北京地区成人社区获得性肺炎非典型病原体流行病学调查

Prevalence of atypical pathogens in adult patients with community-acquired pneumonia in Beijing

目的 对引起社区获得性肺炎 (CAP)的病原体进行流行病学调查 ,加强对非典型致病原重要性的认识。方法 收集 2 0 0 1年 11月至 2 0 0 2年 6月CAP患者共 10 3例。分别检测患者急性期及恢复期肺炎支原体、嗜肺军团菌、肺炎衣原体血清抗体。应用聚合酶链反应 (PCR)分别扩增肺炎支原体P1黏附蛋白基因及肺炎衣原体 16SrRNA基因。应用酶免疫测定 (EIA)方法检测尿中嗜肺军团菌抗原。取患者急性期痰标本进行细菌培养 ,应用常规方法分离鉴定细菌。结果 10 3例CAP患者 ,病原体检出率为 48.5%。 2 3例 (2 2 .3 % )检出肺炎支原体 ,3例 (2 .9% )检出嗜肺军团菌 ,2例 (1.9% )检出肺炎衣原体。 12例分离出肺炎链球菌 (11.7% )、9例分离出流感嗜血杆菌 (8.7% )、7例分离出肺炎克雷伯菌 (6.8% )。 6例患者存在混合感染 (5.8% ) ,其中 5例为肺炎支原体混合其他病原体。结论 非典型病原体尤其是肺炎支原体感染在CAP中占据重要地位 ;肺炎链球菌和流感嗜血杆菌仍为常见的致病细菌 ;

Objective To study the pathogens in community-acquired pneumonia (CAP), especially the prevalence of atypical pathogens. Methods A prospective study was performed on 103 consecutive adult patients with CAP between November 2001 and June 2002. Antibodies of the paired serum samples to Mycoplasma pneumoniae, Legionella pneumophilia, and Chlamydia pneumoniae were detected .The P1 adhesion gene of Mycoplasma pneumoniae and the 16S ribosome gene specific for Chlamydia pneumoniae were detected with polymerase chain reaction (PCR). Legionella antigen in urine was detected using enzyme immunoassay (EIA) method. Sputum samples were collected for culture, and bacteria were isolated and identified using conventional methods. Results The etiology of CAP was identified in 50 (48.5%) patients. The distribution of causal agents was as follws: Mycoplasma pneumoniae in 23(22.3%) cases, Legionella pneumophilia 3 (2.9%),Chlamydia pneumoniae 2(1.9%),streptococcus pneumoniae 12 (11.7%), Haemophilus influenzae 9(8.7%), and Klebsiella pneumoniae 7(6.8%). In 6 patients (5.8%) more than one causal agent were found, among them Mycoplasma pneumoniae was found in 5 cases with mixed infections. Conclusions Atypical pathogens especially Mycoplasma pneumoniae have an important role in CAP. Streptococcus pneumoniae and Haemophilus influenzae remain the most common bacteria, and mixed infection should not be ignored.