切换至 "中华医学电子期刊资源库"

中华肺部疾病杂志(电子版) ›› 2026, Vol. 19 ›› Issue (03) : 504 -509. doi: 10.3877/cma.j.issn.1674-6902.2026.03.026

综述

以病原学为导向的个体化医疗策略诊治重症肺炎的研究进展与展望
杨远舰, 刘红梅, 张晓菊()   
  1. 1450000 郑州,郑州大学人民医院·河南省人民医院呼吸与危重症医学科
  • 收稿日期:2025-10-13 出版日期:2026-06-25
  • 通信作者: 张晓菊
  • 基金资助:
    河南省医学科技攻关计划省部共建重大项目(SBGJ202301003); 河南省医学科技攻关项目(LHGJ20230079); 河南省科技攻关项目(252102310265)

Research progress and prospects of pathogen-oriented personalized medical strategies in the diagnosis and treatment of severe pneumonia

Yuanjian Yang, Hongmei Liu, Xiaoju Zhang()   

  • Received:2025-10-13 Published:2026-06-25
  • Corresponding author: Xiaoju Zhang
引用本文:

杨远舰, 刘红梅, 张晓菊. 以病原学为导向的个体化医疗策略诊治重症肺炎的研究进展与展望[J/OL]. 中华肺部疾病杂志(电子版), 2026, 19(03): 504-509.

Yuanjian Yang, Hongmei Liu, Xiaoju Zhang. Research progress and prospects of pathogen-oriented personalized medical strategies in the diagnosis and treatment of severe pneumonia[J/OL]. Chinese Journal of Lung Diseases(Electronic Edition), 2026, 19(03): 504-509.

全球范围内重症肺炎的发病率与病死率居高不下,尤其在老年体弱、多重耐药菌(multiple drug resistant organism, MDRO)感染及医疗资源匮乏人群中临床结局更差。经验性抗感染治疗已不能满足临床工作的需求,重症肺炎的诊疗模式也已转向以治疗目标导向为核心的个体化医疗模式。尽管抗生素不断迭代、重症生命支持技术日益普及,传统经验性抗感染治疗仍存在病原检测滞后、抗生素滥用及耐药加剧等局限,难以满足个体化治疗需求。以宏基因组学测序(metagenomic next-generation sequencing, mNGS)和靶向测序(targeted next-generation sequencing, tNGS)为代表的高通量测序(next-generation sequencing, NGS)技术可精准、快速检测病原体,技术可精准检测病原体,且以病原学为导向的抗感染治疗方案已应用于临床。在此基础上,整合药代动力学/药效动力学参数与治疗药物监测,结合抗生素降阶梯策略,有助于构建个体化医疗方案,推动重症肺炎治疗从经验性模式向精准医学转型。未来,随着人工智能辅助诊疗系统与智慧化ICU的建设,该策略有望进一步提升重症肺炎的救治成功率,改善患者预后。

