Establishment of a Predictive Diagnostic Model for Acute Mycoplasma Pneumoniae Infection in Elderly Patients with Community-acquired Pneumonia

We established a diagnostic model to predict acute Mycoplasma pneumoniae （M. pneumonia） infection in elderly Community-acquired pneumonia （CAP） patients. We divided 456 patients into acute and non-acute M. pneumoniae infection groups. Binary logistic regression and receiver operating characteristic （ROC） curves were used to establish a predictive model. The following independent factors were identified： age 〉 70 years; serum cTNT level 〉 0.0S ng/mL; lobar consolidation; mediastinal lymphadenopathy; and antibody titer in the acute phase 〉 1：40. The area under the ROC curve of the model was 0.923 and a score of 2 7 score predicted acute M. pneumoniae infection in elderly patients with CAP. The predictive model developed in this study has high diagnostic accuracy for the identification of elderly acute M. pneumoniae infection.

The Effect and Effectiveness Evaluation of Sit-up Training on Elderly Bedridden Patients with Severe Pneumonia

The objective of the study was to access the effect and the effectiveness of sit-up training on elderly bedridden patients with severe pneumonia.A total of 150 elderly bedridden patients diagnosed with severe pneumonia were recruited for this study.They were divided equally into the observation group and control group,that is,75 cases in each group.All patients were selected from January 2016 to April 2018.On this basis,both groups were treated with the same routine nursing care except with the addition of 30–60 min situp trainings twice daily for the control group under supervision.The clinical hospitalization outcomes,length of hospital stay,and patient care satisfaction of the two groups were compared.The clinical hospitalization outcomes,length of hospital stay,and patient satisfaction of the observation group were found to be superior to the control group,and the difference was significant.In bedridden elderly patients with severe pneumonia,sit-up training had positive effects and beneficial in improving the clinical outcomes and recovery rate.

Effect of Xuebijing, thymopentin combined with symptomatic treatment on inflammatory response process in elderly patients with severe pneumonia

Objective:To study the effect of Xuebijing, thymopentin combined with symptomatic treatment on inflammatory response process in elderly patients with severe pneumonia. Methods: A total of 60 elderly patients with severe pneumonia who were treated in the hospital between August 2014 and July 2016 were collected and divided into control group and observation group according to the random number table, 30 cases in each group. Control group received clinical symptomatic treatment, and observation group received Xuebijing, thymopentin combined with symptomatic treatment. The differences in serum pro-inflammatory factors, anti-inflammatory factors as well as liver and kidney function indexes were compared between the two groups before and after treatment.Results: Before treatment, differences in serum levels of pro-inflammatory factors, anti-inflammatory factors as well as liver and kidney function indexes were not statistically significant between the two groups. After treatment, serum IL-1β, IL-6, IL-8, IL-4, IL-13, TB, ALT, AKP, Scr and CysC levels of both groups of patients were lower than those before treatment, and serum IL-1β, IL-6, IL-8, IL-4, IL-13, TB, ALT, AKP, Scr and CysC levels of observation group were lower than those of control group.Conclusion: Xuebijing, thymopentin combined with symptomatic treatment can effectively inhibit the degree of systemic inflammatory response and reduce the liver and kidney function injury in elderly patients with severe pneumonia.

The effect on immune function and inflammatory factors of adjuvant antibiotic therapy through Xuebijing combined with thymopentin in elderly patients with severe pneumonian

