中国全科医学
中國全科醫學
중국전과의학
CHINESE GENERAL PRACTICE
2014年
13期
1506-1510
,共5页
社区获得性肺炎%肺炎链球菌%肺炎支原体%药敏试验%危险因素
社區穫得性肺炎%肺炎鏈毬菌%肺炎支原體%藥敏試驗%危險因素
사구획득성폐염%폐염련구균%폐염지원체%약민시험%위험인소
Community - acquired pneumonia%Streptococcus pneumoniae%Mycoplasma pneumoniae%Drug sensitive test%Risk factors
目的：了解我院老年社区获得性肺炎（CAP）的病原体和耐药性变迁，分析 CAP 发病的高危因素，为老年 CAP 的预防和治疗提供指导意见。方法回顾性分析2008-2012年的315例老年 CAP 患者的资料，对痰标本进行培养、分离和鉴定，药敏试验采用 K - B 法。对相关危险因素进行单因素和多因素 Logistic 回归分析。结果315份痰标本病原体培养阳性113份，阳性率为35.9％，2008-2012年各年阳性率分别为36.2％（21/58）、33.9％（19/56）、36.1％（22/61）、36.4％（24/66）和36.5％（27/74），差异无统计学意义（χ2＝0.574，P ﹥0.05）；共分离出130株病原体，革兰阳性菌43株（占33.1％），革兰阴性菌51株（占39.2％），非典型病原体36株（占27.7％）。其中分布最多的4种病原体为肺炎链球菌、肺炎支原体、流感嗜血杆菌和肺炎克雷伯菌，分别占23.9％、20.8％、15.4％和14.6％。2008-2012年肺炎链球菌（由34.8％下降至18.8％）和流感嗜血杆菌（由26.1％下降至9.4％）的比重逐年下降，肺炎克雷伯菌（由8.7％上升至18.8％）和肺炎支原体（由13.0％上升至31.3％）逐年上升；肺炎链球菌对青霉素的耐药率在5年都很高，且在后2年达到100％。多因素 Logistic 回归分析显示年龄、吸烟史、烟龄、慢性阻塞性肺疾病（COPD）、哮喘、慢性支气管炎、肺结核、支气管扩张和肺癌是 CAP 的独立危险因素（P ﹤0.05）。结论本地区老年 CAP 的病原体构成和耐药性均发生了明显变迁，由以往以肺炎链球菌为主，逐渐变为以肺炎支原体为主，耐药性增强且呈多重耐药特点；吸烟和呼吸道疾病是老年 CAP 的高危因素。
目的：瞭解我院老年社區穫得性肺炎（CAP）的病原體和耐藥性變遷，分析 CAP 髮病的高危因素，為老年 CAP 的預防和治療提供指導意見。方法迴顧性分析2008-2012年的315例老年 CAP 患者的資料，對痰標本進行培養、分離和鑒定，藥敏試驗採用 K - B 法。對相關危險因素進行單因素和多因素 Logistic 迴歸分析。結果315份痰標本病原體培養暘性113份，暘性率為35.9％，2008-2012年各年暘性率分彆為36.2％（21/58）、33.9％（19/56）、36.1％（22/61）、36.4％（24/66）和36.5％（27/74），差異無統計學意義（χ2＝0.574，P ﹥0.05）；共分離齣130株病原體，革蘭暘性菌43株（佔33.1％），革蘭陰性菌51株（佔39.2％），非典型病原體36株（佔27.7％）。其中分佈最多的4種病原體為肺炎鏈毬菌、肺炎支原體、流感嗜血桿菌和肺炎剋雷伯菌，分彆佔23.9％、20.8％、15.4％和14.6％。2008-2012年肺炎鏈毬菌（由34.8％下降至18.8％）和流感嗜血桿菌（由26.1％下降至9.4％）的比重逐年下降，肺炎剋雷伯菌（由8.7％上升至18.8％）和肺炎支原體（由13.0％上升至31.3％）逐年上升；肺炎鏈毬菌對青黴素的耐藥率在5年都很高，且在後2年達到100％。多因素 Logistic 迴歸分析顯示年齡、吸煙史、煙齡、慢性阻塞性肺疾病（COPD）、哮喘、慢性支氣管炎、肺結覈、支氣管擴張和肺癌是 CAP 的獨立危險因素（P ﹤0.05）。結論本地區老年 CAP 的病原體構成和耐藥性均髮生瞭明顯變遷，由以往以肺炎鏈毬菌為主，逐漸變為以肺炎支原體為主，耐藥性增彊且呈多重耐藥特點；吸煙和呼吸道疾病是老年 CAP 的高危因素。
목적：료해아원노년사구획득성폐염（CAP）적병원체화내약성변천，분석 CAP 발병적고위인소，위노년 CAP 적예방화치료제공지도의견。방법회고성분석2008-2012년적315례노년 CAP 환자적자료，대담표본진행배양、분리화감정，약민시험채용 K - B 법。대상관위험인소진행단인소화다인소 Logistic 회귀분석。결과315빈담표본병원체배양양성113빈，양성솔위35.9％，2008-2012년각년양성솔분별위36.2％（21/58）、33.9％（19/56）、36.1％（22/61）、36.4％（24/66）화36.5％（27/74），차이무통계학의의（χ2＝0.574，P ﹥0.05）；공분리출130주병원체，혁란양성균43주（점33.1％），혁란음성균51주（점39.2％），비전형병원체36주（점27.7％）。기중분포최다적4충병원체위폐염련구균、폐염지원체、류감기혈간균화폐염극뢰백균，분별점23.9％、20.8％、15.4％화14.6％。2008-2012년폐염련구균（유34.8％하강지18.8％）화류감기혈간균（유26.1％하강지9.4％）적비중축년하강，폐염극뢰백균（유8.7％상승지18.8％）화폐염지원체（유13.0％상승지31.3％）축년상승；폐염련구균대청매소적내약솔재5년도흔고，차재후2년체도100％。다인소 Logistic 회귀분석현시년령、흡연사、연령、만성조새성폐질병（COPD）、효천、만성지기관염、폐결핵、지기관확장화폐암시 CAP 적독립위험인소（P ﹤0.05）。결론본지구노년 CAP 적병원체구성화내약성균발생료명현변천，유이왕이폐염련구균위주，축점변위이폐염지원체위주，내약성증강차정다중내약특점；흡연화호흡도질병시노년 CAP 적고위인소。
