关键词: 社区获得性肺炎, 呼吸病毒感染, 疾病特征, 流感病毒A型, 流感病毒B型, 鼻病毒属

Abstract: Background　It is unclear whether there is a difference in clinical therapies for adults with community-acquired pneumonia（CAP） complicated with respiratory virus infection（RVI） and CAP alone. This study tried to explore the issue by analyzing the viral spectrum of adults with CAP with RVI，and comparing their clinical features with those with CAP alone. Objective　To investigate the viral spectrum and clinical features of adults with CAP and RVI. Methods　Nasopharyngeal swab samples of 223 CAP patients who were admitted to the inpatient department of Shanghai Fifth People's Hospital from June 2017 to May 2019 were collected. Nested multiplex RT-PCR technique was adopted to detect the 8 species（10 common types） of respiratory viruses in throat swabs，and according to the results，patients were divided into virus-positive and virus-negative groups，and clinical features of virus-positive group were analyzed. ELISA was used to detect the concentration of 6 cytokines（IL-6，IL-8，IL-10，IFN-γ，IP-10，TNF-α） in serum samples of 24 virus-positive CAP patients，24 virus-negative CAP patients and 24 community healthy controls. Results　 Sixty-one（27.35%） were detected positive for respiratory viruses in throat swabs，3 of whom had multiple virus infection，and the other 58（26.01%） had single virus infection，including 22 cases（9.87%） of influenza A virus（Flu A），14 cases（6.28%） of rhinovirus（RhV），9 cases（4.03%） of influenza B virus（Flu B），5 cases（2.24%） of adenovirus，2 cases（0.90%） of coronavirus，2 cases（0.90%） of respiratory syncytial virus A，2 cases（0.90%） of metapneumovirus，1 case（0.45%） of bokavirus，and 1 case（0.45%） of respiratory syncytial virus B. There was no significant difference in virus detection rate between non-elderly group（≤65 years old） and elderly group（>65 years old）（P>0.05）. Patients were infected throughout the four seasons，with a high incidence in winter，and the infected viruses mainly included Flu A，RhV and Flu B. Virus-positive group had statistically higher death rate than virus-negative group（P<0.05）. And all deceased cases in virus-positive group had got the influenza infection. Further analysis found that the LDH level was higher in those with influenza infection（including Flu A and Flu B） than in those without（P<0.05） in virus-positive group. And those with influenza infection in virus-positive group had higher death rate than virus-negative group（P<0.05）. In imaging features analysis，bilateral lung lesions，multiple lobe lesions and patchy exudation presented more frequently in virus-positive group（P<0.05）. Serum concentrations of IL-10 of virus-positive group were significantly higher than those of virus-negative group（P<0.05）. Conclusion　 RVI was common in CAP patients in Shanghai's Minhang District，and the viruses detected were mainly Flu A，RhV and Flu B. Clinical features of CAP virus-positive patients lacked specificity. Influenza virus infection may increase the mortality of CAP. CAP virus-positive patients showed bilateral lung lesions，multiple lung lobe lesions and patchy exudation frequently in chest image，and presented a significant increase in the serum IL-10 levels. These results may provide certain reference values for the management of CAP complicated with RVI.

Key words: Community acquired pneumonia, Respirovirus infections, Disease attributes, Influenza A virus, Influenza B virus, Rhinovirus