蔡文君 吴小妹 雷鸣 钱义明 赵雷 冯文涛

摘要 社区获得性肺炎（Community Acquired Pneumonia，CAP）是比较常见的院外肺部炎性疾病之一，随着细菌、支原体、衣原体等多种病原体的耐药率的上升，以及病患梯度的范围增加，CAP的发病率呈逐年上升的趋势，死亡率日益增高，导致医疗资源消耗巨大。目前临床上CAP的患者主要依靠经验性治疗。正确选择抗生素、减少病原体的耐药率，优化肺部炎症疾病的医疗方案，提高CAP临床治愈率已经成为临床医生当前面临的一项重大挑战。中药制剂具有广谱抗菌、调节免疫、不易耐药、简便价廉等特点，是解决上述难题的一个很好途径。

关键词  社区获得性肺炎;西医现状;致病性;耐药性;病因病机;中医辨证论治;中药制剂;中西医结合治疗

Progress in Research of Community Acquired Pneumonia in Traditional Chinese and Western Medicine

CAI Wenjun¹，WU Xiaomei¹，LEI Ming²，QIAN Yiming³，ZHAO Lei³，FENG Wentao²

（1 Jinshan Integrated Hospital of Traditional Chinese and Western Medicine，Shanghai 201501，China; 2 Seventh People′s Hospital of Shanghai University of TCM，Shanghai 200137，China; 3 Yue Yang Hospital of Integrated Chinese and Western Medicine，Shanghai University of Traditional Chinese Medicine，Shanghai 200437，China）

Abstract Community acquired pneumonia is one of the most common pulmonary inflammatory diseases outside the hospital.With the increase of drug resistance rate of bacteria，mycoplasma，chlamydia and other pathogens，as well as the increase of patient gradient，the incidence of CAP is increasing year by year，and the death rate is increasing，which leads to huge consumption of medical resources.Now clinically，CAP patients mainly rely on empirical treatment.It has become a major challenge for clinicians to select antibiotics correctly，reduce the resistance rate of pathogens，optimize the medical scheme of pulmonary inflammatory diseases，and improve the clinical cure rate of CAP.Traditional Chinese medicine preparation has the characteristics of broad-spectrum antibacterial，immune regulation，not easy to drug resistance，simple and cheap，which is a good way to solve the above problems.This paper aims to analyze the general situation of community acquired pneumonia in the past 15 years at home and abroad.

Keywords Community acquired Pneumonia; Current situation of Western medicine; Source of disease; Drug resistance; Etiology and pathogenesis; Syndrome differentiation and treatment of traditional Chinese Medicine; Chinese medicine preparation; Combined treatment of traditional Chinese medicine and Western medicine

中圖分类号：R242;R563 文献标识码：A doi：10.3969/j.issn.1673-7202.2020.08.026

社区获得性肺炎（Community Acquired Pneumonia，CAP）一般是指在医院外身染细菌、病毒、支原体、衣原体等不典型病原体的肺部炎性疾病，亦包括患者在入院后72 h以内发病的肺炎[1-4]。临证可见咳嗽、咯痰，发病前兆可合并咽喉部卡他症状。CAP的患病主要是病患的自身的防御机制降低，导致肺部毛细血管半透膜的选择通过性下降，没有能力抵挡空气中不典型病原体的侵犯，从而使肺部发生感染性炎性疾病[5]。目前临床上CAP的患者主要依靠经验性治疗，因此优化CAP的整体治疗方案，减少耐药率的发生，提高CAP临床治愈率是临床医生重要职责所在。

1 社区获得性肺炎的西医研究

1.1 国内外CAP的临床流行病学分析 据国内诸多调查证实[6-8]：中国目前老年人身染肺炎后的病死率在5%～15.4%之间，并且随老年人年龄的升高，肺炎的病死率呈上升趋势，其中社区获得性肺炎重症患者病死率为45.3%。……