摘要
目的 分析下呼吸道感染（LRTI）住院患者的病原学分布特点,利用较易获得的临床信息建立细菌、病毒、细菌和病毒混合的下呼吸道感染（LRTI）判别模型,为临床抗病原治疗提供依据.方法 纳入243例2012年4月至2015年9月福建省立临床医学院诊断为LRTI的住院患者,收集其痰液及临床信息,用传统培养法、恒温扩增芯片法、测序方法及实时PCR方法检测病原体.筛选病原结果确切的病历资料,采用判别分析拟合方法建立细菌、病毒及二者混合感染的判别模型.结果243例患者中,呼吸道病原体的检出率为53.9%（131/243）,其中细菌阳性率为23.5%（57/243,其中17例合并病毒,1例合并肺炎支原体及病毒）,主要为铜绿假单胞菌和肺炎克雷伯菌;非典型病原菌阳性率为4.9%（12/243,其中3例合并病毒,1例合并细菌及病毒）,均为肺炎支原体;病毒阳性率为34.6%（84/243,其中17例合并细菌,3例合并肺炎支原体,1例合并肺炎支原体及细菌）,以甲型流感病毒和巨细胞病毒为主,同时也检出少量的腺病毒、副流感病毒、呼吸道合胞病毒、博卡病毒及偏肺病毒.以病原学为应变量,将单因素分析中有统计学意义的精神状态改变、入院前应用抗生素、并发症、异常呼吸音、中性粒细胞碱性磷酸酶（NAP）积分、肺炎严重度指数（PSI）评分及CRUB-65评分作为自变量建立判别方程,初步判别LRTI住院患者可能的病原体,总体阳性预测值为64.7%（77/119）,单纯细菌感染的阳性预测值为66.7%（22/33）,单纯病毒感染的阳性预测值为78.0%（46/59）,混合感染的阳性预测值为33.3%（9/27）.结论 本院LRTI住院患者细菌检出率最高的为铜绿假单胞菌和肺炎克雷伯菌,非典型病原菌均为肺炎支原体,病毒以甲型流感病毒和人巨细胞病毒为主. 通过临床信息建立的病原判别模型,对判别细菌、病毒或二者混合感染具有一定的临床价值.
Objective To analyze the pathogens of lower respiratory tract infection （ LRTI ） including bacterial ,viral and mixed infection , and to establish a discriminant model based on clinical features in order to predict the pathogens .Methods A total of 243 hospitalized patients with lower respiratory tract infections were enrolled in Fujian Provincial Hospital from April 2012 to September 2015.The clinical data and airway （ sputum and/or bronchoalveolar lavage ） samples were collected.Microbes were identified by traditional culture （for bacteria）, loop-mediated isothermal amplification（LAMP） and gene sequencing （for bacteria and atypical pathogen ） , or Real-time quantitative polymerase chain reaction （ Real-time PCR ） for viruses.Finally, a discriminant model was established by using the discriminant analysis methods to help to predict bacterial, viral and mixed infections.Results Pathogens were detected in 53.9% （131/243） of the 243 cases.Bacteria accounted for 23.5%（57/243, of which 17 cases with the virus, 1 case with Mycoplasma pneumoniae and virus ） , mainly Pseudomonas Aeruginosa and Klebsiella Pneumonia .Atypical pathogens for 4.9%（12/243, of which 3 cases with the virus, 1 case of bacteria and viruses ）, all were mycoplasma pneumonia.Viruses for 34.6% （84/243, of which 17 cases of bacteria, 3 cases with Mycoplasma pneumoniae , 1 case with Mycoplasma pneumoniae and bacteria ） of the cases, mainly Influenza A virus and Human Cytomegalovirus , and other virus like adenovirus , human parainfluenza virus , respiratory syncytial virus , human metapneumovirus , human boca virus were also detected fewly .Seven parameters including mental status , using antibiotics prior to admission , complications , abnormal breath sounds , neutrophil alkaline phosphatase （NAP） score, pneumonia severity index （PSI） score and CRUB-65 score were enrolled after univariate analysis , and discriminant analysis was used to establish the discriminant model by applying the identified pathogens as the dependent variable .The total positive predictive value was 64.7%（77/119）, with 66.7%for bacterial infection, 78.0%for viral infection and 33.3%for the mixed infection.Conclusions The mostly detected pathogens were Pseudomonas aeruginosa , atypitcal pathogens , Klebsiella pneumoniae , influenza A virus and human cytomegalovirus in hospitalized patients with LRTI in this hospital.The discriminant diagnostic model established by clinical features may contribute to predict the pathogens of LRTI.
作者
陈愉生
林晓红
李鸿茹
华志丹
林梦晴
黄文森
俞婷
吕辉迎
毛文平
梁嫄琦
彭小蕊
陈诗杰
郑虹
连双庆
胡辛兰
姚秀钦
Chen Yusheng;Lin Xiaohong;Li Hongru;Hua Zhidan;Lin Mengqing;Huang Wensen;Yu Ting;Lyu Huiying;Mao Wenping;Liang Yuanqi;Peng Xiaorui;Chen Shijie;Zheng Hong;Lian Shuangqing;Hu Xinlan;Yao Xiuqin(The Department of Respiratory and Critical Care Medicine, Fujian Province Hospital, Fuzhou 350001, China)
出处
《中华结核和呼吸杂志》
CAS
CSCD
北大核心
2017年第12期909-914,共6页
Chinese Journal of Tuberculosis and Respiratory Diseases
基金
福建省科技厅引导性项目（2016Y0015）
关键词
呼吸道感染
住院病人
细菌
病毒
Respiratory tract infections
Inpatients
Bacteria
Viruses model