Objective:To investigate the effect on immune function and inflammatory factors of adjuvant antibiotic therapy through Xuebijing combined with thymopentin in elderly patients with severe pneumonia.Methods:Divided 100 cases of elderly patients with severe pneumonia into the observation group and the treatment group according to odevity of serial number. Fifty patients in each group. Gave control group severe pneumonia conventional treatment, such as mechanical ventilation, antifebrile, removing phlegm and anti-infection, and gave Xuebijing by intravenous drop simultaneously;observation group was given Xuebijing combined with thymopentin by intravenous drop on the base of conventional treatment. Then compared the T lymphocyte subpopulation and serum inflammatory factors level including CRP, IL-6, IL-1 and TNF-α of two groups before treatment and 7 d, 14 d of treatment respectively.Result:(1) There was significant difference in the level of CD3+, CD4+, CD8+, CD4+/CD8+ in this two groups at different time points, and that the level of CD3+, CD4+, CD4+/CD8+: T2>T1>T0, CD8+ level: T2<T1<T0;The increasing range of CD3+, CD4+, CD4+/CD8+level and the decreasing range of CD8+ in the observation group were larger than that in the control group, there was statistical significant difference. (2) The level of serum inflammatory factors CRP, IL-6, IL-1, TNF-α in two groups at different time points were statistical significant difference, all the CRP, IL-6, IL-1 and TNF-α level were T2<T1<T0, presenting a downward trend;The descending range of serum CRP, IL-6, IL-1, TNF-α level in the observation was larger compared with the control group, there was significant difference.Conclusion:The adjuvant antibiotic therapy through Xuebijing combined with thymopentin in elderly patients with severe pneumonia could improve the immune function and lower the inflammatory factors level.

Clinical characteristics of community-acquired pneumonia in children caused by mycoplasma pneumoniae with or without myocardial damage:A single-center retrospective study

BACKGROUND Mycoplasma pneumoniae(MP)is a prevalent pathogen that causes respiratory infections in children and adolescents.AIM To assess the differences in the clinical features of MP-associated communityacquired pneumonia(CAP)in children who presented with mild or severe mycoplasma pneumoniae pneumonia(MPP);to identify the incidence of myocardial damage between the two groups.METHODS This work is a retrospective study.We identified children between 2 mo and 16 years of age with clinical and radiological findings consistent with CAP.We admitted patients to the inpatient department of the Second Hospital of Jilin University,Changchun,China,from January 2019 to December 2019.RESULTS A total of 409 hospitalized patients were diagnosed with MPP.Among them were 214(52.3%)males and 195(47.7%)females.The duration of fever and cough was the longest in severe MPP cases.Similarly,plasma levels of highly sensitive Creactive protein(t=-2.834,P<0.05),alanine transaminase(t=-2.511,P<0.05),aspartate aminotransferase(t=-2.939,P<0.05),and lactate dehydrogenase(LDH)(t=-2.939,P<0.05)were all elevated in severe MPP cases compared with mild MPP cases,and these elevations were statistically significant(P<0.05).Conversely,the neutrophil percentage was significantly lower in severe MPP cases than in mild MPP cases.The incidence of myocardial damage was significantly higher in severe MPP cases than in mild MPP cases(χ^(2)=157.078,P<0.05).CONCLUSION Mycoplasma pneumoniae is the main cause of CAP.The incidence of myocardial damage was higher and statistically significant in severe MPP cases than in mild MPP cases.

B-type natriuretic peptide in predicting the severity of community-acquired pneumonia

BACKGROUND: Although pneumonia severity index(PSI) is widely used to evaluate the severity of community-acquired pneumonia(CAP), the calculation of PSI is very complicated. The present study aimed to evaluate the role of B-type natriuretic peptide(BNP) in predicting the severity of CAP.METHODS: For 202 patients with CAP admitted to the emergency department, BNP levels, cardiac load indexes, inf lammatory indexes including C-reactive protein(CRP), white blood cell count(WBC), and PSI were detected. The correlation between the indexes and PSI was investigated. BNP levels for survivor and non-survivor groups were compared, and a receiver operating characteristic(ROC) curve analysis was performed on the BNP levels versus PSI.RESULTS: The BNP levels increased with CAP severity(r=0.782, P<0.001). The BNP levels of the high-risk group(PSI classes IV and V) were signifi cantly higher than those of the low-risk group(PSI classes I–III)(P<0.001). The BNP levels were signifi cantly higher in the non-survivor group than in the survivor group(P<0.001). In addition, there were positive correlations between BNP levels and PSI scores(r=0.782, P<0.001). The BNP level was highly accurate in predicting the severity of CAP(AUC=0.952). The optimal cut-off point of BNP level for distinguishing high-risk patients from low-risk ones was 125.0 pg/m L, with a sensitivity of 0.891 and a specifi city of 0.946. Moreover, BNP level was accurate in predicting mortality(AUC=0.823). Its optimal cut-off point for predicting death was 299.0 pg/m L, with a sensitivity of 0.675 and a specifi city of 0.816. Its negative predictive cut-off value was 0.926, and the positive predictive cut-off value was 0.426.CONCLUSION: BNP level is positively correlated with the severity of CAP, and may be used as a biomarker for evaluating the severity of CAP.

