2009-2012年广州市社区获得性肺炎流行特征和病原学研究

Study on epidemic characteristics and etiology of community acquired pneumonia in Guangzhou from 2009 to 2012

目的 分析2009-2012年广州市社区获得性肺炎（CAP）的流行特征及病原谱.方法 于2009-2012年以广州市11个区（县级市）的14间大型综合性医院作为肺炎病例监测哨点医院,开展CAP病例监测,4年共监测就诊病例18 982 223例,按照年份、年龄及季节分层,分析CAP病例病原谱特点.结果 2009-2012年共监测就诊病例18 982 223例,其中CAP病例56 618例.CAP病例数由2009年的8677例增至2012年的19 947例,CAP病例占就诊病例总数比例由0.22％（8677/3 893 800）增至0.41％（19 947/4 839 766）,差异有统计学意义（x2=2693.00,P＜0.05）.住院CAP病例中,≤5岁和＞65岁者占66.05％（10 954/16 585）;单一病原体感染病例占88.11％（14 613/16 585）,混合感染病例占4.17％ （691/16 585）.单一感染病原体类型构成中细菌所占比例最大,为65.25％ （10 821/16 585）,其次为支原体[13.54％（2245/16 585）]、病毒[9.01％（1494/16 585）],最低为衣原体[0.32％ （53/16 585）].病毒所致CAP比例逐年升高,由4.74％（146/3081）增至11.64％ （525/4512）,差异有统计学意义（x2=135.32,P＜0.05）.各年龄组CAP病例均以细菌感染多见,随着年龄增高,细菌感染所致CAP比例不断增大,由≤5岁组的48.35％（2993/6191）增至＞65岁组的81.31％（3873/4763）,差异有统计学意义（x2=1632.00,P＜0.05）.儿童（≤15岁）非典型病原体（支原体、衣原体）感染率[25.99％（1805/6945）]高于成年人（≥16岁）的5.12％ （494/9640）,差异有统计学意义（x2=1472.00,P ＜0.05）.未发现季节对病原体分布的影响.2009-2012年,住院CAP死亡病例共433例,＞65岁组病死率最高[4.70％（224/4763）],6～15岁组病死率最低[0.27％ （2/754）].结论 2009-2012年广州市社区CAP发病呈上升趋势,细菌为优势病原体,儿童和老年人是CAP的高发人群,混合感染呈现较低水平.

Objective To investigate the epidemic characteristics and pathogenic spectrum of community acquired pneumonia （CAP） in Guangzhou from 2009 to 2012. Method 14 major comprehensive hospitals were selected from 11 districts as sentinel hospitals for CAP cases surveillance, including 18 982 223 in total during the 4 years. The characteristics of pathogenic spectrum of CAP were stratified and analyzed by year,age and season. Results 18 982 223 cases were included in the surveillance from year 2009 to 2012,in which 56 618 cases were CAP. The number of CAP cases increased from 8677 in year 2009 to 19 947 in year 2012 in Guangzhou; while the percentage of visits for CAP raised from 0. 22% （8677/3 893 800） to 0. 41% （19 947/4 839 766）. The difference showed statistical significance （X2 = 2693.00,P 〈 0. 05 ）. Among the hospitalized CAP cases,66. 05% （ 10 954/16 585 ） were aged ≤5 years old or 〉66 years old. The percentage of cases infected by a single pathogen was 88. 11% （ 14 613/16 585） , while co-infected cases accounted for 4. 17% （691/16 585）. Bacteria accounted for the largest proportion of 65.25% （10 821/16 585） as a single pathogen,followed by mycoplasma 13.54% （2245/16 585）, virus 9.01% （1494/16 585 ） and ehlamydia 0. 32% （53/16 585 ）. The proportion of virus infection was increasing from 4. 74% to 11.64%. The difference showed statistical significance （ X2 = 135.32 ,P 〈 0. 05 ）. Bacteria infection was the leading causes for CAP eases in all age groups; however the percentage increased with the increasing of ages. The rate of bacterial infection was increased from 48.35% （2993/6191） among children aged ≤5 years old to 81.31% （3873/4763） among adults aged over 65 years （X2 = 1632. O0,P 〈 0. 05）. The rate of atypieal pathogens （mycoplasma,ehlamydia） for children （ ≤ 15 years old） （25.99% , 1805/6945） was higher than that for adults aged ≥ 16 years old （5.12% ,494/9640） （X2 =2. ll,P 〈 0. 05 ）. The effect from season on the pathogenic spectrmn was not observed. 433 hospitalized CAP cases were dead from 2009 to 2012. Case tatality rate was highest among people aged over 65 years old （4.70%, 224/4763 ） and lowest among children aged between 6 to 15 years old （0.27% ,2/754）. Conclusion The incidence of comnmnity acquired pneumonia was rising in Guangzhou fi＇om 2009 to 2012. Bacteria was the dominant pathogen. Children and old people were the high-risk population of community acquired pneumonia; while co-intection was still at low level.