【摘要】 目的:了解四川地区社区获得性肺炎的致病原分布情况及影响CAP致病原分布的因素,为四川地区CAP的经验治疗提供依据。方法:在四川地区采取多中心前瞻性的临床研究,收集2004年4月~2005年3月期间的≥15岁的CAP患者共380例,用PORT评分标准[1]对CAP患者进行危险分级,取患者急性期痰标本进行细菌培养,高热患者(体温>39℃)行血培养,应用常规方法分离鉴定细菌,用酶联免疫吸附试验(ELISA)检测患者急性期及恢复期肺炎支原体、嗜肺军团菌、肺炎衣原体血清抗体。结果:380例CAP患者的痰或血培养结果显示,细菌感染率为39.74%,其中革兰氏阴性杆菌占66.89%,常见致病菌主要为嗜血杆菌属(8.73%)、肺炎链球菌(7.67%)及肺炎克雷伯菌(7.41%)。行血清学检测的273例CAP患者中非典型病原体69例(25.27%),其中肺炎支原体感染为50例(18.32%),13例(4.76%)为肺炎衣原体,6例(2.19%)为嗜肺军团菌。细菌和非典型病原体的混合感染22例(8.06%)。病原体的分布与季节无关(P>0.05)。肺炎支原体、嗜血杆菌属在≤30岁组的阳性率较高(P<0.05);肺炎按PORT分级,肺炎支原体、嗜血杆菌属在Ⅰ、Ⅱ级组的阳性检出率高于Ⅲ~Ⅳ级的患者;军团菌在≥Ⅲ级的患者中多见(5/6)(P<0.05)。结论:肺炎支原体已为首要的致病原;流感嗜血杆菌和肺炎链球菌是CAP最重要的病原菌;CAP的混合感染不容忽视;革兰阴性杆菌感染增多。在不同年龄和不同PORT分级的患者中CAP病原体构成不同。更多还原

【Abstract】 Objective:To investigate the etiology of community-acquired pneumonia(CAP)in Sichuan and analyse factors that may influence the distribution of common pathogens.Methods:A multicentre prospective study was performed on 380 consecutive adult patients(≥15 years old) with CAP from April 2004 to March 2005 in Sichuan.Sputum samples in all patients and blood samples in patients with high fever(T>39℃) were collected for bacteria culture.Bacteria were isolated and identified by using conventional methods.Antibodies of the paired serum samples to Mycoplasma pneumoniae,Chlamydia pneumoniae and Legionella pneumophilia were detected.Results:Three hundred and eighty patients(15 to 82 years)were evaluated.Bacteria were isolated from 151 cases(yield,39.74%),in which Gram-negtive bacilli were up to 66.89%.Haemophilus influenzae,the most common pathogen,was isolated in 33 cases(8.73%),while Streptococcus pneumoniae presented in 29 cases(7.67%),Klebsiella pneumonia accounting for 7.41% of the isolates.Specific antibodies were detected in paired serum from 273 cases.The results showed Mycoplasma pneumoniae in 18.32%,Chlamydia pneumoniae in 4.76%and Legionella pneumophilia in 2.19%.Mixed infection of bacteria and atypical pathogens were found in 22 patients(8.06%).There was no correlation between season and distribution of common pathogens(P>0.05).Mycoplasma pneumoniae and Haemophilus species were more frequent among patients aged below 30.According to the criteria conducted by Fine(PORT),the percent of Mycoplasma pneumoniae and Haemophilus species infections in the low-risk groups(Ⅰ～Ⅱ)was higher than patients in the high-risk groups(Ⅲ～Ⅳ),while Legionella pneumophilia was the common pathogen in patients in the high-risk groups(≥Ⅲ)(P<0.05).Conclusion:Mycoplasma pneumoniae have an important role in CAP,while Haemophilus influenzae and Streptococcus pneumoniae remain the major bacteria.Mixed infection shoud not only be ignored,but infection with Gram-negtive bacilli are frequent.The distribution of common pathogens is related with age,severity while no correlation to season.更多还原