肺上叶与下叶社区获得性肺炎患者的临床特点及比较分析

Clinical characteristics and comparative analysis of community acquired pneumonia in patients with upper and lower lobes

目的探讨上叶社区获得性肺炎(CAP)与下叶CAP患者的临床特点。方法采用回顾性分析方法,选择2011年1月至2014年12月期间在上海市肺科医院住院的197例上叶或下叶社区获得性肺炎患者为研究对象,详细收集并整理患者的病史资料,分析上述患者的临床表现、影像学特点、实验室检查,伴发疾病及治疗上的特点,比较上叶CAP与下叶CAP的区别,更进一步了解上叶社区获得性肺炎的临床特点。结果上叶社区获得性肺炎组患者男女比例相仿,下叶CAP组男性为多。上叶社区获得性肺炎组咳嗽患者70/82例,无咳嗽12/82例,以白痰为主;下叶组咳嗽患者相对较多,脓痰患者的比例亦高于上叶肺炎患者。合并胸腔积液较下叶CAP少,上叶社区获得性肺炎组合并胸腔积液的有21/82例,下叶CAP组为63/115例;合并发热比例较下叶相仿,但40℃以上的超高热明显较下叶组少,统计显示上叶肺炎组发热41/82例,40℃以上2/82例;下叶肺炎组发热63/115例,40℃以上11/115例;血白介素6较下叶高,但D-二聚体均值较下叶组低,差异均有统计学意义(P<0.05)。结论上叶CAP临床表现常常不典型,但炎症刺激更为持久,治疗相对更为复杂,抗生素使用应该从重,所需治疗疗程相对较长。

Objective To compare the clinical characteristics between upper lobe community-acquired pneumonia（ CAP） and lower lobe CAP. Methods 197 inpatients confirmed CAP in Shanghai Pulmonary Hospital From January 2011 to November 2014 were enrolled. We retrospectively reviewed the medical records of the clinical manifestations,imaging features,laboratory data,complications and treatments. The differences between upper lobe CAP and low lobe CAP were compared. Results The male / female ratio of patients with community-acquired pneumonia in the upper lobes was equal,but men The male / female ratio of patients with community-acquired pneumonia in the upper lobes was equalwere the majority in lower lobe group pneumonia.The patients with white sputum were 70 /82 and 12 /82 patients had no cough in lower lobe group. Lower lobe pneumonia patients with cough and phlegm were more than the upper lobe pneumonia patients. However,the patients with the upper lobe pneumonia complicated with pleural effusion were fewer compared with patients with the lower lobe pneumonia（ the upper lobe 21 /82 cases,the lower lobe 63 /115 cases）. The number of patients with fever was similar in two groups,while the patients with high temperature（ more than 40 ℃） are fewer in upper lobe pneumonia. The upper lobe pneumonia patients with fever were 41 /82 cases,while 2 /82 cases were more than 40 ℃. Likewise,the upper lobe pneumonia patients were 63 /115 cases,and 11 /115 were cases;Moreover,the level of serum interleukin-6 and CD4 were higher in upper lobe pneumonia than that in the lower lobe pneumonia,but the level of serum D-dimmer was lower,the difference was statistically significant（ P 0.05）. Conclusions The clinical features of CAP in the upper lobes are often atypical,with more enduring inflammation stimulation and relatively more complicated treatment. Consequently,this type of patients should be given relatively large doses of antibiotics and long treatment course.