原发非典型肺炎的诊疗进展

Advances in diagnosis and treatment for respiratory infection by atypical pathogens

非典型肺炎在全球的发病率较高,占所有社区获得性肺炎的15%～50%。流行病学资料显示,引起非典型肺炎的病原体以肺炎支原体所占比例最高,肺炎衣原体次之,军团菌最低,但后者可引起暴发流行,致死率最高。Q热肺炎也属于非典型肺炎,但临床相关报道较少。非典型肺炎的临床表现无特征性,病原体培养困难,确诊仍是目前面临的难题。血清学检测对早期诊断和临床治疗的帮助不大。PCR法有望成为非典型肺炎早期诊断的重要检测手段,但要注意进行严格的质量控制,并降低假阳性率。治疗非典型肺炎的药物较多,大环内酯类和呼吸喹诺酮类药物最有效。在对社区获得性肺炎患者进行初始治疗时,建议选择覆盖非典型病原体的药物;怀疑军团菌感染者应及早应用呼吸喹诺酮类药物以降低死亡率。

The incidence of atypical pneumonia is pretty high throughout the world,accounting for 15%-50% of the community-acquired pneumonia.Epidemiological studies have revealed that Mycoplasma pneumoniae （MP） ranks the top among the pathogens which are most likely to cause atypical pneumonia,while Chlamydia pneumoniae （CP） ranks the second and Legionella pneumophila （LP） the lowest.However,LP may induce outbreak of pneumonia with the highest mortality.Q fever pneumonia is also one type of atypical pneumonia,which is not commonly seen in clinic and rarely reported.Definite diagnosis of atypical pneumonia remains a difficult problem since specific clinical presentations are unavailable,with difficulties in culturing etiological agents,and low value of serum tests for diagnosis.Nevertheless,PCR assay seemed to be an important technique for early diagnosis of atypical pneumonia,provided that false positive rate was effectually reduced by strict quality control.Regarding to the therapeutic drugs,macrolides and quinolones are the most effective ones for the treatment of atypical pneumonia.Those drugs covering atypical pneumonia related pathogens are recommended for initial treatment for patients with community-acquired pneumonia.Moreover,patients who are suspected to have Legionella pneumophila infection are recommended to take quinolones to decrease mortality.