Objective To explore the pathogen changes and drug - resistance evolution of community - acquired pneu-monia(CAP)in the elderly,and to analyze the risk factors related to CAP,in order to to provide guidance for the prevention and treatment of CAP in the elderly. Methods 315 elderly cases with CAP were reviewed during 2008 ~ 2012 years. The sputum specimens were cultured,isolated and indentified. The drug sensitive was tested by K - B method. The related risk factors were analyzed by single factor and multi - factor logistic test. Results 113 specimens were cultured positively,and the positive rate was 35. 9% ,and in 2008 ~ 2012 years it was 36. 2% (21 / 58)、33. 9% (19 / 56)、36. 1% (22 / 61)、36. 4% (24 / 66)and 36. 5% (27 / 74)respectively;the difference was not significant(χ2 = 0. 574,P ﹥ 0. 05). A total of 130 pathogens were isola-ted with 43 strains of Gram - positive bacteria(33. 1% ),51 strains of Gram - negative bacteria(39. 2% )and 36 strains of a-typical pathogen(27. 7% ). The four most common pathogens were Streptococcus pneumoniae,Mycoplasma pneumoniae,Hae-mophilus influenzae and Klebsiella pneumoniae,accounting for 23. 9% ,20. 8% ,15. 4% and 14. 6% ,respectively. From 2008 to 2012,the proportions of Streptococcus pneumoniae and Haemophilus influenzae were dropped from 34. 8% (26. 1% )to 18. 8% (9. 4% ),while the proportions of Mycoplasma pneumoniae and Klebsiella pneumoniae increased year by year from 8. 7% (13. 0% )to 18. 8% (31. 3% ). The resistance rate of Streptococcus pneumoniae to penicillin were high in five years, and up to 100% in the last two years. Logistic regression analysis showed that age,smoking,smoke age,COPD,asthma, chronic bronchitis,tuberculosis,bronchiectasis and lung cancer were the independent risk factors for CAP( P ﹤ 0. 05 ).Conclusion The pathogen changes and drug - resistance evolution are both obvious in the elderly with CAP in our region. The main pathogen is changed from Streptococcus pneumoniae in the past to Mycoplasma pneumoniae nearly,and Streptococcus pneu-moniae gives multiple drug resistance characteristics. Smoking and respiratory diseases are high risk factors for CAP.
