Watanabe Akira, Goto Hajime, Kohno Shigeru, Matsushima Toshiharu, Abe Shosaku, Aoki Nobuki, Shimokata Kaoru, Mikasa Keiichi, Niki Yoshihito
Institute of Development, Aging and Cancer, Tohoku University, Research Division for Development of Anti-Infective Agents, Seiryo-machi 4-1, Aoba-ku, Sendai 980-8575, Miyagi, Japan.
Respir Investig. 2012 Mar;50(1):14-22. doi: 10.1016/j.resinv.2012.02.002. Epub 2012 Mar 10.
The Japanese Respiratory Society Guidelines for the Management of Community-Acquired Pneumonia (CAP) in Adults (JRS 2005) were published to revise the Basic Concept for the Management of CAP in Adults (JRS 2000). Revisions in JRS 2005 mainly focused on the criteria for the assessment of pneumonia severity and the differentiation between bacterial pneumonia and atypical pneumonia. To evaluate the JRS 2005 criteria for the assessment of pneumonia severity, we conducted a prospective survey.
The survey was conducted from July 2006 to March 2007 as a nationwide joint study by 200 institutions. The study subjects included patients aged ≥16 years of age who had CAP. The severity at initial consultation was determined using the criteria established by JRS 2005, JRS 2000, and Infectious Diseases Society of America Guidelines (IDSA-GLs). The survival outcome 30 days after the start of the initial antimicrobial agent treatment was confirmed.
A total of 1875 patients were analyzed. The numbers of cases of pneumonia assessed as being moderate and severe were significantly lower when the JRS 2005 criteria were used than when the JRS 2000 criteria were used. Thus, the severity of pneumonia could be determined more appropriately using the JRS 2005 criteria. Furthermore, the severity-dependent prediction of fatal outcomes or mortality according to these criteria was similar to that determined using the IDSA-GLs.
Determining severity on the basis of JRS 2005 can resolve nearly all the problems encountered with JRS 2000; these criteria were found to be useful and rapidly and easily applicable in clinical practice.
日本呼吸学会发布了《成人社区获得性肺炎（CAP）管理指南（2005年版）》（JRS 2005），以修订《成人CAP管理基本概念（2000年版）》（JRS 2000）。JRS 2005的修订主要集中在肺炎严重程度评估标准以及细菌性肺炎与非典型肺炎的鉴别上。为评估JRS 2005的肺炎严重程度评估标准，我们进行了一项前瞻性调查。
该调查于2006年7月至2007年3月作为一项由200家机构参与的全国性联合研究开展。研究对象包括年龄≥16岁的CAP患者。初次就诊时的严重程度根据JRS 2005、JRS 2000以及美国传染病学会指南（IDSA - GLs）所确立的标准来确定。确认了初始抗菌药物治疗开始后30天的生存结局。
共分析了1875例患者。使用JRS 2005标准评估为中度和重度肺炎的病例数显著低于使用JRS 2000标准时的病例数。因此，使用JRS 2005标准能够更恰当地确定肺炎的严重程度。此外，根据这些标准对致命结局或死亡率的严重程度依赖性预测与使用IDSA - GLs所确定的相似。
基于JRS 2005确定严重程度几乎可以解决JRS 2000所遇到的所有问题；这些标准被发现是有用的，并且在临床实践中可快速且容易地应用。
