PDF(Pubmed)
Abstract：
Environmental exposures are known to be associated with pathogen transmission and immune impairment, but the association of exposures with aetiology and severity of community-acquired pneumonia (CAP) are unclear. A retrospective observational study was conducted at nine hospitals in eight provinces in China from 2014 to 2019. CAP patients were recruited according to inclusion criteria, and respiratory samples were screened for 33 respiratory pathogens using molecular test methods. Sociodemographic, environmental and clinical factors were used to analyze the association with pathogen detection and disease severity by logistic regression models combined with distributed lag nonlinear models. A total of 3323 CAP patients were included, with 709 (21.3%) having severe illness. 2064 (62.1%) patients were positive for at least one pathogen. More severe patients were found in positive group. After adjusting for confounders, particulate matter (PM) 2.5 and 8-h ozone (O3-8h) were significant association at specific lag periods with detection of influenza viruses and Klebsiella pneumoniae respectively. PM10 and carbon monoxide (CO) showed cumulative effect with severe CAP. Pollutants exposures, especially PM, O3-8h, and CO should be considered in pathogen detection and severity of CAP to improve the clinical aetiological and disease severity diagnosis.
摘要：
已知环境暴露与病原体传播和免疫损伤有关,但暴露与病因学和社区获得性肺炎(CAP)严重程度的关系尚不清楚.2014年至2019年在中国8个省的9家医院进行了回顾性观察研究。根据纳入标准招募CAP患者，并采用分子检测方法对呼吸道样本进行33种呼吸道病原体的筛选。社会人口统计学，利用环境和临床因素，结合分布滞后非线性模型，采用logistic回归模型分析病原体检测和疾病严重程度的相关性。共纳入3323例CAP患者，709人(21.3%)患有严重疾病。2064例（62.1％）患者至少一种病原体呈阳性。在阳性组中发现更严重的患者。在调整了混杂因素后，颗粒物（PM）2.5和8-h臭氧（O3-8h）在特定滞后期分别与流感病毒和肺炎克雷伯菌的检测显着相关。PM10和一氧化碳（CO）显示出严重CAP的累积效应。污染物暴露，尤其是PM,O3-8h,在CAP的病原体检测和严重程度中应考虑CO，以提高临床病因和疾病严重程度的诊断。