1
Martin-Loeches I, Torres A, Nagavci B, et al. ERS/ESICM/ESCMID/ALAT guidelines for the management of severe community-acquired pneumonia[J]. Eur Respir J, 2023, 61(4): 2200735.
2
Teh BW, Mikulska M, Averbuch D, et al. Consensus position statement on advancing the standardised reporting of infection events in immunocompromised patients[J] . Lancet Infect Dis, 2024, 24(1): e59-e68.
3
Inke RK, Oliver F, Gesine H, et al. What is precision medicine?[J]. Eur Respir J, 2017, 50(4): 1700391.
4
中华医学会呼吸病学分会. 下呼吸道感染宏基因组二代测序报告临床解读路径专家共识[J] . 中华结核和呼吸杂志2023, 46(4): 322-335.
5
Markussen DL, Serigstad S, Ritz C, et al. Diagnostic stewardship in community-acquired pneumonia with syndromic molecular testing: A randomized clinical trial[J]. JAMA Netw Open, 2024, 7(3): e240830.
6
GBD 2017 Causes of Death Collaborators. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the Global Burden of Disease Study 2017[J] . Lancet, 2018, 392(10159): 1736-1788.
7
GBD 2021 Lower Respiratory Infections and Antimicrobial Resistance Collaborators. Global, regional, and national incidence and mortality burden of non-COVID-19 lower respiratory infections and aetiologies, 1990-2021: a systematic analysis from the Global Burden of Disease Study 2021[J] . Lancet Infect Dis, 2024, 24(9): 974-1002.
8
Niederman MS, Torres A. Severe community-acquired pneumonia[J]. Eur Respir Rev, 2022, 31(166): 220123.
9
Meyer NJ, Gattinoni L, Calfee CS, et al. Acute respiratory distress syndrome[J] . Lancet, 2021, 398(10300): 622-637.
10
刘大为. 一个值得深思的问题:重症治疗是病情导向抑或治疗目标导向[J]. 中华内科杂志2022, 61(6): 607-610.
11
中华医学会,中华医学会临床药学分会,中华医学会杂志社,等. 成人社区获得性肺炎基层合理用药指南[J]. 中华全科医师杂志2020, 19(9): 783-791.
12
袁喆,钱克莉,王忠杰. 耐碳青霉烯肺炎克雷伯菌耐药机制及治疗策略[J]. 西南医科大学学报2024, 47(2): 104-110.
13
Gadsby NJ, Musher DM. The microbial etiology of community-acquired pneumonia in adults: from Classical bacteriology to host transcriptional signatures[J] . Clin Microbiol Rev, 2022, 35(4): e0001522.
14
Fagerli K, Ulziibayar M, Suuri B, et al. Epidemiology of pneumonia in hospitalized adults ≥18 years old in four districts of Ulaanbaatar, Mongolia, 2015-2019[J] . Lancet Reg Health West Pac, 2022, 30: 100591.
15
Barbier F, Buetti N, Dupuis C, et al. Prognostic impact of early appropriate antimicrobial therapy in critically Ⅲ patients with nosocomial pneumonia due to gram-negative pathogens: A Multicenter Cohort Study[J] . Crit Care Med, 2025, 53(5): e1066-e1079.
16
Kim C, Holm M, Frost I, et al. Global and regional burden of attributable and associated bacterial antimicrobial resistance avertable by vaccination: modelling study[J]. BMJ Glob Health, 2023, 8(7): e011341.
17
中华医学会细菌感染与耐药防治分会. 呼吸系统感染中宏基因组测序技术临床应用与结果解读专家共识[J]. 中华临床感染病杂志2022, 15(2): 90-102.
18
中国医疗保健国际交流促进会临床微生物学分会. 靶向高通量测序在感染性疾病中应用与实践专家共识[J]. 中华医学杂志2024, 104(48): 4375-4383.
19
姜宁,龙秋月,郑雅莉,等. 社区获得性肺炎流行病学与病原学及其治疗进展[J]. 中华预防医学杂志2023, 57(1): 91-99.
20
