Other TitlesCommunity-acquired Legionella pneumonia in elderly patients: clinical characteristics and outcome
Community-acquired infections
Issue Date2010
Abstract目的 分析社区获得性军团菌肺炎老年患者的临床特征,探讨与非老年患者的异同.方法 收集2001年1月至2009年10月在北京大学第一医院住院治疗的80例社区获得性军团菌肺炎患者的流行病学、临床、实验室资料及转归情况,通过单变量及多变量分析的方法比较老年组与非老年组间的差异.结果 (1)与非老年组比较,老年组患者更多并存脑血管病、慢性阻塞性肺疾病、糖尿病,更多应用免疫抑制剂(均P<0.05);(2)老年组与非老年组感染军团菌的血清型差异无统计学意义;(3)与非老年组比较,老年组乏力、低钠血症、低磷血症更为常见(x2值分别为5.300、5.520、4.470,P值分别为0.021、0.019、0.034),血肌酐水平更高[分别为(108.55±56.57)μmmol/L和(75.42±17.62)μmmol/L,t=-3.062,P=0.002]、氧合指数更低(氧合指数<300者分别有57.7%和29.2%,x2=4.120,P=0.042),而外周血白细胞总数升高不显著[分别为(8.34±3.65)×109/L和(10.63±5.02)×109/L,t=-2.287,P=0.022];(4)老年组病情更严重(x2=41.140,P=0.000),更易并发左心功能不全(P=0.037),住院时间更长(Z=-2.194,P=0.028);而在病死率、入住重症监护病房以及接受糖皮质激素、机械通气方面与非老年组比较,差异无统计学意义.结论 社区获得性军团菌肺炎老年患者并存症多,受累器官多,病情重;但经适当治疗,预后与非老年患者无差异.
Objective To analyze and compare the clinical features of community-acquired pneumonia caused by Legionella in elderly (age≥60 years) and younger patients. Methods The epidemiological, clinical, laboratory data and the outcomes of 80 cases with community-acquired Legionella pneumonia (CALP) from January 2001 to October 2009 were studied retrospectively, and the differences between elderly and younger group were compared using univariate and multivariate analysis. Results (1) Underlying diseases, such as cerebrovascular diseases, chronic obstructive pulmonary diseases, diabetes mellitus and immunosuppressive therapy were significantly more frequent in elderly group than in younger group (all P<0. 05). (2) No significant differences were observed between the two groups in legionella serotype. (3) Malaise, hyponatremia and hypophosphatemia were all more frequent in elderly group than in younger group (x2=5. 300, 5. 520, 4. 470; P=0. 021,0. 019, 0. 034, respectively). And elderly versus younger group had higher creatinine levels [(108.55±56.57) μmmol/L vs. (75.42±17.62) μmmol/L, t= -3. 062, P=0. 002], lower PaO2/FiO2 (<300) (57.7% vs. 29.2%, x2=4. 120, P=0.042), less leucocyte counts [(8.34±3.65)×109/Lvs. (10.63±5.02)×109/L, t=-2.287, P=0.022]. (4) Elderly patients more likely complicated with congestive heart failure (P=0.037) and their length of staying in hospital was also longer (Z=-2.194, P=0.028). No significant differences were observed between the two groups in mortality, intensive care unit admission, and the need for corticosteroids or mechanical ventilation.Conclusions Elderly patients with CALP have a higher frequency of underlying comorbidities and more organs involvement than younger patients, although greater severity of illness at onset and outcome are not significantly different between the two groups.
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