海南地区某医院肺纤维化急性加重患者病原学分析

Pathogens in patients with acute exacerbation of idiopathic pulmonary fibrosis in a hospital of Hainan area

目的分析海南地区某医院肺纤维化急性加重(AE-IPF)患者病原学检测结果,为AE-IPF患者诊疗提供依据。方法回顾性分析2016年1月—2019年12月海南省该院住院的AE-IPF患者,分析其呼吸道病毒IgM抗体、痰细菌学培养和非典型病原体核酸检测结果,比较病原学阳性组与病原学阴性组患者临床资料的差异。结果共纳入AE-IPF患者52例,其中病原学阳性组23例,病原学阴性组29例。病原学阳性组患者发热、脓痰,以及接受抗感染治疗的比例更高,血白细胞、中性粒细胞及降钙素原更高,而病原学阴性组患者接受糖皮质激素治疗的比例更高,各组差异均有统计学意义(均P<0.05)。两组患者住院病死率比较,差异无统计学意义(P>0.05)。病原学阳性组患者痰细菌培养、病毒IgM、非典型病原体核酸检测阳性分别为15、10、9例,痰细菌培养中检出最多的是绿假单胞菌(14.7%,5例),病毒IgM检测阳性以呼吸道合胞病毒和腺病毒为多,均为8.8%(3例),非典型病原体核酸检测阳性者中肺炎支原体居多(17.7%,6例)。结论感染可能是海南地区该院AE-IPF患者急性加重的重要诱因,临床表现及炎症指标有助于提示AE-IPF患者存在感染的诱因。

Objective To analyze the pathogen detection results of patients with acute exacerbation of idiopathic pulmonary fibrosis(AE-IPF)in a hospital in Hainan area,so as to provide basis for diagnosis and treatment of AE-IPF patients.Methods Patients who were with AE-IPF and admitted to a hospital in Hainan Province from January 2016 to December 2019 were retrospectively analyzed,detection results of IgM antibody of respiratory virus,sputum bacterial culture,and atypical pathogen nucleic acid were analyzed,difference in clinical data between pathogen-positive group and pathogen-negative group were compared.Results A total of 52 patients with AE-IPF were analyzed,including 23 cases in pathogen-positive group and 29 in pathogen-negative group.The proportion of patients with fever,purulent sputum and anti-infection treatment,as well as white blood cells,neutrophils and procalcitonin were higher in pathogen-positive group,proportion of patients receiving glucocorticoid treatment was higher in pathogen-negative group,differences were all statistically significant(all P<0.05).There was no significant diffe-rence in mortality between two groups of patients(P>0.05).In patients in pathogen-positive group,15,10,and 9 cases were with positive sputum culture,virus IgM,and atypical pathogen nucleic acid respectively,Pseudomonas aeruginosa was most frequently detected pathogen in sputum culture(n=5,14.7%),respiratory syncytial virus(RSV)and adenovirus(ADV)were the most common virus in positive IgM detection(n=3,both 8.8%),Mycoplasma pneumoniae was the most common pathogen in positire detection of atypical pathogen nucleic acid(n=6,17.7%).Conclusion Infection may be an important cause of patients with AE-IPF in this hospital in Hainan area,clinical manifestations and inflammatory markers is conductive to indicating the cause of infection in AE-IPF patients.