼吸科,北京100730 [6]首都医科大学附属北京同仁医院感染科,北京100730

出　　处：《中华预防医学杂志》2021年第12期1410-1418,共9页Chinese Journal of Preventive Medicine

基　　金：国家科技重大专项“综合医院急性严重呼吸道传染病病原学诊断研究”(2014ZX10004005);国家科技重大专项“结核病多重组合诊断技术的多中心评估”(2018ZX10103001)。

摘　　要：目的探讨成人社区获得性肺炎(community acquired pneumonia,CAP)患者病原体分布特点,为CAP诊疗及防控提供依据。方法回顾性纳入2015年1月至2019年12月首都医科大学附属北京同仁医院5年期间临床确诊的1446例CAP住院患者,中位年龄70岁,男性858例,占59.34%,女性588例,占40.66%。采集呼吸道标本行涂片、培养、聚合酶链反应(polymerase chain reaction,PCR)及抗原抗体检测以明确CAP病原。连续变量用Mann-Whitney U检验;分类资料用χ^(2)检验或者Fisher精确检验进行统计分析。结果(1)1446例患者中822例(56.85%)单一病原体感染,231例(15.98%)混合感染,393例(27.18%)未明确病原。流感病毒是CAP首位病原体(20.95%,303/1446),以甲型流感病毒H1N1亚型(influenza A virus subtype H1N1,H1N1)(8.51%,123/1446)为主,其次为肺炎支原体(7.19%,104/1446),结核分枝杆菌(5.33%,77/1446)及肺炎链球菌(5.05%,73/1446)。(2)2018年12月至2019年2月出现H1N1的暴发流行,2019年8至11月监测到肺炎支原体肺炎流行。<65岁患者肺炎支原体(14.41%比2.41%,χ^(2)=74.712,P<0.001)、肺炎链球菌(8.16%比2.99%,χ^(2)=18.156,P<0.001)、鼻病毒(6.08%比3.56%,χ^(2)=5.025,P=0.025)、肺炎衣原体(5.90%比1.15%,χ^(2)=26.542,P<0.001)及腺病毒(3.13%比0.92%,χ^(2)=9.547,P=0.002)检出率高。(3)CAP重症率为14.66%(212/1446),平均死亡率为3.66%(53/1446),细菌-病毒合并感染的重症率及死亡率分别为28.97%(31/107)和19.63%(21/107)。结论流感病毒是引起成人CAP的首要病原体,在2018年和2019年分别监测到肺炎支原体肺炎和H1N1肺炎的暴发流行,病毒-细菌合并感染者重症率和死亡率显著高于单一病原体感染。Objective To explore the distribution characteristics of pathogens in adult patients with community-acquired pneumonia(CAP)and to provide basis for the diagnosis,treatment,prevention of CAP.Methods 1446 inpatients with CAP were prospectively enrolled in a third-class hospital in Beijing in recent 5 years(from January 2015 to December 2019).Respiratory tract samples were collected for smear,culture,nucleic acid,antigen and antibody detection to identify the pathogen of CAP.Mann-Whitney U test was used for continuous variables andχ2 test or Fisher′s exact test was used for categorical data for statistical analysis.Results Among the 1446 patients,822(56.85%)patients were infected with a single pathogen,231(15.98%)patients were infected with multiple pathogens,and 393(27.18%)patients were not clear about the pathogen.Influenza virus is the first pathogen of CAP(20.95%,303/1446),mainly H1N1(8.51%,123/1446),followed by mycoplasma pneumoniae(7.19%,104/1446),Mycobacterium tuberculosis(5.33%,77/1446)and Streptococcus pneumoniae(5.05%,73/1446).The outbreak of H1N1 occurred from December 2018 to February 2019,and the epidemic of mycoplasma pneumoniae pneumonia was monitored from August to November 2019.Patients under 65 years old had high detection rates of Mycoplasma pneumoniae(14.41%vs.2.41%,χ^(2)=74.712,P<0.001),Streptococcus pneumoniae(8.16%vs.2.99%,χ^(2)=18.156,P<0.001),rhinovirus(6.08%vs.3.56%,χ^(2)=5.025,P<0.025),Chlamydia pneumoniae(5.90%vs.1.15%,χ^(2)=26.542,P<0.001)and adenovirus(3.13%vs.0.92%,χ^(2)=9.547,P=0.002).The severe disease rate of CAP was 14.66%(212/1446),and the average mortality rate was 3.66%(53/1446).The severe illness rate and mortality rate of bacterial-viral co-infection were 28.97%(31/107)and 19.63%(21/107),respectively.Conclusions Influenza virus is the primary pathogen of adult CAP.Outbreaks of Mycoplasma pneumoniae and H1N1 were detected in 2018 and 2019,respectively.The remission rate and mortality rate of virus-bacteria co-infection were significantly higher than those of single path

关 键 词：社区获得性感染 肺炎 病原学 预防与控制 

分 类 号：R563.1[医药卫生—呼吸系统]