老年慢性支气管炎急性发作患者病原体检测结果分析

An Analysis of Pathogens Isolated from Elderly Patients withAcute Phrase of Chronic Bronchitis

目的分析引起老年慢性支气管炎急性发作的病原体,为临床提供诊断和治疗依据。方法回顾2018年12月至2019年11月本院收治的199例老年慢性支气管炎急性发作患者的嗜肺军团菌1型(LP1)、肺炎支原体(MP)、Q热立克次体(COX)、肺炎衣原体(CP)、腺病毒(ADV)、呼吸道合胞病毒(RSV)、甲型流感病毒(IFA)、乙型流感病毒(IFB)、副流感病毒(PIV)抗体(IgM)水平以及痰病原菌培养结果,并对病原体耐药特点进行分析。结果MP、LP1、PIV为最常见的非典型病原体,其IgM抗体阳性率分别为52.8%、26.1%和14.6%;2种以上(含2种)非典型病原体混合感染的检出率为30.7%,混合感染主要集中在MP及LP1合并病毒感染;非典型病原体抗体的阳性率受季节因素的影响,冬季的非典型病原体抗体的总阳性率显著高于其他季节(χ^(2)=13.75,P<0.05),其中嗜肺军团菌的感染好发于冬季(χ^(2)=15.03,P<0.05);副流感病毒的感染好发于冬季(χ^(2)=10.67,P<0.05),其余非典型病原体抗体的阳性率未见明显季节性差异。细菌和非典型病原体混合感染的阳性率为6.5%(13/199);真菌和非典型病原体混合感染的阳性率为4.0%(8/199)。结论引起老年慢性支气管炎急性发作的病原体以MP、LP1、PIV等非典型病原体为主;非典型病原体的混合感染、非典型病原体与细菌的混合感染、非典型病原体与真菌的混合感染比较常见。

Objective To investigate the pathogens isolated from elderly patients with acute phrase of chronic bronchitis,so as to improve the theoretical basis for the clinical diagnosis and treatment.Methods 199 elderly patients with chronic bronchitis admitted to our hospital from December,2018 to November,2019 were enrolled and indirect immunofluorescence was employed to conduct a joint detection for the pathogen antibody against Legionellapneumophila 1(Lp1),Mycoplasma pneumoniae(MP),RickettsiaQ(COX),Chlamydia pneumoniae(CP),adenovirus(ADV),respiratory syncytialvirus(RSV),influenza A virus(IFA),influenza B virus(IFB),and parainfluenza virus(PIV)in respiratory tract.The level of atypical pathogen antibody,and the pathogenic bacteria in the sputum were analyzed retrospectively,and the antimicrobial resistant characteristics of the pathogen was investigated.Results MP showed the highest positive rate of 52.8%,followed by Lp1 and PIV,with the positive rates of 26.1%and 14.6%,respectively.The detection rate of more than two(including two)atypical pathogens was 30.7%,most of which were MP and LP1 combined with other virus.The seasonal factors had an impact on the infection rate of respiratory atypical pathogen,the positive infection rate of atypical pathogen antibodies in winter was significantly higher than other seasons(χ^(2)=13.75,P<0.05),also the positive infection rate of the Legionella pneumophila in in the winter was significantly higher than other seasons(χ^(2)=5.03,P<0.05),and the positive infection rate of the parainfluenza virus in the winter was significantly higher than other seasons(χ^(2)=10.67,P<0.05).There was no significant seasonal difference between the antibody positive rate of other atypical pathogens.The detection rate of atypical pathogen combined with bacteria was 6.5%(13/199).The detection rate of atypical pathogen combined with fungi was 4.0%(8/199).Conclusion Infection of atypical pathogens is popular in the acute attack of chronic bronchitis in the elderly,such as MP,LP1 and PIV.Mixed infections of different atypical pathogens,atypical pathogens and bacteria,atypical pathogens and fungi are common.