急诊中青年医疗保健相关性肺炎与社区获得性肺炎的多中心比较研究

A multicenter comparative study of healthcare associated pneumonia and community-acquired pneumonia in young and middle-aged emergency patients

目的探讨比较急诊中青年医疗保健相关性肺炎(healthcare associated pneumonia,HCAP)与社区获得性肺炎(community-acquired pneumonia,CAP)的特点与差异,以指导临床精细化诊疗.方法收集首都医科大学附属北京天坛医院、首都医科大学附属北京朝阳医院、北京积水潭医院回龙观院区自2018年9月—2019年5月入住急诊符合纳排标准的中青年HCAP和CAP患者的临床资料,统计分析比较两组患者的人口学基本信息、基础疾病、临床表现、辅助检查、CURB-65评分、病原学特征、临床转归等.结果根据纳排标准,纳入HCAP组患者29例,CAP组患者38例.人口学基本信息,HCAP组患者平均年龄为51.66岁高于CAP组的45.58岁(P<0.05),男女比例分布无显著统计学差异.基础疾病及临床表现两组无显著统计学差异.辅助检查及病情评分,HCAP组患者的降钙素原增高比例为75.86%高于CAP组的68.42%(P<0.05),其余白细胞计数、乳酸、肺部影像学、CURB-65评分等两组无显著统计学差异.病原学方面HCAP组鲍曼不动杆菌的感染比例为44.83%高于CAP组的10.53%(P<0.05),HCAP组多耐药比例为65.52%高于CAP组的15.79%(P<0.05).临床转归两组无显著统计学差异,HCAP组住院时间则多集中在1~2周,而CAP组则分布较为分散(P<0.05).结论急诊中青年HCAP和CAP患者基础疾病、临床表现、多数辅助检查等方面无显著差异,但中青年HCAP患者较CAP患者发病平均年龄偏高、降钙素原更容易升高,且易感染如鲍曼不动杆菌这类易产生多耐药的细菌,如得到及时敏感抗生素治疗,预后多数良好且住院时间可控制在2周以内.

Objective To compare the characteristics and differences between healthcare associated pneumonia(HCAP)and community-acuired pneumonia(CAP)in young and middle-aged emergency patients in order to guide chnical fine diagnosis and treatment.Methods Collect the clinical data of young and middle-aged HCAP and CAP emergency patients admitted to Beijing Tiantan Hospital,Capital Medical University,Beijing Chao-Yang Hospital,Captial Medical University,Beijing Jishuitan Hospital from September 2018 to May 2019,and analyze and compare the demographic information,combined diseases,clinical manifestations,clinical examination,CURB-65 score,pathogenic and clinical outcome,etc.Results According to the criteria,29 patients with HCAP and 38 patients with CAP were included.The average age of HCAP group was 51.66 years old,which was higher than that of CAP group,45.58 years old,and P<0.05.There was no significant difference in combined diseases and clinical manifestations between the two groups.The percentage of increase of procalcitonin in HCAP group was 75.86%,which was higher than that in CAP group,68.42%,and P<0.05.In etiology,the infection rate of Acinetobacter baumannii in HCAP group was 44.83% higher than that in CAP group,10.53%,and P<0.05.There was no significant statistical difference in clinical outcome between the two groups.The hospitalization time of HCAP group was more concentrated in 1〜2 weeks,while the distribution of CAP groups was more scattered(P<0.05).Conclusion There were no significant differences in the combined diseases,clinical manifestations and most clinical examinations between the young and middle-aged emergency patients with HCAP and CAP.However,the average age of onset of young and middle-aged patients with HCAP was higher than that of the patients with CAP,and the level of procalcitonin was higher,and they were more susceptible to infections,such as Acinetobacter bauman nii,which was prone to be multi-drug re-sistant.lf they were trealted with sensitive antibiotics in time.the prognosis was mostly good and the length of the hos-pitalization tiame could be controlled within 2 weeks.