CAJ | 학술논문

目的研究非典型病原菌感染在成人住院社区获得性肺炎中的重要地位,并对其临床特点进行分析.方法收集2005年5月至2008年5月来自国内多中心的153例成人社区获得性肺炎住院患者急性期及恢复期双份血清和急性期痰标本,采用间接免疫荧光法检测肺炎衣原体IgG抗体及嗜肺军团菌IgG、IgA及IgM混合抗体滴度,采用被动凝集法检测肺炎支原体IgG、IgA及IgM混合抗体滴度,同时对153份急性期痰标本进行普通细菌培养.用回顾性分析方法了解非典型病原菌在成人社区获得性肺炎住院患者中的地位.结果 153例血清学检测结果中符合非典型病原菌致社区获得性肺炎诊断标准的52例(34.0%),其中47例为单一非典型病原菌感染,其中肺炎衣原体38例,肺炎支原体4例,嗜肺军团菌5例;5例为2种非典型病原菌混合感染,其中肺炎衣原体+肺炎支原体2例,肺炎衣原体+嗜肺军团菌3例;52例中合并细菌感染者11例.结论非典型病原菌(肺炎衣原体、肺炎支原体及嗜肺军团菌)为成人住院社区获得性肺炎的重要致病菌,以肺炎衣原体为主,同时不能忽视合并细菌感染情况的存在.
목적 연구비전형병원균감염재성인주원사구획득성폐염중적중요지위,병대기림상특점진행분석.방법 수집2005년5월지2008년5월래자국내다중심적153례성인사구획득성폐염주원환자급성기급회복기쌍빈혈청화급성기담표본,채용간접면역형광법검측폐염의원체IgG항체급기폐군단균IgG、IgA급IgM혼합항체적도,채용피동응집법검측폐염지원체IgG、IgA급IgM혼합항체적도,동시대153빈급성기담표본진행보통세균배양.용회고성분석방법료해비전형병원균재성인사구획득성폐염주원환자중적지위.결과 153례혈청학검측결과중부합비전형병원균치사구획득성폐염진단표준적52례(34.0%),기중47례위단일비전형병원균감염,기중폐염의원체38례,폐염지원체4례,기폐군단균5례;5례위2충비전형병원균혼합감염,기중폐염의원체+폐염지원체2례,폐염의원체+기폐군단균3례;52례중합병세균감염자11례.결론 비전형병원균(폐염의원체、폐염지원체급기폐군단균)위성인주원사구획득성폐염적중요치병균,이폐염의원체위주,동시불능홀시합병세균감염정황적존재.
Objective To investigate the current status of atypical pathogen associated infections in community-acquired pneumonia(CAP) in adults, and their clinical attributes. Methods Clinical data,sputum specimens from acute phase, and paired sera from acute- and convalescent-phases of CAP in 153 adult patients were collected from May 2005 to May 2008 in multiple medical centers. Chlamydia pneumoniae(Cpn) IgG antibody, and Legionella pneumophila(LP) mixed IgG, IgA and IgM antibodies were determined by indirect immuno-fluorenscent assay. Mycoplasma pneumoniae(Mpn) mixed IgG, IgA and IgM antibodies were determined by passive agglutionation assay. All the sputum specimens were routinely cultured for bacterial isolation. Results Fifty-two(34% ) out of the 153 cases were diagnosed as atypical CAP per the paired serum-antibody assay. Forty-seven of the 52 atypical CAP cases were infected by one atypical pathogen, 38 with Cpn, 4 with Mpn, and 5 with LP, while 5 out of the 52 atypical CAP cases were infected by 2 pathogens, Cpn and Mpnin 2, Cpn and LP in 3 cases. Eleven cases(21.2%) out of the 52 patients with atypical pneumonia were complicated with bacterial infection. Except peripheral white blood count was significant increased in the group of typical( bacterial only) pneumonia( WBC ＞ 10 × 109/L, P =0. 03), all the other clinical parameters did not show statistically significant difference between the typical and the atypical pneumonia groups. Conclusions Our data suggest that Chlamydia pneumoniae,Mycoplasma pneumoniae and Legionella pneumophila are common pathogens of adult CAP. Chlamydia pneumoniae might be the most frequent atypical pathogen associated with atypical CAP.