80岁以上老年人社区获得性肺炎的临床特点及病原学分析  

Clinical characteristics and etiological analysis of community-acquired pneumonia in the elderly aged 80 and over

作　　者：余小丽[1] 俞婷 陈愉生[1] 李鸿茹[1] 岳文香[1] 林明[1] 胡辛兰[3] YU Xiaoli;YU Ting;CHEN Yusheng;LI Hongru;YUE Wenxiang;LIN Ming;HU Xinlan(Provincial Clinical Medical College Affiliated to Fujian Medical University,Department of Respiratory and Critical Care Medicine,Fujian Provincial Hospital,Fuzhou,Fujian 350001,P.R.China;Department of General Practice,Fujian Provincial Hospital,Fuzhou,Fujian 350001,P.R.China;Microbiology Department,Fujian Provincial Hospital,Fuzhou,Fujian 350001,P.R.China)

机构地区：[1]福建医科大学省立临床医学院福建省立医院呼吸与危重症医学科,福建福州350001 [2]福建省立医院全科医学科,福建福州350001 [3]福建省立医院微生物室,福建福州350001

出　　处：《中国呼吸与危重监护杂志》2022年第2期90-95,共6页Chinese Journal of Respiratory and Critical Care Medicine

基　　金：国家重大科技专项(2017 ZX10103004);福建省卫生计生青年科研课题(2018-1-2)。

摘　　要：目的分析80岁以上老年人社区获得性肺炎(community-acquired pneumonia,CAP)的临床特点及病原学分布,为临床诊治提供依据。方法收集和比较高龄CAP组(≥80岁,94例)和对照组(65~79岁,100例)临床信息和病原学资料,分析80岁以上老年人CAP的临床和病原学特点。结果临床症状上两组相比,呼吸困难及消化道症状、全身症状、精神状态改变相比差异有统计学意义(P<0.05),上呼吸道症状、发热、咳嗽、咳痰、咯血、胸闷痛两组相比差异无统计学意义(P>0.05)。并发症上高龄CAP组相比对照组易于出现呼吸衰竭、脓毒血症、泌尿系感染和电解质代谢紊乱(P<0.05)。实验指标上高龄CAP组出现贫血和肾功能异常比例高,炎症指标(白细胞计数、降钙素原、C反应蛋白、红细胞沉降率、中性粒细胞碱性磷酸酶积分)升高程度两组比较差异无统计学意义。病情评分上高龄CAP组的肺炎严重程度指数评分、CURB-65评分均明显高于对照组(P<0.001)。病原学上高龄CAP组中细菌感染(23/94)、病毒感染(21/94)和细菌混合病毒感染(21/94)例数相当,两种及以上细菌感染的比例占17.0%(16/94);细菌检出率上依次为肺炎链球菌(22.4%)、铜绿假单胞菌(19.4%)、嗜麦芽窄食单胞菌(16.4%)、金黄色葡萄球菌(14.9%)。病毒感染以甲型流感病毒(23/94)、人巨细胞病毒(21/94)感染为主,细菌混合病毒感染以肺炎链球菌合并甲型流感病毒感染为主。两组细菌感染最常见致病菌均为肺炎链球菌,但总体比例上均以革兰阴性菌为主,以铜绿假单胞菌、嗜麦芽窄食单胞菌、鲍曼不动杆菌、肺炎克雷伯菌多见;两组革兰阳性菌主要为肺炎链球菌和金黄色葡萄球菌,两组相比各细菌检出率差异无统计学意义(P>0.05)。病毒感染两组比较上均以甲型流感病毒为主,差异无统计学意义(P>0.05)。两组单一细菌、单一病毒感染、病毒双重感染率及细菌混合病毒感染率Objective To analyze the clinical features and etiologic of community-acquired pneumonia(CAP among the elderly aged 80 and over,and provide evidence for clinical diagnosis and treatment.Methods The clinical characteristics and etiology of the elderly CAP(≥80 years old)were analyzed by collecting and comparing the clinical characteristics and etiology between the very elderly CAP group(≥80 years old,94 cases)and control group(65 to 79years old,100 cases).Results On clinical symptoms,there were statistical differences in dyspnea and gastrointestinal symptoms,systemic symptoms,and mental status(P<0.05)between the two groups.There was no statistically significant difference in upper respiratory tract symptoms,fever,cough,sputum,hemoptysis and chest pain between the two groups(P>0.05).On the complications,the very elderly CAP group was more prone to respiratory failure,sepsis,urinary tract infection and electrolyte metabolism than the control group(P<0.05).On the experimental indicators,anemia and abnormal renal function in the elderly CAP group were high(P<0.05).There was no statistical difference between the two groups of inflammation indicators(white blood count,procalcitonin,C-reactive protein,erythrocyte sedimentation rate,neutrophil alkaline phosphatase score).The pneumonia severity index score and CURB-65 score of the very elderly CAP group were significantly higher than those of the control group(P<0.001).On pathogen analysis,in the very elderly CAP group the number of bacterial infections(23/94),viral infections(21/94)and bacterial mixed virus infections(21/94)were probably equivalent,and the proportion of bacterial infections of two or more types accounted for 17.0%(16/94);The bacteria detection rate was Streptococcus pneumoniae(22.4%),Pseudomonas aeruginosa(19.4%),Stenotrophomonas maltophilia(16.4%),Staphylococcus aureus(14.9%).Viral infection mainly focused on influenza A virus(23/94)and human cytomegalovirus(21/94).Bacterial mixed virus infection was mainly caused by Streptococcus pneumoniae and influ

关 键 词：高龄老年人 社区获得性肺炎 临床特点 病原学 

分 类 号：R563.1[医药卫生—呼吸系统]