Clinical factors associated with composition of lung microbiota and important taxa predicting clinical prognosis in patients with severe community-acquired pneumonia

Few studies have described the key features and prognostic roles of lung microbiota in patients with severe community-acquired pneumonia(SCAP).We prospectively enrolled consecutive SCAP patients admitted to ICU.Bronchoscopy was performed at bedside within 48 h of ICU admission,and 16S rRNA gene sequencing was applied to the collected bronchoalveolar lavage fluid.The primary outcome was clinical improvements defined as a decrease of 2 categories and above on a 7-category ordinal scale within 14 days following bronchoscopy.Sixty-seven patients were included.Multivariable permutational multivariate analysis of variance found that positive bacteria lab test results had the strongest independent association with lung microbiota(R2=0.033;P=0.018),followed by acute kidney injury(AKI;R2=0.032;P=0.011)and plasma MIP-1βlevel(R2=0.027;P=0.044).Random forest identified that the families Prevotellaceae,Moraxellaceae,and Staphylococcaceae were the biomarkers related to the positive bacteria lab test results.Multivariable Cox regression showed that the increase inα-diversity and the abundance of the families Prevotellaceae and Actinomycetaceae were associated with clinical improvements.The positive bacteria lab test results,AKI,and plasma MIP-1βlevel were associated with patients’lung microbiota composition on ICU admission.The families Prevotellaceae and Actinomycetaceae on admission predicted clinical improvements.

Desmoglein 2(DSG2) Is A Receptor of Human Adenovirus Type 55 Causing Adult Severe Community-Acquired Pneumonia

Human adenovirus type 55(HAdV-B55) is a re-emergent acute respiratory disease pathogen that causes adult communityacquired pneumonia(CAP). Previous studies have shown that the receptor of HAdV-B14, which genome is highly similar with HAdV-B55, is human Desmoglein 2(DSG2). However, whether the receptor of HAdV-B55 is DSG2 is undetermined because there are three amino acid mutations in the fiber gene between HAdV-B14 and HAdV-B55. Here, firstly we found the 3T3 cells, a mouse embryo fibroblast rodent cell line which does not express human DSG2, were able to be infected by HAdV-B55 after transfected with pcDNA3.1-DSG2, while normal 3T3 cells were still unsusceptible to HAdV-B55 infection. Next, A549 cells with h DSG2 knock-down by siRNA were hard to be infected by HAdV-B3/-B14/-B55, while the control siRNA group was still able to be infected by all these types of HAdVs. Finally, immunofluorescence confocal microscopy indicated visually that Cy3-conjugated HAdV-B55 viruses entered A549 cells by binding to DSG2 protein.Therefore, DSG2 is a major receptor of HAdV-B55 causing adult CAP. Our finding is important for better understanding of interactions between adenoviruses and host cells and may shed light on the development of new drugs that can interfere with these processes as well as for the development of potent prophylactic vaccines.

