北京地区成人社区获得性肺炎病原学分析

Etiologic characteristics of adult patients with community-acquired pneumonia in Beijing

目的对北京地区成人社区获得性肺炎（CAP）患者进行病原学分析。方法人选2010年11月至2012年5月北京地区多中心510例成人CAP患者。多重聚合酶链反应（PCR）、荧光定量PCR、军团菌尿抗原分别用于检测常见呼吸道病毒、肺炎支原体、军团菌，痰培养、血培养、肺炎链球菌尿抗原用于检测细菌。对检出病原体的病原学分布及季节分布进行统计分析。结果510例患者中240例（47．1％）至少检测出一种病原体，其中不同病原体混合感染42例（8．2％）；病原体分布为病毒164例（32．2％）、肺炎支原体91例（17．8％）、细菌26例（5．1％）、军团菌3例（0．6％）。检测出病毒的164例患者中，共检出病毒194株，其中流感病毒105株（54．1％）。2010至2011年度流行的流感病毒为甲型，流行时间为2010年11月至2011年3月，流行高峰在2011年2月；肺炎支原体主要检出于冬春季节。结论北京地区成人CAP中病毒和肺炎支原体检出率高，在冬季和初春季节尤其要重视成人CAP中流感病毒及肺炎支原体的感染。

Objective To explore the etiologic characteristics of adult patients with community- acquired pneumonia （CAP） in Beijing. Methods A muhicenter cohort of 510 adult CAP patients were enrolled from Beijing during the period of November 2010 to May 2012. Multiplex polymerase chain reaction （PCR）, real-time fluorescence quantitative PCR and legionella urinary antigen were used to detect common respiratory viruses, Mycoplasma pneumoniae and legionella respectively. Bacteria were detected by sputum culture, blood culture and Streptococcus pneumoniae urinary antigen. Statistical analyses were performed for the etiologic characteristics and seasonal distribution of detected pathogens. Results Pathogens were detected in 240/500 （47. 1% ） study patients. The mixed infection of different pathogens was present in 42 cases （ 8. 2% ）, viruses in 164 （ 32. 2% ）, Mycoplasma pneumoniae in 91 （ 17.8% ）, bacteria in 26 （5.1%） and Legionella in 3 （0. 6% ）. Among 164 patients infected with viruses, 194 viral strains were detected. Influenza virus represented the greatest proportion with 105 （54. 1% ） in viral infections. Between November 2010 to October 2011, Influenza A infections increased gradually in November 2010, peaked in February 2011 and declined by March 2011 in China. Mycoplasma pneumoniae was predominant in winter and spring. Conclusions There is a high detection rate of virus and Mycoplasma pneumoniae in adult CAP patients in Beijing. And more consideration should be given to influenza virus and Mycoplasma pneumoniae infections in winter and early spring.