新型冠状病毒感染疫情前后成人社区获得性肺炎病原谱变化及分析

Pathogen spectrum changes and analysis of adult community-acquired pneumonia before and after the epidemic of novel coronavirus infection

目的 探讨新型冠状病毒感染疫情前后成人社区获得性肺炎(CAP)患者的病原体分布特点,为CAP诊疗及防控提供理论依据。方法 纳入2017年6月至2022年7月就诊于北京大学第三医院发热门诊的CAP患者,按照时间节点(2020-01-24北京进入新型冠状病毒一级防控)分为疫情前组和疫情后组。用实时荧光定量聚合酶链反应检测方法对采集的呼吸道样本进行病原体核酸检测,对病原体的检出情况及分布情况进行分析。结果 纳入415例CAP患者,分为疫情前组(312例)和疫情后组(103例)。肺炎支原体、肺炎链球菌、甲型流感病毒是疫情前CAP组患者最常见的3种病原体。而乙型流感病毒、肺炎克雷伯菌、肺炎链球菌是疫情后社区获得性肺炎中最常见的3种病原体。甲型流感病毒、副流感病毒、肺炎支原体在疫情前的发生率均显著高于疫情后,2组间差异均有统计学意义(均P<0.05)。结论 疫情前后,流感病毒均为CAP患者主要致病菌,对今后经验性的治疗,保护易感人群和防控传染病具有重要意义。

Objective To investigate the distribution characteristics of pathogens in adult community-acquired pneumonia(CAP) patients who visited the fever clinic before and after the outbreak of the novel coronavirus infection,and to provide theoretical basis for the diagnosis,treatment,and prevention of CAP.Methods CAP patients who visited the fever clinic of Peking University Third Hospital from June 2017 to July 2022 were included in the study and divided into pre-outbreak and post-outbreak groups based on the time point(January 24,2020,when Beijing entered the first-level COVID-19 prevention and control).Respiratory samples were collected and pathogen nucleic acid detection was performed using real-time fluorescence quantitative polymerase chain reaction.The detection and distribution of pathogens were analyzed.Results A total of 415 CAP patients were included,divided into pre-outbreak group(312 cases) and post-outbreak group(103cases).Mycoplasma pneumoniae,Streptococcus pneumoniae,and Influenza A virus were the three most common pathogens in the preoutbreak CAP group.In the post-outbreak community-acquired pneumonia,Influenza B virus,Klebsiella pneumoniae and Streptococcus pneumoniae were the three most common pathogens.The incidence of Influenza A virus,Parainfluenza virus,and Mycoplasma pneumoniae was significantly higher in the pre-outbreak period than in the post-outbreak period,and the differences between the two groups were statistically significant(all P <0.05).Conclusion Before and after the epidemic,viral infection are the main pathogens of CAP patients,which is of great significance for future empirical treatment,protection of susceptible population and control of infectious diseases.