362例社区获得性肺炎患者临床特征及影响因素分析

Clinical characteristics and determinants of 362 patients with community-acquired pneumonia

目的:分析南京医科大学第二附属医院呼吸科社区获得性肺炎(community-acquired pneumonia,CAP)住院患者的临床、病原学和转归特点,以及相关的影响因素。方法:回顾性分析CAP住院患者的临床资料,比较其年龄、吸烟情况、基础疾病、病原学特点、临床用药情况等;并分析易感CAP的危险因素。结果:362例CAP患者平均年龄为(69.3±17.2)岁。位居前5位的基础疾病分别是高血压164例(45.3%)、慢性阻塞性肺疾病151例(41.7%)、心功能不全81例(22.4%)、糖尿病79例(21.8%)、冠心病72例(19.9%)。177例(48.9%)治愈,168例(46.4%)好转,17例(4.7%)未愈或死亡。362例中312例进行了病原体检测,仅100例查到了病原体,其中前5位的病原体分别是白假丝酵母菌31例,革兰氏阴性菌11例,鲍曼不动杆菌和肺炎克雷伯菌各8例,铜绿假单胞菌7例。Logistic回归分析显示:高龄(β=0.180,P=0.001)、中性粒细胞百分比高(β=0.127,P=0.035)、前白蛋白低(β=0.140,P=0.024)、合并肺心病(β=7.851,P=0.046)、合并脑梗死(β=4.861,P=0.029)是CAP转归不良的危险因素。结论:南京医科大学第二附属医院呼吸科CAP患者以老年人为主。患者大量合并各种基础疾病,以高血压、慢性阻塞性肺疾病、糖尿病、心功能不全、冠心病最常见,且年龄越大越容易合并基础疾病。病原体检出阳性率低。高龄、中性粒细胞百分比高、前白蛋白低、合并肺心病、合并脑梗死是转归不良的危险因素。

Objective：To observe the clinical characteristics,pathogens of inpatients with community-acquired pneumonia（CAP）and to explore the relative risk factors.Methods：The database of inpatients with CAP were retrospectively analyzed.The age,tobacco use,underlying disease,pathogens and clinical treatment were compared.The risk factors which may affect the prognosis of patients with CAP were also determined.Results：A total of 362 CAP patients（average age of 69.3 ± 17.2） were retrospectively analyzed.The top 5 underlying diseases were hypertension（164,45.3%）,chronic obstructive pulmonary disease（COPD,151,41.7%）,cardiac functional insufficiency（81,22.4%）,diabetes（79,21.8%） and coronary heart disease（72,19.9%）.A total of 177（48.9%） patients were cured,168 patients（46.4%） improved and 17（4.7%） patients did not improve or died.Of the 362 patients,312 patients underwent pathogen detection,and only 100 patients were detected pathogens.The top 5 pathogens were Candida albicans（31cases）,Gram-negative bacterium（11 cases）,Baumanii（8 cases）,Klebsiella pneumoniae（8 cases） and Pseudomonas aeruginosa（7cases）.Logistic regression analysis suggested that high age（β = 0.180,P = 0.001）,high percentage of neutrophil（β = 0.127,P =0.035）,low prealbumin（β = 0.140,P = 0.024）,pulmonary heart disease（β = 7.851,P = 0.046） and cerebral infarction（β = 4.861,P = 0.029） were risk factors of adverse prognosis.Conclusion：The CAP inpatients of the second affiliated hospital of NJMU were predominantly aged population.Most of them had underlying disease with hypertension,COPD,diabetes,cardiac functional insufficiency and coronary heart disease.High age,high percentage of neutrophil,low prealbumin,pulmonary heart disease and cerebral infarction were risk factors of adverse prognosis.