广州地区下呼吸道感染老年患者非典型病原体与病毒检测及临床特征分析

Detection and clinical features analysis of atypical pathogens, respiratory virus in elderly patients with lower respiratory tract infection in Guangzhou

目的探讨广州地区下呼吸道感染老年患者的非典型病原体与病毒分布及临床特征。方法收集2014年9月~2015年7月广东省中医院住院患者290份60岁以上诊断为下呼吸道感染的老年患者血清标本,进行九项病原体Ig M抗体检测,并对患者临床特征进行分析。结果病原学分布:290例患者中共检测病原体阳性71份,总阳性率为24.5%。检出以肺炎支原体为主,共34例(11.7%),其余分别为嗜肺军团菌血清1型10例(3.4%);乙型流感病毒8例(2.7%);Q热立克次体、呼吸道合胞病毒各6例(2.0%);肺炎衣原体3例(1.0%);未发现腺病毒和副流感病毒1~3型病毒感染。混合感染17例(5.8%),其中双重感染13例,以肺炎支原体合并甲型流感病毒为多见;三重感染4例。临床特征:广州地区老年人下呼吸道感染患者男女比例1.45∶1,平均年龄为(77.0±6.8)岁,以发热、咳嗽、咳痰、气促为主要临床症状,肺部实变体征的比例为75.8%(220/290)。结论引起广州地区老年人下呼吸道感染的非典型病原体以肺炎支原体为主,其他病原体散发。不同非典型病原体和病毒感染的老年患者多见发热,伴有明显的全身和呼吸道症状,肺部感染多见。

Objective To discuss distribution of atypical pathogens, respiratory virus and in clinical features of elderly patients with lower respiratory tract infection in Guangzhou. Methods 290 lower respiratory infection of elderly patients over 60 years old with serum were collected from September 2014 to July 2015. The Pneumoslide IgM test was used to detected the atypical pathogens and respiratory virus and the clinical features were analyzed. Results Detection of pathogens： the total positive rate was 24.5%. Among the examined pathogens, MP was the highest, 34 cases （11.7%）, next was LP1 （3.4%） and others were INFB （2.7%）, COX （2.0%）, RSV （2.0%）, CP （1.0%）, no ADV and parainfluenza type 1-3 virus infection were found. The results showed 17 cases （5.8%） were multiple infection, including 13 cases were double infection and 4 cases were triple infection. Clinical features： male vs femaile of the elderly patients with lower respiratory tract in Guangzhou was 1.45：1, the average age was （77.0±6.8） years. The fever, cough, expectoration, anhelation were as the main clinical symptoms, the rate of signs of consolidation of the lung was 75.8% （220/290）. Conclusion For elderly people in Guangzhou, atypical pathogens of lower respiratory infection are mycoplasma pneu-moniae and other pathogens. The symptoms of different atypical pathogens and virus infection of elderly pa- tients are mainly fever accompanied with obvious sys- temic and respiratory symptoms, lung infection.