低磷血症与老年重症肺炎预后相关性研究

目的 重症肺炎是引起老年人死亡的主要病因之一,而低磷血症在老年患者中发病率高且常被忽视,探究二者相关性为老年重症肺炎合并低磷血症者提供临床诊疗依据;方法 采用回顾性研究方法,按照入组标准及排除标准收集自2021年2月—2022年9月诊断为“重症肺炎”老年患者,共88例,按照不同血磷水平分为低磷血症组及血磷正常组,在不同组间对患者基础状况、预后情况进行比较。结果 低磷血症与患者预后情况密切相关,低磷血症组既往存在脑血管疾病史者较多(45.9%vs.22.2%,χ^(2)=4.42,P=0.03),低磷血症及血磷正常组相比死亡率、休克患者比例及机械通气(有创机械通气及无创机械通气)比例无明显差异,低磷血症组有创机械通气比例明显升高(36.1%vs.14.8%,χ^(2)=4.06,P=0.04),且在存活患者中,低磷血症组有创机械通气时间比血磷正常组延长[(7.70±2.94)d vs.(3.33±0.57)d,t=2.47,P=0.03],存活患者中低磷血症组住院费用比血磷正常组更高(3.48万元vs. 5.17万元,Z=2.85,P<0.02)。在不同病原学之间血磷水平无明显差异性。结论 血磷水平和老年重症肺炎患者预后有相关性,严重低磷血症可引起患者有创机械通气比例及通气时间延长,并引起患者住院费用增多。

Efficacy and significance of various scores for pneumonia severity in the management of patients with community-acquired pneumonia in China

Background Community-acquired pneumonia （CAP） remains one of the leading causes ot death from infectious diseases around the world.Most severe CAP patients are admitted to the intensive care unit （ICU）,and receive intense treatment.The present study aimed to evaluate the role of the pneumonia severity index （PSI）,CURB-65,and sepsis score in the management of hospitalized CAP patients and explore the effect of ICU treatment on prognosis of severe cases.Methods A total of 675 CAP patients hospitalized in the Second Affiliated Hospital of Zhejiang University School of Medicine were retrospectively investigated.The ability of different pneumonia severity scores to predict mortality was compared for effectiveness,while the risk factors associated with 30-day mortality rates and hospital length of stay （LOS） were evaluated.The effect of ICU treatment on the outcomes of severe CAP patients was also investigated.Results All three scoring systems revealed that the mortality associated with the low-risk or intermediate-risk group was significantly lower than with the high-risk group.As the risk level increased,the frequency of ICU admission rose in tandem and LOS in the hospital was prolonged.The areas under the receiver operating characteristic curve in the prediction of mortality were 0.94,0.91 and 0.89 for the PSI,CURB-65 and sepsis score,respectively.Compared with the corresponding control groups,the mortality was markedly increased in patients with a history of smoking,prior admission to ICU,respiratory failure,or co-morbidity of heart disease.The differences were also identified in LOS between control groups and patients with ICU treatment,heart,or cerebrovascular disease.Logistic regression analysis showed that age over 65 years,a history of smoking,and respiratory failure were closely related to mortality in the overall CAP cohort,whereas age,ICU admission,respiratory failure,and LOS at home between disease attack and hospital admission were identified as independent risk factors for mortality in the high-risk CAP sub-group.The 30-day mortality of patients who underwent ICU treatment on admission was also higher than for non-ICU treatment,but much lower than for those patients who took ICU treatment subsequent to the failure of non-ICU treatment.Conclusions Each severity score system,CURB-65,sepsis severity score and especially PSI,was capable of effectively predicting CAP mortality.Delayed ICU admission was related to higher mortality rates in severe CAP patients.

Can the detection of IgA anti-Mycoplasma pneumoniae added to IgM increase diagnostic accuracy in patients with infections of the lower respiratory airways?

AIM To evaluate the increase in diagnostic yield, by using IgA in addition to IgM, instead of IgM alone, in relation to the age of the patients.METHODS The study considered 1067 blood samples from patients with clinical signs of lower respiratory tract infections, tested for anti-Mycoplasma IgG, IgM and IgA antibody.RESULTS The increase in diagnostic yield with IgA, compared to IgM detection alone was of 3.5% with statistically significant differences between age groups(0.8% for those equal/under 50 years of age and 4.3% for those over 50).CONCLUSION Our findings demonstrate that IgA detection lead to a twofold increase in the number of diagnoses among the older age groups, but it did not result in relevant increase among the younger age groups.

