不同时期老年社区获得性肺炎患者不典型病原检测结果分析

摘要

Objective To analyze virus, mycoplasma, chlamydia and legionella infection status of community acquired pneumonia (CAP) in hospitalized elderly patients in three different period and to provide reference resources for clinical epidemic-logical studies. Methods 492 elderly patients with CAP during October 2001 to June 2004, July 2005 to October 2007 and January 2008 to December 2010 were enrolled. All patients' serums were collected for IgM antibody detection (including chlamydia, mycoplasma, legionella and virus such as EB virus, adenovirus, respiratory syncytial virus, cytomegalovirus, herpes simplex vims, Coxsackie virus, rubella virus) on the day of admission and 7-10 days later at the same time data in different period were analyzed. Results In492 patients, 80( 16. 26% ) person-time presented mycoplasma pneumoniae IgM antibody positive, 46(9. 35% ) person-time presented chlamydia pneumoniae IgM antibody positive, 25(5. 08% ) person-time presented legionella IgM antibody positive, and 118(23.99%) person-time presented virus IgM antibody positive. In comparison, the detection rates of legionella, syncytial virus, cytomegalovirus, herpes simplex virus and rubella virus during SARS period were the highest. The detection rate of atypical pathogens antibody during the onset of 20 days was high. Conclusions Atypical pathogens are important pathogenic in elderly patients with CAP, mycoplasma infection is one of the most common reasons. In comparison, virus infection was more common in SARS period. Infection rate of atypical pathogens in elderly patients with CAP is not significantly increased and has a downward trend in part. In the onset of 20 days, most positive result of IgM antibody can be found in patients with atypical pathogens infection.%目的 调查3个时期老年社区获得性肺炎(CAP)住院患者病毒、支原体、衣原体及军团菌感染状况,为临床流行病学研究提供参考. 方法 选取2001年10月至2004年6月[称为围严重急性呼吸综合征(SARS)期]、2005年7月至2007年10月及2008年1月至2010年12月(称为围甲流期)于河北联合大学附属医院住院的492例老年患者作为研究对象,于入院当天及入院后7～10d行血清支原体、衣原体、军团菌IgM抗体及7种常见病毒IgM抗体检查,对3个期间的资料进行分析. 结果 492例患者支原体IgM抗体阳性80人次(16.26％)、衣原体IgM抗体阳性46人次(9.35％)、军团菌IgM抗体阳性25人次(5.08％)、病毒IgM抗体阳性118人次(23.99％).“围SARS期”不典型病原体总检出率及军团菌、合胞病毒、巨细胞病毒、单纯疱疹病毒及风疹病毒检出率明显高于其他2个时期.不典型病原体抗体在起病20d内的检出率较高. 结论 不典型病原体仍为老年CAP的重要致病原,其中以支原体感染最为常见.前后对比围SARS期间病毒感染更为普遍.老年CAP患者不典型病原体感染率无明显上升,部分有下降趋势.在起病20 d内多数不典型病原体感染患者IgM抗体可检出阳性.