Liakopoulos A, Aulin LBS, Buffoni M, et al. Allele-specific collateral and fitness effects determine the dynamics of fluoroquinolone resistance evolution[J]. Proc Natl Acad Sci U S A, 2022, 119(18): e2121768119.
21
Abdalla JS, Albarrak M, Alhasawi A, et al. Narrative review of the epidemiology of hospital-acquired pneumonia and ventilator-associated pneumonia in gulf cooperation council countries[J] . Infect Dis Ther, 2023, 12(7): 1741-1773.
22
陈思缄,詹庆元,黄琳娜,等. 流感病毒继发肺部金黄色葡萄球菌的感染机制[J] . 中华结核和呼吸杂志2023, 46(6): 646-650.
23
刘玉强,侯春霞,成亚东,等. 不同抗生素治疗MRSA感染性肺炎的研究进展[J/OL]. 中华肺部疾病杂志(电子版), 2025, 18(1): 171-175.
24
Lu H, Zhang K, Zhang W, et al. Inflammation-targeting and self-limited neutrophilic membrane-encapsulated teicoplanin for the treatment of infectious pneumonia[J]. Trends Biotechnol, 2025, 43(9): 2276-2303.
25
Yin YY, Zhao CJ, Li HN, et al. Clinical and microbiological characteristics of adults with hospital-acquired pneumonia: a 10-year prospective observational study in China[J] . Eur J Clin Microbiol Infect Dis, 2021, 40(4): 683-690.
26
中华医学会呼吸病学分会感染学组. 中国铜绿假单胞菌下呼吸道感染诊治专家共识(2022年版)[J]. 中华结核和呼吸杂志2022, 45(8): 739-752.
27
Tamma PD, Aitken SL, Bonomo RA, et al. Infectious diseases society of america guidance on the treatment of extended-spectrum β-iactamase producing enterobacterales (ESBL-E), carbapenem-resistant enterobacterales (CRE), and pseudomonas aeruginosa with difficult-to-treat resistance (DTR-P. aeruginosa)[J] . Clin Infect Dis, 2022, 75(2): 187-212.
28
Tan X, Huang YQ, Rana A, et al. Optimization of an in vitro pseudomonas aeruginosa biofilm model to examine antibiotic pharmacodynamics at the air-liquid interface[J]. NPJ Biofilms Microbiomes, 2024, 10(1): 16.
29
中国医药教育协会感染疾病专业委员会(IDSC). 多黏菌素类药物雾化吸入治疗下呼吸道多重耐药革兰阴性菌感染中国专家共识(2024年版)[J]. 中华临床感染病杂志2024, 17(5): 353-366.
30
Albin OR, Kaye KS, McCreary EK, et al. Less is more Antibiotic treatment duration in pseudomonas aeruginosa ventilator-associated pneumonia[J]. Clin Infect Dis, 2023, 76(4): 745-749.
31
Jason MP, Zhou Y, Hemanth K, et al. Burden of illness in carbapenem-resistant acinetobacter baumannii infections in US hospitals between 2014 and 2019[J] . BMC Infect Dis, 2022, 22(1): 36.
32
Wahid B, Tiwana MS, Ali A. Revolutionising infection control: building the next generation of phage banks[J]. Drug Resist Updat, 2024, 77: 101143.
33
中国研究型医院学会危重医学专业委员会,中国研究型医院学会感染性疾病循证与转化专业委员会. 多黏菌素临床应用中国专家共识[J]. 中华危重病急救医学2019, 31(10): 1194-1198.
34
John TM , Deshpande A, Brizendine K, et al. Epidemiology and outcomes of community-acquired escherichia coli pneumonia[J] .Open Forum Infect Dis, 2022, 9(1): ofab597.
35
Assefa M. Multi-drug resistant gram-negative bacterial pneumonia: Etiology, risk factors, and drug resistance patterns[J] . Pneumonia (Nathan), 2022, 14(1): 4.
36
Celebi D, Aydin E, Rakici E, et al. Evaluation of presence of clone ST131 and biofilm formation in ESBL producing and non-producing Escherichia coli strains[J] . Mol Biol Rep, 2023, 50(7): 5949-5956.
37
