社区获得性肺炎患者联合检测肺炎支原体和衣原体的临床研究

摘要

目的：观察分析联合检测肺炎支原体（Mp）和肺炎衣原体（Cp）对社区获得性肺炎（CAP）患者的临床意义。方法选取1500例 CAP 患者作为研究对象，对其咽拭子标本中的 Mp 和 Cp DNA 进行检测，对主要病原菌进行培养和鉴定，观察比较患者的抗感染治疗方案和治愈率。结果本组 CAP 患者的病原体分布以 Mp、肺炎链球菌、流感嗜血杆菌和 Cp 的比例最大，而感染类型以2种病原体感染的比例最多；在本组患者的治疗过程中，β-内酰胺类抗菌药物的使用频率最高，应用β-内酰胺类联合大环内酯类或氟喹诺酮类药物治疗的患者的治愈率显著高于单独应用β-内酰胺类药物的患者（P ＜0．05）；在治疗Mp 或 Cp 单纯感染时，单独应用β-内酰胺类药物与应用β-内酰胺类联合大环内酯类或氟喹诺酮类药物治疗的患者治愈率无显著性差异（P ＞0．05）；在治疗细菌合并 Mp 或 Cp 感染时，应用β-内酰胺类联合大环内酯类或氟喹诺酮类药物的患者治愈率显著高于单独应用β-内酰胺类药物者（P ＜0．05）。结论 Mp 和 Cp 感染在 CAP 患者中比较多见，患者的主要感染类型是2种病原体的混合性感染，β-内酰胺类药物是治疗过程中常用药物，应用β-内酰胺类联合大环内酯类或氟喹诺酮类药物的抗感染方案可提高患者的治愈率，特别是在有细菌合并 Mp 或 Cp 感染时，可发挥显著疗效，临床医生应根据 Mp 或 Cp 的检测结果合理、有效地选择抗感染治疗方案。%Objective To observe and analyze the clinical significance of the combined de-tection of Mycoplasma pneumoniae (Mp)and Chlamydia pneumoniae (Cp)for the patients with community acquired pneumonia (CAP).Methods 1500 CAP patients were selected as the re-search objects.DNA of Mp and Cp in the throat swab specimens of the patients were detected and the main pathogenic bacteria were cultured and identified,and anti-infection treatment methods and the curative rate of the patients were observed and compared.Results The largest proportions in the distribution of pathogens of the CAP patients in this group were Mp,Streptococcus pneumo-niae,Haemophilus influenzae and Cp,and infection of two pathogens was the main type of infec-tion.In the course of treatment of the patients in this group,βlactam antibiotic drug usage fre-quency was highest,the curative rate of the patients treated with combined application ofβlactam and macrolides or fluoroquinolones drug was significantly higher than that of single application ofβlactam drugs (P <0.05).In the treatment of single Mp or Cp herpes infection,the difference was not significant in the curative rate between the patients treated with single application ofβlactam drugs and combined application ofβlactam and macrolides or fluoroquinolones drug (P > 0 .0 5 ). In the treatment of bacterial infection complicated with Mp or Cp infection,the curative rate of the patients treated with combined application ofβlactam and macrolides or fluoroquinolones drug was significantly higher than that of single application ofβlactam drugs (P <0.05).Conclusion Mp and Cp infections are commonly seen in CAP patients.The main type of infection of the patients is mixed infection of two pathogens.In the treatment process,βlactam drugs are com-monly used.The anti infection treatment of application combinedβlactam with macrolide or fluo-roquinolones can improve the curative rate.Especially in treatment of bacteria infection complicat-ed with Mp or Cp infection.The clinicians should choose reasonable and effective anti infection treatment methods on the basis of the detection results of Mp or Cp.