| Objective: Although the virus has been recognized as one of the important pathogens of CAP,in China,the incidence,epidemiological characteristics and clinical features of viral pneumonia in patients aged 14 years or older are still blank,and some clustered pneumonia Often the pathogens are unknown.The research results of this subject will fill the blank of CAP virology research in our city.This study mainly compares the clinical features,pathogenic characteristics and prognosis of patients with viral pneumonia and non-viral pneumonia in Qingdao to improve the diagnosis rate of influenza virus pneumonia in the season.Reduce the impact of antibiotic use and save on treatment costs.Methods: This study was part of a national multi-center,forward-looking,national science and technology support project(Project No.2015BAI12B00)led by the China-Japan Hospital.The data was obtained from the CAP-China Network(Clinical Registration No.NCT024 89578).The data of patients with acquired pneumonia in the respiratory department of Qingdao Municipal Hospital of 2016.1.1-2017.8.1 were collected,and the basic clinical characteristics,imaging findings,pathogenic characteristics,treatment and prognosis of the patients were analyzed.Compare the difference between viral pneumonia and non-viral pneumonia,fill the gap in the epidemiology and disease burden of viral pneumonia in Qingdao to better guide clinical work.Results: A total of 190 patients with pneumonia were enrolled in the study,of which100 were viral pneumonia and 90 were non-viral pneumonia.The mean ages of the two groups were 50.0 years and 49.7 years,respectively.There was no significant difference between the two groups(t =1.945,P=0.107>0.05).The most common underlying diseases are cardiovascular disease,diabetes,and chronic lung disease.17% of patients with viral pneumonia(n=17)had a history of alcohol abuse,significantly higher than non-viral pneumonia(n= 6,6.7%),p = 0.01.Patients with viral pneumonia had a lower proportion of systemic symptoms such as fatigue,muscle and joint pain,and headache than those with negative virus test(p=0.014).In 100 patients with viral pneumonia,26% had two ormore lobar infiltrations,which was statistically different from those with negative virus-negative pneumonia(p<0.01).Compared with pneumonia patients with negative viral nucleic acid detection,lymphocyte reduction was more obvious.The lymphocyte count of viral pneumonia was 1.705±0.780,and the lymphocyte of patients with negative viral nucleic acid detection was 1.929±0.703.The difference was statistically significant(p=0.043)..The mean values of PCT and CRP in the viral pneumonia group were 1.03±2.91 ng/ml and 25.50±21.31 mg/dl,respectively,which were significantly lower than those in the pneumonia patients with negative viral nucleic acid detection.The difference was statistically significant(p=0.048).,p=0.006).On the day before admission and discharge,190 patients with CAP were clinically judged,and 10% considered viral infection.Among the population of viral pneumonia of different ages,the positive rate of virus detection is different,mainly 65-75 years old and 30-40 years old young adults,and190 CAP patients have 100 cases of CAP patients with positive viral nucleic acid test results,accounting for 52.63 %.Of the 100 cases of viral pneumonia,86 were simple virus infections,of which the highest rate of infection was influenza A(66 cases,76.74%).Seven patients(8.14%)were infected with two or more viruses.There were 14 mixed infections,which were infected with viruses or mycoplasma.Most of the virus was concentrated in the winter and spring,and rhinovirus and adenovirus did not find obvious seasonal patterns.Of the 190 hospitalized patients,8.95% used antiviral drugs,all of which were oseltamivir.Most patients(58.42%)had achieved clinical stability within 24 hours of admission.Except for the dead patients(0.53%),4.74% of the patients did not meet discharge criteria at discharge.In patients with viral pneumonia,PSI,CURB-65,and CRB-65 scores were used to assess the severity of the disease,mainly in patients with mild or moderate disease.Among them,10 patients(10%)had initial treatment failure.Compared with different pneumonia severity scores,the oxygenation index ≤250mmHg combined with lymphocyte count <0.8×109/L was the best in the initial treatment failure prediction of hospitalized patients with viral pneumonia,with an AUC of 0.861(95%confidence interval,0.698-1.000).The number of hospitalized patients with CAP increased with age.With the increase in age and severity of illness,hospitalization costs are on the rise.Conclusion: In summary,most of the incidence of viral pneumonia is seasonal,with epidemiological exposure history,and the clinician’s admission diagnosis rate for viral pneumonia is extremely low.Patients with systemic symptoms such as fatigue,muscle and joint pain,headache and other symptoms in the virus-negative patients weresignificantly higher than the CAP patients with negative virus detection.The peripheral blood leukocytes of viral pneumonia are normal or reduced,and the lymphocyte count is low.In imaging,patients with viral pneumonia have a higher incidence of bilateral or multiple lobe infiltration than those with negative CAP.The oxygenation index combined with peripheral blood lymphocyte counts better reflects the initial treatment. |
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