中国呼吸与危重监护杂志

中国呼吸与危重监护杂志

肠杆菌社区获得性肺炎的临床特征和预后因素分析

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目的 探讨肠杆菌社区获得性肺炎(EnCAP)的临床特征和影响 30 d 病死率的因素。 方法 回顾性分析我院 2010 年至 2015 年收治的 EnCAP 237 例和肺炎链球菌社区获得性肺炎(SpCAP)120 例,比较两组的人口学、基础病、临床症状体征、相关实验室检查和影像学,以及治疗和预后。单因素分析和 Logistic 回归分析影响 EnCAP 30 d 病死率的危险因素。 结果 和 SpCAP 组相比,EnCAP 组脑血管疾病(19.8% 比 8.3%)、慢性肝病(8.4% 比 1.7%)、慢性肾病(5.1% 比 0.0%)、吸入因素(11.0% 比 0.0%)比例高,PSI 分级(2.9±1.3 比 2.5±0.8)/CURB-65 评分(1.1±0.1 比 0.6±0.4)更高;意识改变(12.2% 比 0.0%)常见,血白细胞计数[(9.5±5.7)×109/L 比(10.4±4.8)×109/L]、血红蛋白[(125.0±9.0)g/L 比(135.0±15.0)g/L]、白蛋白[(32.0±8.0)g/L 比(36.0±9.4)g/L]水平低,合并胸腔积液者(30.4% 比 12.5%)更常见;在合理经验性抗感染治疗比例接近的条件下,两者临床结局类似,但 EnCAP 住院时间更长(12.0 d 比 7.0 d)。Logistic 回归分析证实血红蛋白(OR 0.087,95%CI 0.857~0.981)、合理的经验性抗感染治疗(OR 0.108,95%CI 0.011~0.151)和脓毒性休克(OR 1.700,95%CI 0.781~38.326)是影响 EnCAP 30 d 病死率的独立危险因素。 结论 EnCAP 的临床表现不同于SpCAP。脓毒性休克是 EnCAP 30 d 死亡的独立危险因素,血红蛋白与合理的经验性抗感染治疗是保护因素,能够降低 30 d 病死率。

Objective To explore clinical characteristics and risk factors for mortality of community-acquired pneumonia due to Enterobacteriaceae (EnCAP) . Methods This was a single-center, retrospective study. Baseline demographic, clinic, radiologic characteristcs, treatment and outcomes were compared between patients hospilized with EnCAP and community-acquired pneumonia due to Streptoccocus pneumoniae (SpCAP) during January 1, 2010 to December 31, 2015. A univariate and multivariate logistic regression analysis was performed to determine factors independently associated with 30-day mortality for EnCAP. Results In comparison with SpCAP, cerebrovascular disease, chronic hepatopathy, chronic renal disease, aspiration risk, confusion, pleural effusion and higher PSI risk class/CURB-65 score, lower leukocyte, hemoglobin, albumin, longer length of stay in hospital were associated with EnCAP. Multivariate logistic regression analysis demonstrated sepsis shock (OR 1.700, P=0.018, 95%CI 0.781 to 38.326), hemoglobin (OR 0.087, P=0.011, 95%CI 0.857 to 0.981) and appropriate empirical antimicrobial therapy (OR 0.108, P=0.002, 95%CI 0.011 to 0.151) were risk factor for 30-day mortality of EnCAP. Conclusions The clinical characteristics of EnCAP are different with SpCAP. Clinic physicians should pay much attention to the risk factors for 30-day mortality of EnCAP.

关键词: 肠杆菌; 社区获得性肺炎; 临床特征; 预后

Key words: Enterobacteriaceae; Community-acquired pneumonia; Clinical characteresitics; 30-Day mortality

引用本文: 陈亮, 刘佳, 白鹭. 肠杆菌社区获得性肺炎的临床特征和预后因素分析. 中国呼吸与危重监护杂志, 2017, 16(5): 441-445. doi: 10.7507/1671-6205.201703021 复制

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