重症下呼吸道感染病原学及临床特点研究现状

Research status of etiology and clinical features of severe lower respiratory tract infection

重症社区获得性肺炎 （ SCAP ）和慢性阻塞性肺疾病急性加重 （ AECOPD ）作为重症下呼吸道感染的主要组成部分,具有较高的发病率和病死率,而对上述疾病的病原学流行病情况和临床特点的研究,具有重要的临床意义。目前国际上对于 SCAP 病原学的研究提示,最常见的病原体仍为肺炎链球菌,而非典型病原体尤其是军团菌在致病原中的地位逐渐显现出来,在一项研究中甚至上升为第 2 位常见的病原体。而国内尚缺乏针对 SCAP 的全国性、多中心流行病调查资料。多个研究提示 SCAP 具有：男性患者多见,多为高龄,至少合并一种基础疾病,常伴随合并症的临床特点。关于AECOPD 的致病原,近年来国际上的研究提示仍为革兰阴性杆菌,且在部分研究中提示铜绿假单胞菌的检出率高于流感嗜血杆菌;对于非典型病原体,由于使用的诊断方法不同,非典型病原体的检出率波动较大。国内针对 AECOPD 的病原学大型研究提示,结果与国际上基本一致,但是未进行非典型病原体的检测。

Severe community acquired pneumonia （SCAP） and acute exacerbation of chronic obstructive pulmonary disease （AECOPD）, with high morbidity and mortality, are the main parts of severe lower respiratory tract infection, therefore the researches about pathogen and clinical characteristics of the two disease are very important to clinical physician. Currently, many internationalresearches of SCAP about etiology showed that the most common pathogen was still Streptococcus pneumonia and atypical pathogens especially Legionella gradually appeared more and more important and even became the second common pathogens. The national multi-center study of etiology of SCAP is lack in China. Most studies suggested that the clinical features of SCAP included more male than female, more in the elderly, at least with a basic disease, often with complications. Most international researches, in recent years, showed that the main etiology of AECOPD was still gram negative bacilli, and some studies suggested that Pseudomonas aeruginosa detection rate was higher than that of Haemophilus influenzae. For atypical pathogens of AECOPD, due to the different methods used in diagnosis, their detection rates have large fluctuations. In China, there was a large-scale research on the etiology of AECOPD. And the research results were basically consistent with the international ones on bacteria, but the atypical etiology was not detected.