老年重症肺炎合并低钠血症的临床治疗观察

目的:观察老年重症肺炎合并低钠血症的临床特点和治疗效果。方法:对我院2005年3月～2009年3月收治的26例老年重症肺炎合并低钠血症患者和未合并低钠血症26例患者的临床资料进行回顾性分析。结果:经治疗后,26例合并低钠血症的老年重症肺炎患者治疗总有效率为57.7%,未合并低钠血症26例患者治疗总有效率为73.1%,两者比较差异无统计学意义(P>0.05)。两组死亡患者均死于感染加重导致器官功能衰竭。结论:临床上密切监测电解质,及早发现低钠血症和及时纠正血钠水平,对提高患者的治疗效果至关重要。

老年重症肺炎抗生素降阶梯治疗及比阿培南的应用

目的:评价降阶梯治疗策略治疗老年重症肺炎的疗效。方法:回顾分析2008年1月—2011年1月解放军成都军区总医院老年科重症肺炎患者42例,分为治疗组(降阶梯治疗组,21例)和对照组(传统治疗组,21例),比较2组的不适当抗生素治疗发生率、临床疗效、细菌清除率、感染控制天数、住院费用等指标。结果:治疗组与对照组比较总有效率分别为90.48%(19/21)、61.90%(13/21);细菌清除率分别为82.60%(19/23)、59.09%(13/22);感染控制天数分别为(8.5±4.8)、(13.3±6.4)d,2组比较差异显著,有统计学意义(P<0.05);不适当抗生素治疗发生率和住院费用明显低于对照组,差异显著,有统计学意义(P<0.01)。结论:抗生素降阶梯疗法能迅速控制感染,提高治愈率,对老年重症肺炎可获得良好疗效。

心肌肌钙蛋白T和CK在老年重症肺炎患者中的临床意义及对预后的影响

目的探讨血清心肌肌钙蛋白T（cTnT）和CK在老年重症肺炎患者中的临床意义及对预后的影响。方法观察181例老年重症肺炎患者入院后3d内最高cTnT、CK测值和APACHEII评分，并对3者进行相关性分析。将患者分为cTnT正常组和升高组，比较两组的APACHEII评分和病死率。依据预后分为生存组和死亡组，比较两组cTnT、CK测值的变化。结果cTnT正常组APACHEII评分和死亡例数与升高组差异有统计学意义（P〈005）。生存组cTnT、CK测值和APACHEII评分与死亡组差异均有统计学意义（均P〈0．01），cTnT、CK与APACHEII评分3者之间呈正相关（均P〈0.01）。生存组cTnT、CK和APACHEII评分为（0．056±0．023）ng／ml、（13567±2071）μg／L和（17．4±2．8）分；死亡组cTnT、CK和APACHEII评分为（0．92±0.035）ng／ml、（210．22±32．6）μg／L和（24．8±5．6）分。结论老年重症患者cTnT、CK升高较常见，cTnT、CK监测对判断老年重症肺炎的预后具有一定临床意义。

老年重症肺炎患者炎症因子、D-dimer和血浆纤维结合蛋白动态监测的临床预后价值

目的通过回顾性分析,分析老年重症肺炎患者动态监测D-二聚体(D-dimer,D-D)、血清炎症因子和血浆纤维结合蛋白(Fn)对病情严重程度及预后的临床作用。方法抽取68例老年重症肺炎患者作为研究对象,均源自于新乡医学院第三附属医院2019年10月至2021年10月收入,根据患者临床治疗结局分为死亡组(n=27)与幸存组(n=41),详细记录所有患者基线资料(例如性别、年龄及病史等)。同时积极检测患者入院时、入院3 d、7 d的生命体征、血生化、血气分析、血常规等指标,并根据结果开展急性生理与慢性健康评估评分(APACHEⅡ),详细记录各时间点患者血清炎症因子、D-D及Fn指标状况。结果幸存组患者各时间段APACHEⅡ评分均低于死亡组,同时幸存组患者呈降低趋势,死亡组呈升高趋势,差异有统计学意义(P<0.05);两组患者入院时炎症因子水平比较,差异无统计学意义(P>0.05),入院3 d、7 d后幸存组患者炎症因子呈降低趋势发展,差异有统计学意义(P<0.05),而死亡组虽略有上升趋势,但差异无统计学意义(P>0.05);幸存组患者D-D指标各时间段均低于死亡组,且Fn指标各时间段均高于死亡组,差异有统计学意义(P<0.05),幸存组患者D-D指标呈降低趋势、Fn指标呈上升趋势发展,死亡组患者Fn指标呈降低趋势发展,差异有统计学意义(P<0.05),而死亡组D-D指标略有上升趋势,但差异无统计学意义(P>0.05)。结论对于老年重症肺炎患者应用炎症因子、D-D及Fn指标进行动态监测,均可起到分析病情严重程度及预后的效果,且D-D及Fn指标对患者病情预后判断价值更高,具有推广价值。

