联合检测肺炎支原体和肺炎衣原体在社区获得性肺炎患者中的临床意义

The clinical role of Mycoplasma pueumoniae and Chlamydia pneumoniae detection in patients with Community-acquired pneumonia

目的探讨社区获得性肺炎患者检测肺炎支原体(Mp)和肺炎衣原体(Cp)的临床意义。方法对1 443例确诊为社区获得性肺炎患者进行Mp、Cp的痰培养和聚合酶链反应(PCR)检测,同时对患者的抗菌药物治疗的临床效果进行评估。结果引起社区获得性肺炎的主要致病菌分别为:Mp 215例(14.90%);肺炎链球菌111例(7.69%);流感嗜血杆菌96例(6.65%);Cp74例(5.13%);肺炎克雷伯菌59例(4.09%);金黄色葡萄球菌52例(3.60%);铜绿假单胞菌44例(3.05%);大肠埃希菌44例(3.05%)。其中,两种病原混合感染者133例(9.22%);三种病原混合感染者7例(0.49%)。此外,对一种细菌合并一种Mp或Cp感染的社区获得性肺炎患者使用β-内酰胺类抗菌药物的治愈率为42.3%(22/52),而对患者使用β-内酰胺类联合大环内酯类或氟喹诺酮类抗菌药物的治愈率为74.6%(44/59)。结论在社区获得性肺炎患者中,常规培养不能检测的Mp、Cp感染率高。且应用β-内酰胺类联合大环内酯类或氟喹诺酮类抗菌药物可以获得更好的治疗效果。

Objective To investigate the clinical significance of detecting the mycoplasma pneumoniae and chlamydia pneumoniae in community acquired pneumonia（CAP）.Methods The study was performed on the confirmed patients with CAP.Pathogens of respiratory tract sputum were detected by bacterial culture and polymerase chain reaction（PCR）.And to estimate the clinical effects about the antibiotics therapying.Results The main pathogenic bacteria causing the CAP respectively were mycoplasma pneumoniae 215（14.90%）,streptococcus pneumoniae 111（7.69%）,hemophilus influenza 96（6.65%）,chlamydia pneumoniae 74（5.13%）,klebsiella pneumoniae 59（4.09%）,staphylococcus aureus 52（3.60%）,pseudomonas aeruginosa 44（3.05%）,escherichia coli 44（3.05%）.Mixed infection of two pathogens was found in 133cases（9.22%）,and mixed infection of three pathogens was found 7cases（0.49%）.In addition,on the CAP patients infected of bacteria mixed with mycoplasma pneumoniae or chlamydia pneumoniae,the cure rate is 42.3%（22/52）by using beta-lactams antibiotics;in contrast,the cure rate is 74.6%（44/59）by jointly using beta-lactams antibiotics and macrolide antibiotics or fluoroquinolones antibiotics.Conclusion Mycoplasma pneumoniae and chlamydia pneumoniae are the common pathogens of CAP.The results show that jointly using beta-lactams antibiotics and macrolide antibiotics or fluoroquinolones antibiotics can get better therapeutic effect in CAP.