Zhan Yangqing, Yang Zifeng, Chen Rongchang, Wang Yutao, Guan Wenda, Zhao Suishan
Department of Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease (Guangzhou Medical University, China), Guangzhou Institute of Respiratory disease, 151 Yanjiang Road, Guangzhou, PR, China.
BMC Pulm Med. 2014 Sep 2;14:144. doi: 10.1186/1471-2466-14-144.
Viral pathogens were more commonly reported than previously estimated in community-acquired pneumonia (CAP) patients. However, the real role of virus was still controversial.
Consecutive adult patients with CAP between April and December, 2009 were prospectively enrolled. A four-fold or greater increase of IgG-titres against respiratory viruses in pair sera was tested by means of hemagglutination inhibition assay or indirect immunofluorescence. Swab samples were tested by cell culture and/or nucleic amplification tests. Viral etiology was considered definitive if at least one of the above tests was positive.
Viral etiology was established in fifty-two (34.9%) of 149 CAP patients, twenty-two (81.5%) of 27 influenza like illness patients, and none of 75 volunteer controls. Forty-seven CAP patients were infected by a single virus (24 influenza A virus, 5 influenza B, 10 parainfluenza virus type 3 [PIV-3], 2 PIV-1, 2 adenovirus, 2 human rhinovirus and 2 coronavirus OC43), five cases by two or three viruses co-infection. Fever ≥ 39 °C (66.7%), fatigue (64.6%), and purulent sputum (52.1%) was the most common symptoms in viral pneumonia patients. On multivariate analysis, myalgia was included in the model for pneumonia associated with influenza infection. In the CURB-65 model only influenza infection was found independently associated with severe disease (CURB-65 score ≥ 3) out of variables, including age(years), sex, current smoking status, sick contact with febrile patients, numbers of comorbidity, presence of influenza infection, presence of PIV infection, with P = 0.021, OR 7.86 (95% CI 1.37-45.04).
Respiratory virus was not a bystander, but pathogenic in pneumonia and was a common cause of CAP.
在社区获得性肺炎（CAP）患者中，病毒病原体的报告比之前估计的更为常见。然而，病毒的实际作用仍存在争议。
前瞻性纳入2009年4月至12月期间连续的成年CAP患者。通过血凝抑制试验或间接免疫荧光检测双份血清中针对呼吸道病毒的IgG滴度升高四倍或更高。拭子样本通过细胞培养和/或核酸扩增试验进行检测。如果上述至少一项检测呈阳性，则认为病毒病因明确。
149例CAP患者中有52例（34.9%）确定为病毒病因，27例流感样疾病患者中有22例（81.5%），75例志愿者对照均未发现病毒病因。47例CAP患者感染单一病毒（24例甲型流感病毒、5例乙型流感病毒、10例3型副流感病毒[PIV-3]、2例1型PIV、2例腺病毒、2例人鼻病毒和2例冠状病毒OC43），5例为两种或三种病毒合并感染。发热≥39℃（66.7%）、乏力（64.6%）和脓性痰（52.1%）是病毒性肺炎患者最常见的症状。多因素分析显示，肌痛被纳入与流感感染相关的肺炎模型。在CURB-65模型中，在包括年龄（岁）、性别、当前吸烟状况、与发热患者的患病接触、合并症数量、流感感染情况、PIV感染情况等变量中，仅发现流感感染与重症疾病（CURB-65评分≥3）独立相关，P = 0.021，OR 7.86（95%CI 1.37 - 45.04）。
呼吸道病毒并非旁观者，而是肺炎的病原体，是CAP的常见病因。
