成人社区获得性肺炎病原学特点分析

Etiologic characteristics of adults with community-acquired pneumonia

目的研究成人社区获得性肺炎(community acquired pneumonia,CAP)病原学特点。方法收集2017年6月至2019年4月在北京大学第三医院发热急诊就诊的246例经检查排除肺结核、肺部肿瘤、非感染性肺间质性疾病、肺水肿、肺不张、肺栓塞、肺嗜酸粒细胞浸润症及肺血管炎等疾病,确诊社区获得性肺炎病例的呼吸道标本,采用多重实时荧光定量PCR检测方法对19种呼吸道病原体进行检测,回顾性分析本中心成人CAP呼吸道病原体的分布情况。结果本组所有呼吸道标本核酸检测阳性率为46.7%,其中病毒、细菌、不典型病原体阳性率分别为25.6%、19.9%和18.7%,其中肺炎支原体占18.3%。三种主要的呼吸道病毒依次为流感病毒(14.6%)、副流感病毒(2.8%)和鼻病毒(2.8%)。三种主要的呼吸道细菌为肺炎链球菌(8.5%)、流感嗜血杆菌(6.1%)和肺炎克雷伯杆菌(2.4%)。≥65岁组支原体感染检出率低于<65岁组(2.6%vs 21.3%,χ2=10.376,P=0.001)。结论本组样本中,呼吸道病毒超过呼吸道细菌和肺炎支原体,是社区获得性肺炎的主要病原体。肺炎支原体、流感病毒和肺炎链球菌是位列前三位的病原体。

Objective To investigate the etiologic characteristics of adults with community acquired pneumonia(CAP).Methods Respiratory tract specimens were collected from 246 cases of community acquired pneumonia in Peking University Third Hospital after excluding tuberculosis,pulmonary tumor,non-infectious pulmonary interstitial disease,pulmonary edema,pulmonary atelectasis,pulmonary embolism,pulmonary eosinophil infiltration and pulmonary vasculitis.Nineteen respiratory pathogens were tested by multiple real-time fluorescent quantitative PCR to investigate the distribution of respiratory pathogens.Results The positive rate of nucleic acid detection in respiratory pathogens was 46.7%,among which 25.6%was virus,19.9%atypical pathogens and 18.7%bacteria.The most prevalent viruses were influenza virus(14.6%),parainfluenza virus(2.8%)and rhinovirus(2.8%).The three most prevalent bacteria were Streptococcus pneumoniae(8.5%),Haemophilus influenzae(6.1%)and Klebsiella pneumoniae(2.4%).The positive rate of Mycoplasma pneumoniae was higher in patients<65 years than that in patients≥65 years(21.3%vs 2.6%,χ2=10.376,P=0.001).Conclusions Respiratory virus is the leading respiratory pathogens in community acquired pneumonia exceeding bacteria and Mycoplasma pneumoniae,Influenza virus and Streptococcus pneumoniae are the top three pathogens in CAP.