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发热门诊社区获得性肺炎的发病及病因。

The incidence and etiology of community-acquired pneumonia in fever outpatients.

机构信息

Department of Infectious Diseases, Beijing Shijitan Hospital, Capital Medical University (The 9th Affiliated Hospital of Peking University), Beijing, PR China.

出版信息

Exp Biol Med (Maywood). 2012 Nov;237(11):1256-61. doi: 10.1258/ebm.2012.012014.

Abstract

The purpose of this study was to analyze the incidence, etiology and clinical characteristics of community-acquired pneumonia (CAP) among outpatients with sore throat and/or cough, and thus to provide theoretical basis for timely and accurate diagnosis and treatment for CAP. We used chest X-rays for fever (a temperature greater than 37.5°C) patients, who were recruited since 2007, presenting with sore throat and/or cough. The patients' age, gender, days of fever, respiratory symptoms (e.g. cough and sputum), peripheral blood count and etiology (pathogens) of CAP were recorded. Of all the 6539 fever outpatients, those aged 10-39 and above 60 years old accounted for 61.0% and 15.6%, respectively. In total, 402 were diagnosed with CAP with an incidence rate of 6.1%. Among them, 38.1% were above 60 years old. The prevalence increased with age. Of the 402 CAP patients, 36.8% (148/402) presented no respiratory symptoms and 30.1% (121/402) had positive etiology. The top three pathogens were Mycoplasma pneumoniae (23.1%), Streptococcus pneumoniae (17.3%) and Haemophilus influenzae (9.1%). Among the 121 etiology-positive patients, 14 cases were mixed infections (at least one atypical pathogen). Nine cases were M. pneumoniae mixed with bacterial/virus infection, and five cases were Chlamydia pneumoniae mixed with other bacteria/mycoplasma infection. We found that fever outpatients have a higher prevalence of CAP, which increases with age, i.e. older people are more susceptible to CAP. S. pneumoniae and H. influenzae are common pathogens in CAP; however, atypical pathogens, especially M. pneumoniae, remain the most common pathogens in CAP.

摘要

本研究旨在分析门诊咽痛和/或咳嗽患者社区获得性肺炎(CAP)的发病率、病因学和临床特征,为 CAP 的及时准确诊断和治疗提供理论依据。我们对 2007 年以来因发热(体温>37.5°C)就诊的患者进行了胸部 X 线检查,这些患者均伴有咽痛和/或咳嗽。记录患者的年龄、性别、发热天数、呼吸道症状(如咳嗽、咳痰)、外周血象和 CAP 的病因(病原体)。在 6539 例发热门诊患者中,年龄在 10-39 岁和>60 岁的患者分别占 61.0%和 15.6%。共有 402 例患者被诊断为 CAP,发病率为 6.1%。其中>60 岁的患者占 38.1%。发病率随年龄增长而增加。402 例 CAP 患者中,36.8%(148/402)无呼吸道症状,30.1%(121/402)有明确病因。前三种病原体分别为肺炎支原体(23.1%)、肺炎链球菌(17.3%)和流感嗜血杆菌(9.1%)。在 121 例病因阳性患者中,14 例为混合感染(至少有一种非典型病原体)。9 例为肺炎支原体混合细菌/病毒感染,5 例为肺炎衣原体混合其他细菌/支原体感染。我们发现发热门诊患者 CAP 的患病率较高,且随年龄增长而增加,即老年人更易患 CAP。肺炎链球菌和流感嗜血杆菌是 CAP 的常见病原体;然而,非典型病原体,尤其是肺炎支原体,仍是 CAP 最常见的病原体。

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