成人社区获得性肺炎主要病原体分布的Meta分析

The meta-analysis of the distribution of the pathogens among community acquired pneumonia infections in adults

目的综合分析并评价成人社区获得性肺炎（communityacquiredpneumonia，cAP）主要病原体的分布情况，以期为临床初始用药提供理论支持。方法对病原体的检出率进行Meta分析，根据异质性检验结果对其检出率加权合并，以明确不同病原体的分布情况。结果（1）病原体的检出率为47．00％（95％CI：40．90％-53．20％），其中病毒、肺炎链球菌、非典型病原体和混合病原体检出率分别为23．10％（95％CI：14．10％-35．30％）、14．90％（95％CI：9．60％～22．40％1、9．40％（95％CI：6．10％～14．40％）和8．40％（95％Ch5．80％-11．90％）；（2）非中国人群病毒检出率最高，中国人群非典型病原体的检出率最高，肺炎链球菌检出率低于非中国人群（P=0．035）；（3）60岁及以上人群检出率最高的是病毒，其次为非典型病原体；（4）心脑血管疾病为CAP患者最可能合并的疾病。结论近半数患者未检出病原体，病毒、肺炎链球菌、非典型病原体为成人CAP检出率较高的病原体，混合病原体感染不可忽视，中国人群与非中国人群病原体分布有所差异。

Objective To investigate the distribution of pathogens among community acquired pneumonia（CAP） and provide theoretical supports to the initial clinical medicine. Methods The analysis of pathogens distribution was performed by meta analysis. According to statistical tests for the heterogeneity test, the pathogens detection rates were merged. The distribution of CAP among different pothogens could be clarified by this method. Results （1） The pathogen detection rates were 47.00% （95%CI： 40.90%-53.20%）： 23.30% （95%CI： 14.20% -35.60%）, 14.9% （95%CI： 9.60%-22.40%）, 9.40% （95%CI： 6.40%-14.40%） and 8.40% （95%CI： 5.80%-11.90%） for viruses, Streptococcus pneumoniae, atypical pathogens and mixed pathogens respectively. （2） Virus detection rate was the highest among non-Chinese populations. Atypical pathogens rate was the highest among Chinese population.The Streptococcus pneumoniae rate was lower among Chinese population than that of the non＇Chinese populations （P=-0.035）. （3）The virus and atypical pathogens detection rates were the highest and the second highest among people above 60 years old. （4） The most likely complications were cardiovascular diseases. Conclusion No pathogens were detected among nearly half of the patients, viruses had the highest detection rate among pathogens in adults CAP, the second highest was Streptococcus pneumoniae, and followed by atypical pathogens. Mixed pathogen infections should not be neglected. There were some differences of pathogen distribution between non-Chinese population and Chinese population,