中国“不明原因肺炎”预警病例现状及其临床研究

Current status and clinical study of suspected pneumonia cases of unknown origin in China

目的了解我国"不明原因肺炎(PUO)"预警病例的现状和临床特征,为其病例定义等的改进工作提供一定的参考依据。方法在2个项目省选择省级、地市级和县级医院各1所,对其2008年4月1日—2009年3月31日期间"社区获得性肺炎"住院患者的临床资料进行筛选及分析。结果共调查1 506份"社区获得性肺炎"患者病历,其中442例(29.35%)患者符合现有"PUO"的病例定义。此442例患者发病多在冬季(32.35%);男性占60.63%,≤14岁患者占57.24%;临床主要表现为急性起病,发热伴咳嗽、咳痰,预后良好(治愈率>95%);未引发重大公共卫生事件。结论 "社区获得性肺炎"住院患者中符合现有"PUO"定义的预警病例占相当比例,但临床经过良好。建议对临床症状、体征或影像学支持肺炎诊断的患者积极进行流行病学史的询问,以及时且较为特异地发现"PUO"预警病例。

Objective To realize the current status and clinical characteristics of suspected pneumonia cases of unknown origin （PUO） in China, so as to provide the appropriate reference for revising and adjusting the definition of PUO. Methods One provincial-, one municipal- and one countylevel hospital were selected from 2 provinces par ticipating in the project, clinical data of community-acquired pneumonia（CAP） patients who were hospitalized be tween April 1, 2008 and March 31, 2009 were collected, screened and analyzed. Results A total of 1 506 CAP case histories were collected, 442 （29. 35 %） of which were conformed with PUO definition. The peak incidence season was winter （32. 35%） ; 60. 63% were male patients , 57. 24%%00 were ≤ 14 years old; The main clinical manifestations were acute onset, fever, cough, and expectoration, most patients had promising prognosis （recovery rate〉 95%）, and no clustering events occurred. Conclusion A large part of CAP in inpatients were conformed with suspected cases of PUO, but the clinical course is good. In order to screen out the suspected cases of PUO more specifically and timely, it should be paid more attention to the epidemiological history inquiry into pneumonia cases diagnosed by signs and symptoms or imagings.