重症肺炎并发ARDS老年患者血清TNF-α、IL-6、IL-10、HMGB1水平及其与预后的相关性分析

目的探讨重症肺炎并发急性呼吸窘迫综合征(ARDS)老年患者血清肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、白介素-10(IL-10)及高迁移率族蛋白B1(HMGB1)水平及其与预后的相关性分析。方法随机选取我院2016年1月~2019年1月收治的30例重症肺炎并发ARDS老年患者为A组,30例重症肺炎无ARDS老年患者为B组,30例非重症肺炎老年患者为C组,30例健康体检者为D组。比较四组受试者TNF-α、IL-6、IL-10、HMGB1水平,并分析TNF-α、IL-6及IL-10与HMGB1水平之间的相关性,根据A组患者预后结局将其分为死亡组和对照组,比较两组患者TNF-α、IL-6、IL-10及HMGB1水平。结果四组受试者血清TNF-α、IL-6、IL-10和HMGB1水平值比较,组间差异明显,且A、B、C组均值均明显高于D组,差异有统计学意义(P<0.01)。Pearson相关分析发现,重症肺炎并发ARDS老年患者血清TNF-α、IL-6水平与HMGB1水平呈现正相关关系,Pearson相关系数分别为0.493和0.566(P均<0.01)。IL-10水平与HMGB1水平呈负相关,Pearson相关系数为-0.502(P<0.01)。死亡组IL-6及HMGB1水平均显著高于存活组,差异有统计学意义(P<0.01),而死亡组IL-10水平显著低于存活组,差异有统计学意义(P<0.01)。结论 IL-6及HMGB1的超表达或过度释放可能是导致重症肺炎并发ARDS老年患者不良预后的重要因素。

尿N-乙酰-β-D-氨基葡萄糖苷酶与尿肌酐比在老年重症肺炎合并急性肾损伤患者中的诊断意义

目的探讨尿N-乙酰-β-D-氨基葡萄糖苷酶(N-acecyl-β-D-glucosaminidase,NAG)/尿肌酐(creatinine,Cr)的在老年重症肺炎急性肾损伤患者中的诊断意义。方法回顾分析19例老年重症肺炎合并急性肾损伤患者(试验组)的尿NAG/Cr的变化情况,患病前后48h、第7d的血肌酐应用生化分析仪检测,尿NAG/Cr用速率散射法检测。对照组为同期住院不伴有肺部感染的19例非肾脏疾病患者。结果试验组患病前与对照组比较,血Cr及尿NAG/Cr差异无统计学意义(P>0.05);根据急性肾损伤网络(Acute KidneyInjury Network,AKIN)的标准,患重症肺炎后48h诊断急性肾损伤Ⅰ期15例,Ⅱ期3例,Ⅲ期1例;合并急性肾损伤的患者尿NAG/Cr均明显增高。患重症肺炎后的第7d,检测了尿NAG/Cr的12例患者中的5例肾衰竭患者尿NAG/Cr明显高于已好转的另7例非肾衰竭患者。结论尿NAG/Cr的增高对老年重症肺炎合并急性肾损伤有诊断意义。

