發(fā)布時間：2018-05-06 19:52

  本文選題：社區(qū)獲得性肺炎 + 病原學(xué)��； 參考：《華中科技大學(xué)》2016年碩士論文

【摘要】：目的:社區(qū)獲得性肺炎(CAP)是常見的呼吸道感染性疾病,給人類社會帶來了沉重的健康和經(jīng)濟負(fù)擔(dān)。人冠狀病毒(Human coronaviruse,HCo V)尤其是SARS冠狀病毒(SARS-Co V)和中東呼吸綜合征冠狀病毒(Middle east respiratory syndrome coronaviruse,MERS-Co V)的出現(xiàn)給人類健康帶來了嚴(yán)重的危害。不同地區(qū)CAP病原學(xué)各有其特點,因此了解一地區(qū)CAP病原學(xué)分布對指導(dǎo)治療意義重大。因此本研究致力于明確我國華中地區(qū)成人CAP住院病人的病原學(xué)分布特點和HCo V的流行病學(xué)特征,為CAP經(jīng)驗性抗菌治療提供依據(jù),同時為提升我國新生冠狀病毒相關(guān)新發(fā)突發(fā)呼吸道傳染病應(yīng)急處理能力提供理論支撐。方法:選取2014年5月至2015年1月華中科技大學(xué)同濟醫(yī)學(xué)院附屬同濟醫(yī)院呼吸內(nèi)科成人社區(qū)獲得性肺炎住院患者,采集入選病例的相關(guān)臨床資料,包括性別、年齡、身高、體重、職業(yè)、臨床癥狀體征、基礎(chǔ)疾病、影像學(xué)表現(xiàn)、實驗室數(shù)據(jù)、病原學(xué)資料、抗生素使用情況、住院時間、治療效果等,收集合格痰標(biāo)本,運用PCR方法進行常見呼吸道感染性病原菌及人冠狀病毒的核酸檢測。對收集的臨床資料及檢測結(jié)果進行統(tǒng)計性分析。結(jié)果:調(diào)查共納入CAP患者78例,其中男性73.1%(57/78)、女性26.9%(21/78),男女比例為2.71:1。年齡范圍為18~85歲,平均年齡55.19±16.01歲,主要集中在40歲以上的中老年患者(82.1%)。痰培養(yǎng)陽性率37.68%(26/69),共檢出34株病原菌,以銅綠假單胞菌、鮑曼不動桿菌和念珠菌為主。痰液病原體核酸檢測陽性率80.77%,明顯高于痰培養(yǎng)結(jié)果,以肺炎克雷伯桿菌、巨細(xì)胞病毒和甲型流感病毒為主,混合感染占48.72%(38/78)。人冠狀病毒HCo V-NL63、HCo V-229E和HCo V-OC43的檢出率分別為5.13%、2.56%和1.28%,未檢出HCo V-HKU1。結(jié)論:我國華中地區(qū)成人CAP住院患者以40歲以上中老年為主,病原體以革蘭陰性桿菌為主,因此在對CAP患者進行抗感染治療時應(yīng)充分考慮以上特點。采用PCR方法可以提高病原體陽性率,但仍需繼續(xù)設(shè)法提高檢驗水平,還需根據(jù)患者實際情況綜合判斷可能致病菌。研究中檢出了人冠狀病毒HCo V-OC43、HCo V-229E和HCo V-NL63,未檢出HCo V-HKU1,它們在CAP患者發(fā)病中所起的作用還不清楚,需要進一步研究。
[Abstract]:Objective: community acquired pneumonia (CAP) is a common respiratory infectious disease, which brings heavy health and economic burden to human society. The emergence of human coronavirus (human coronavirus), especially SARS coronavirus (SARS-Co) and Middle east respiratory syndrome coronavirus (MERS-Co) has brought serious harm to human health. The etiology of CAP has its own characteristics in different regions, so it is very important to understand the distribution of CAP etiology in a region. Therefore, this study aims to clarify the etiological distribution and epidemiological characteristics of HCo V in adult CAP inpatients in central China, and to provide evidence for empirical antimicrobial therapy of CAP. At the same time, it provides theoretical support for improving the ability of emergency management of newborn coronavirus related emerging respiratory infectious diseases in China. Methods: selected adult community acquired pneumonia patients from Tongji Medical College affiliated to Tongji Medical College of Huazhong University of Science and Technology from May 2014 to January 2015, and collected the clinical data of selected patients, including gender, age, height, weight. Occupation, clinical symptoms and signs, basic diseases, imaging manifestations, laboratory data, etiological data, use of antibiotics, length of stay, therapeutic effect, etc. PCR method was used to detect common respiratory tract pathogens and human coronavirus nucleic acid. The collected clinical data and test results were statistically analyzed. Results: a total of 78 patients with CAP were included in the study, of whom the male was 73.1 / 78, the female was 26.921 / 78, and the ratio of male to female was 2.71: 1. The average age was 55.19 鹵16.01 years old, which was mainly concentrated in the middle and old patients over 40 years old, and the average age was 55.19 鹵16.01 years old. The positive rate of sputum culture was 37.68%. 34 strains of pathogenic bacteria were detected, mainly Pseudomonas aeruginosa, Acinetobacter baumannii and Candida. The positive rate of nucleic acid detection of sputum pathogens was 80.77, which was significantly higher than that of sputum culture. Klebsiella pneumoniae, cytomegalovirus and influenza A virus were the main pathogens. The detection rates of HCo V-NL63HCo V-229E and HCo V-OC43 were 5.13% and 1.28%, respectively. No HCo V-HKU1 was detected. Conclusion: adult CAP inpatients in central China are mainly over 40 years old and the pathogens are Gram-negative bacilli. Therefore, the above characteristics should be fully considered in the treatment of CAP patients. Using PCR method can improve the positive rate of pathogens, but we still need to try to improve the level of testing, and we also need to comprehensively judge the possible pathogens according to the actual situation of the patients. Human coronavirus HCo V-OC43HCo V-229E and HCo V-NL63 were detected in the study, but HCo V-HKU1 was not detected. The role of HCo V-HKU1 in the pathogenesis of CAP patients is unclear and needs further study.
【學(xué)位授予單位】：華中科技大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R563.1

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