我国华中地区成人社区获得性肺炎病原学及人冠状病毒流行病学调查

发布时间：2018-05-06 19:52

本文选题：社区获得性肺炎 + 病原学　；参考：《华中科技大学》2016年硕士论文

【摘要】：目的:社区获得性肺炎(CAP)是常见的呼吸道感染性疾病,给人类社会带来了沉重的健康和经济负担。人冠状病毒(Human coronaviruse,HCo V)尤其是SARS冠状病毒(SARS-Co V)和中东呼吸综合征冠状病毒(Middle east respiratory syndrome coronaviruse,MERS-Co V)的出现给人类健康带来了严重的危害。不同地区CAP病原学各有其特点,因此了解一地区CAP病原学分布对指导治疗意义重大。因此本研究致力于明确我国华中地区成人CAP住院病人的病原学分布特点和HCo V的流行病学特征,为CAP经验性抗菌治疗提供依据,同时为提升我国新生冠状病毒相关新发突发呼吸道传染病应急处理能力提供理论支撑。方法:选取2014年5月至2015年1月华中科技大学同济医学院附属同济医院呼吸内科成人社区获得性肺炎住院患者,采集入选病例的相关临床资料,包括性别、年龄、身高、体重、职业、临床症状体征、基础疾病、影像学表现、实验室数据、病原学资料、抗生素使用情况、住院时间、治疗效果等,收集合格痰标本,运用PCR方法进行常见呼吸道感染性病原菌及人冠状病毒的核酸检测。对收集的临床资料及检测结果进行统计性分析。结果:调查共纳入CAP患者78例,其中男性73.1%(57/78)、女性26.9%(21/78),男女比例为2.71:1。年龄范围为18~85岁,平均年龄55.19±16.01岁,主要集中在40岁以上的中老年患者(82.1%)。痰培养阳性率37.68%(26/69),共检出34株病原菌,以铜绿假单胞菌、鲍曼不动杆菌和念珠菌为主。痰液病原体核酸检测阳性率80.77%,明显高于痰培养结果,以肺炎克雷伯杆菌、巨细胞病毒和甲型流感病毒为主,混合感染占48.72%(38/78)。人冠状病毒HCo V-NL63、HCo V-229E和HCo V-OC43的检出率分别为5.13%、2.56%和1.28%,未检出HCo V-HKU1。结论:我国华中地区成人CAP住院患者以40岁以上中老年为主,病原体以革兰阴性杆菌为主,因此在对CAP患者进行抗感染治疗时应充分考虑以上特点。采用PCR方法可以提高病原体阳性率,但仍需继续设法提高检验水平,还需根据患者实际情况综合判断可能致病菌。研究中检出了人冠状病毒HCo V-OC43、HCo V-229E和HCo V-NL63,未检出HCo V-HKU1,它们在CAP患者发病中所起的作用还不清楚,需要进一步研究。
[Abstract]:Objective: community acquired pneumonia (CAP) is a common respiratory infectious disease, which brings heavy health and economic burden to human society. The emergence of human coronavirus (human coronavirus), especially SARS coronavirus (SARS-Co) and Middle east respiratory syndrome coronavirus (MERS-Co) has brought serious harm to human health. The etiology of CAP has its own characteristics in different regions, so it is very important to understand the distribution of CAP etiology in a region. Therefore, this study aims to clarify the etiological distribution and epidemiological characteristics of HCo V in adult CAP inpatients in central China, and to provide evidence for empirical antimicrobial therapy of CAP. At the same time, it provides theoretical support for improving the ability of emergency management of newborn coronavirus related emerging respiratory infectious diseases in China. Methods: selected adult community acquired pneumonia patients from Tongji Medical College affiliated to Tongji Medical College of Huazhong University of Science and Technology from May 2014 to January 2015, and collected the clinical data of selected patients, including gender, age, height, weight. Occupation, clinical symptoms and signs, basic diseases, imaging manifestations, laboratory data, etiological data, use of antibiotics, length of stay, therapeutic effect, etc. PCR method was used to detect common respiratory tract pathogens and human coronavirus nucleic acid. The collected clinical data and test results were statistically analyzed. Results: a total of 78 patients with CAP were included in the study, of whom the male was 73.1 / 78, the female was 26.921 / 78, and the ratio of male to female was 2.71: 1. The average age was 55.19 卤16.01 years old, which was mainly concentrated in the middle and old patients over 40 years old, and the average age was 55.19 卤16.01 years old. The positive rate of sputum culture was 37.68%. 34 strains of pathogenic bacteria were detected, mainly Pseudomonas aeruginosa, Acinetobacter baumannii and Candida. The positive rate of nucleic acid detection of sputum pathogens was 80.77, which was significantly higher than that of sputum culture. Klebsiella pneumoniae, cytomegalovirus and influenza A virus were the main pathogens. The detection rates of HCo V-NL63HCo V-229E and HCo V-OC43 were 5.13% and 1.28%, respectively. No HCo V-HKU1 was detected. Conclusion: adult CAP inpatients in central China are mainly over 40 years old and the pathogens are Gram-negative bacilli. Therefore, the above characteristics should be fully considered in the treatment of CAP patients. Using PCR method can improve the positive rate of pathogens, but we still need to try to improve the level of testing, and we also need to comprehensively judge the possible pathogens according to the actual situation of the patients. Human coronavirus HCo V-OC43HCo V-229E and HCo V-NL63 were detected in the study, but HCo V-HKU1 was not detected. The role of HCo V-HKU1 in the pathogenesis of CAP patients is unclear and needs further study.
【学位授予单位】：华中科技大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R563.1

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