摘要
目的了解深圳某医院社区获得性肺炎(CAP)患者中呼吸道病原谱特征,给临床提供有价值的重要信息。方法选取2021年3月-2023年4月深圳市宝安区人民医院门急诊、住院部收治的CAP患者472例。采集痰液、咽拭子或支气管肺泡灌洗液,采用多重巢式反转录酶-聚合酶链式反应检测18种呼吸道病原体。分析18种呼吸道病原体的检出情况以及相关血液指标的变化。结果2021年CAP患者的呼吸道病原体的检出率为69.0%(109/158),2022和2023年的检出率分别为75.2%(103/137)、79.1%(140/177),差异有统计学意义(χ^(2)=4.47,P=0.03)。根据年龄分为婴幼儿组(0~<7岁)、青少年组(7~<18岁)、成人组(18~<60岁)和老年组(60~岁)4组,婴幼儿组呼吸道病毒的检出率(65.4%)高于其他组,差异有统计学意义(χ^(2)=33.58,P<0.05)。青少年组的肺炎支原体的检出率(26.7%),与其他组相比差异有统计学意义(χ^(2)=31.70,P<0.05)。呼吸道病原体检出率为74.6%、其中病毒检出率为56.1%、细菌为70.8%、不典型病原体为7.2%,排在前3位的病毒是呼吸道合胞病毒(14.62%)、鼻病毒(13.98%)、甲型流感病毒InfA(9.11%)。2023年前4个月,呼吸道病毒的检出率(77.4%)高于2022年同期,其主要以呼吸道合胞病毒(23.2%)、甲型流感病毒InfA(18.1%)、甲型流感病毒H1N1(16.9%)、鼻病毒(16.4%)为主,差异均有统计学意义(P均<0.05)。而流感嗜血杆菌的检出率(27.1%)低于2022年同期,肺炎链球菌的检出率(44.1%)有明显的上升,差异均有统计学意义(P均<0.05)。血液指标中C反应蛋白在仅检出支原体组和仅检出病毒组中的差异有统计学意义(P<0.05),其他组的差异无统计学意义(P>0.05)。结论在诊治CAP患者中,临床医生应了解本地区的社区获得性肺炎的病原谱特征并结合其流行特点,对患者作出准确的判断,针对性的使用药物,减少耐药菌的产生。
Objective To investigate the respiratory pathogen spectrum characteristics of patients with community acquired pneumonia(CAP)in a hospital in Shenzhen,hoping to provide valuable information for clinical practice.Methods From March 2021 to April 2023,472 patients with CAP were selected from the outpatient,emergency and inpatient departments of the Baoan District People's Hospital of Shenzhen.Sputum,throat swab or bronchoalveolar lavage fluid were collected and 18 respiratory pathogens were detected by multiple nested reverse transcriptase polymerase chain reaction.The detection of 18 kinds of respiratory pathogens and the changes of related blood indexes were analyzed.Results The detection rate of respiratory pathogens in CAP patients was 69.0%(109/158)in 2021,75.2%(103/137)in 2022 and 79.1%(140/177)in 2023,respectively,which showed an increase year by year with statistical significance(χ^(2)=4.47,P=0.03).They were divided into four groups according to age:infant group(0-<7 years old),adolescent group(7-<18 years old),adult group(18-<60 years old)and elderly group(60-years old).The detection rate of respiratory virus in infant group(65.4%)was higher than that in other groups,and the differences were statistically significant(χ^(2)=33.58,P<0.05).The detection rate of mycoplasma pneumoniae in the adolescent group(26.7%)was statistically significant compared with the other groups(χ^(2)=31.70,P<0.05).The detection rate of respiratory pathogens was 74.6%,of which 56.1%were viruses,70.8%were bacteria and 7.2%were atypical pathogens.The top three viruses were respiratory syncytial virus(14.62%),rhinovirus(13.98%)and influenza A virus InfA(9.11%).In the first four months of 2023,the detection rate of respiratory viruses(77.4%)was higher than that in the same period of 2022,mainly respiratory syncytial virus(23.2%),influenza A virus InfA(18.1%),influenza A virus H1N1(16.9%),and rhinovirus(16.4%).The differences were statistically significant(all P<0.05).The detection rate of Haemophilus influenzae(27.1%)was lower than that of the same period in 2022,and the detection rate of Streptococcus pneumoniae(44.1%)was significantly increased(all P<0.05).The difference of C-reactive protein in blood indexes between mycoplasma only group and virus only group was statistically significant(P<0.05),but there was no statistically significant differences between other groups(P>0.05).Conclusion In the diagnosis and treatment of CAP patients,clinicians should understand the pathogen spectrum characteristics of community-acquired pneumonia in the region and combine its epidemic characteristics to make accurate judgments,treatments and the use of targeted drugs to reduce the generation of drug-resistant bacteria.
作者
卢霞芬
曾柳芳
罗柳苑
梁尚燕
王革非
LU Xiafen;ZENG Liufang;LUO Liuyuan;LIANG Shangyan;WANG Gefei(Department of Clinical Laboratory,Shenzhen Baoan People's Hospital,Shenzhen,Guangdong 518116,China;Shantou University Medical College,Shantou,Guangdong 515000,China)
出处
《热带医学杂志》
CAS
2023年第11期1524-1529,共6页
Journal of Tropical Medicine
基金
广东省自然科学基金(2021A1515012470)
关键词
社区获得性肺炎
呼吸道病原体
呼吸道合胞病毒
甲型流感病毒
鼻病毒
Community acquired pneumonia
Respiratory pathogens
Respiratory syncytial virus
Influenza A virus
Rhinovirus