一例高龄糖尿病足溃疡感染合并重症肺炎的护理

介绍1例高龄糖尿病足溃疡感染合并重症肺炎患者的护理体会。护理要点包括:成立糖尿病足护理小组;糖尿病足局部创面处理;腿部物理治疗;全身抗感染治疗及控制血糖等措施。经过12周的护理,患者糖尿病足溃疡面愈合,重症肺炎好转,血糖控制稳定,患者家属表示满意。

胸腺肽α1对老年重症医院获得性肺炎患者免疫功能的影响

目的:探讨胸腺肽α1治疗对老年重症医院获得性肺炎(SHAP)患者细胞免疫功能的影响及其临床意义。方法:48例SHAP患者随机分为治疗组和对照组。治疗组在对照组基础上给予胸腺肽α1 1.6 mg皮下注射,qd,持续1周,之后改为1.6 mg,皮下注射,隔日一次,共2周。结果:治疗组治疗后单核细胞人类白细胞抗原(HLA-DR)、自然杀伤(NK)细胞、CD4+细胞及CD4+/CD8+比值明显上升;治疗组住院死亡率明显低于对照组,其存活者抗生素应用时间亦比对照组明显缩短。结论:胸腺肽α1能提高SHAP患者免疫功能,有利于感染控制,并降低住院死亡率。

小剂量低分子肝素可改善老年重症肺炎患者预后:一项1 173例患者的Meta分析

目的通过系统评价方法探讨小剂量低分子肝素对老年重症肺炎患者疗效及预后的影响。方法检索万方数据、维普数据库(VIP)、中国知网(CNKI)、中国生物医学文献服务系统(SinoMed)和美国国立医学图书馆PubMed数据库、荷兰医学文摘Embase数据库、Cochrane图书馆数据库等中英文数据库,从建库至2019年8月发表的有关比较常规治疗与低分子肝素对老年重症肺炎患者疗效及预后影响的随机对照试验(RCT)。常规治疗组给予改善通气、抗感染、祛痰、平喘、纠正内环境等常规治疗;低分子肝素组在常规治疗基础上,加用低分子肝素4000 U皮下注射、每日1次、治疗7 d。主要结局指标为治疗7 d后氧合指数(PaO2/FiO2)、呼吸机支持时间、住院病死率;次要结局指标为治疗7 d后急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、凝血功能指标以及重症监护病房(ICU)住院时间和出血发生率。对纳入文献进行严格的质量评价与资料提取,应用RevMan 5.3软件对符合质量标准的RCT进行Meta分析。对纳入文献数不少于10篇的指标进行漏斗图分析,评价纳入文献的发表偏倚。结果最终纳入14项RCT、共1173例患者,均为老年重症肺炎患者;其中低分子肝素组590例,常规治疗组583例。纳入研究整体设计良好,质量较高。Meta分析结果显示,与常规治疗组相比,低分子肝素组患者治疗7 d后PaO2/FiO2明显升高〔均数差(MD)=19.25,95%可信区间(95%CI)为16.88~21.61,P<0.00001〕,呼吸机支持时间明显缩短(MD=-48.88,95%CI为-67.42^-30.33,P<0.00001),住院病死率明显降低〔优势比(OR)=0.40,95%CI为0.22~0.73,P=0.003〕,治疗7 d后APACHEⅡ评分显著降低(MD=-3.38,95%CI为-3.94^-2.83,P<0.00001),ICU住院时间明显缩短(MD=-4.51,95%CI为-5.75^-3.27,P<0.00001);而两组治疗7 d后凝血指标及治疗期间出血发生率比较差异均无统计学意义〔7 d凝血酶时间(TT):MD=0.57,95%CI为-0.15~1.28,P=0.12;7 d凝血酶原时间(PT):MD=0.32,95%CI为-0.35~0.98,P=0.35;7 d纤维蛋白原(FIB):MD=-0.17,95%CI为-0.45~0.10,P=0.22;出血发生率:OR=0.86,95%CI为0.36~2.07,P=0.74〕。对纳入文献数为10篇的APACHEⅡ评分进行漏斗图分析,结果显示文献存在发表偏倚。结论小剂量低分子肝素能够改善老年重症肺炎患者预后,且对凝血功能无明显影响。