社区获得性肺炎的预后及其相关因素分析

目的研究社区获得性肺炎（CAP）的预后及其相关因素。方法选择2003年8月～2009年3月全国37家医院中社区获得性肺炎患者，记录患者发病时的情况和发病1个月后的生存状况。所有资料输入SPSS 12．0统计软件做单因素Pearson卡方检验和Logistic回归分析，筛选和分析影响CAP预后的相关危险因素。结果共有689例患者入选，其中男396例，女293例。患者的平均年龄为（53±19）岁，其中老年人（t〉65岁）247例，占35．8％。死亡44例，病死率为6．4％。单因素分析筛选出年龄≥65岁，吸烟，误吸食物、呼吸道分泌物，3个月内使用过抗菌药物，2个月内使用过免疫抑制剂，合并心功能衰竭、慢性肾功能衰竭、慢性肝病、神经系统疾病和糖尿病，消瘦，神智改变，呼吸频率〉28次／min，脉搏〉100次／min，舒张压降低，外周血中性粒细胞比例〉0．9，ALT升高，BUN升高及PORT评分Ⅳ级以上共19个CAP的预后危险因素。Logistic多因素回归分析表明3个月内使用过抗菌药物，呼吸频率加快，脉搏〉100次／min和PORT分级≥Ⅳ级是影响CAP预后的独立危险因素。结论我国成人CAP总体病死率不高，3个月内使用过抗菌药物、呼吸频率加快、脉搏〉100次/min，以及PORT分级≥Ⅳ级是影响CAP预后的独立危险因素，对于具有这些危险因素的患者在临床中应加以重视。

Prognostic factors related to community acquired pneumonia

Objective To investigate the prognosis and related factors of community acquired pneumonia （CAP）. Methods From August 2003 to March 2009, 689 CAP cases from 37 hospitals of 23 cities in China were enrolled. The onset information and clinical outcomes in one month of onset were recorded. Pearson Chi-square test and Logistic regression test were performed using the SPSS 12.0 software to identify prognosis-related factors. Results Among 689 patients there were 396 male and 293 female. The median age was （53 19） years old, 247 patients （35.8%） were≥65 years old. Forty four patients died with a fatality rate of 6.4%. Univariate analysis identified 19 risk factors, they were age≥65 years old, smoking, aspiration, use of antimicrobial agents in 3 months, use of immunodepressant in 2 months, heart failure, chronic renal failure, chronic liver disease, cerebrovascular disease, diabetes, emaciation, altered mental status, respiratory rate 〉 28/min, pulse 〉 100/min, lower diastolic blood pressure, neutrophil ratio 〉 0.9, ALT 〉 40 U/L, elevated blood urea nitrogen level and PORT classification 〉/Ⅳ. By multivariate analysis, use of antimicrobial agents in 3 months, respiratory rate 〉 28/min, pulse 〉 100/min and PORT classifications〉Ⅳ were identified as the independent risk factors for mortality. Conclusions The general fatality rate of CAP is low in China. Use of antimicrobial agents in 3 months, respiratory rate 〉 28/min, pulse 〉 100/min and PORT classifications〉 Ⅳ are independent risk factors for mortality.