Lima AH, van der Kamp MW. Insights into the enhanced ceftazidime hydrolysis by ent385 ampC β-Lactamase from multiscale simulations[J]. ACS Catal, 2025, 15(13): 11739- 11748.
38
Andre CK, Mark LM, Michael K, et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the infectious diseases society of america and the american thoracic society[J] . Clin Infect Dis, 2016, 63(5): e61-e111.
39
孔海芳,胡志东. 高毒力肺炎克雷伯菌流行病学特征及其致病性毒力因子[J]. 国际流行病学传染病学杂志2021, 48(1): 80-83.
40
Sree RA, Gupta A, Gupta N, et al. Ceftazidime-avibactam alone or in combination with Aztreonam versus Polymyxins in the management of carbapenem-Resistant Klebsiella pneumoniae nosocomial Infections (CAPRI study): a retrospective cohort study from South India[J]. Infection, 2024, 52(2): 429-437.
41
Tavleen KJ, Ritesh A, Pei YT, et al. Fungal lung disease[J]. Eur Respir J, 2024, 64(5): 2400803.
42
Azoulay E, Russell LVan de Louw Andry, et al. Diagnosis of severe respiratory infections in immunocompromised patients[J] . Intensive Care Med, 2020, 46: 298-314.
43
Donnelly JP, Chen SC, Kauffman CA, et al. Revision and update of the consensus definitions of invasive funga disease from the european organization for research and treatment of cancer and the Mycoses study group education and research consortium[J]. Clin Infect Dis, 2020, 71(6): 1367-1376.
44
Nagai T, Matsui H, Fujioka H, et al. Low-dose vs. conventional-dose trimethoprim-sulfamethoxazole treatment for pneumocystis pneumonia in patients not infected with HIV: A multicenter, retrospective observational cohort study[J]. Chest, 2024, 165(1): 58-67.
45
冯佳佳,孔维华,林丽开. 中国真菌感染管理政策解读[J]. 中华实用儿科临床杂志2024, 39(1): 7-9.
46
Li H, Liu L, Zhang D, et al. SARS-CoV-2 and viral sepsis: observations and hypotheses[J]. Lancet, 2020, 395(10235): 1517-1520.
47
Febbo J, Revels J, Ketai L. Viral Pneumonias[J]. Infect Dis Clin North Am, 2024, 38(1): 163-182.
[1] 李隆松, 易阳, 沈凯悦, 江凯华, 葛亚文, 张优仪, 宋健, 彭然, 王秋伟, 赵根明, 张涛. 2020年至2024年常州市儿童重症肺炎的流行特征及影响因素分析[J/OL]. 中华危重症医学杂志(电子版), 2026, 19(01): 33-41.
[2] 庞秋菊, 陈灿, 任宝恒, 韩菊玲, 王婧. 重症肺炎患者肺泡灌洗液中核因子κB表达与计算机断层扫描影像特征的相关性及其对转归的预测价值[J/OL]. 中华实验和临床感染病杂志(电子版), 2026, 20(01): 46-53.
[3] 李东晖. 重症烧伤患者多重耐药菌感染风险的机器学习预测模型构建及验证[J/OL]. 中华实验和临床感染病杂志(电子版), 2025, 19(06): 368-377.
[4] 徐丽珍, 黄显博, 杜锋蔚. 异基因造血干细胞移植后难治性腹泻三例并文献复习[J/OL]. 中华移植杂志(电子版), 2026, 20(02): 123-126.
[5] 周智, 张文波, 蒋国路, 朱名梅. NLRP3信号通路及相关细胞因子预测老年重症肺炎患者预后的意义[J/OL]. 中华肺部疾病杂志(电子版), 2026, 19(03): 464-469.
[6] 冯英凯, 苏琛, 彭波, 韩志礼, 王晓明, 陶冠宇, 熊六波, 王恋, 陈兴兵. 中西医结合治疗89例重症肺炎患者的疗效分析[J/OL]. 中华肺部疾病杂志(电子版), 2026, 19(02): 282-288.
[7] 张金, 叶强, 姚淳, 许金凤, 郑礼杰. 血清钙卫蛋白水平动态变化与重症肺炎患者预后的相关性分析[J/OL]. 中华肺部疾病杂志(电子版), 2026, 19(02): 275-281.
[8] 杨德建, 晏东, 戴忠红, 黎宏, 杨鹏, 钟常文. 平均血小板体积/血小板计数、乳酸/白蛋白比值对119例重症肺炎预后预测的价值研究[J/OL]. 中华肺部疾病杂志(电子版), 2026, 19(01): 132-138.
[9] 马彬, 王启超, 王圣元, 赵虎林, 沈玥. 俯卧位通气管理在59例重症肺炎患者中的临床应用[J/OL]. 中华肺部疾病杂志(电子版), 2025, 18(06): 1012-1014.
[10] 刘宝德, 郑娉娉, 肖宇翔, 沈凌, 王柳盛, 张维. 肺泡灌洗液中炎症因子对重症肺炎患者痰栓风险的预测分析[J/OL]. 中华肺部疾病杂志(电子版), 2025, 18(06): 917-922.
[11] 唐杉杉, 吴红梅, 王爽, 周静, 王露梦, 彭茜. 重症肺炎合并急性呼吸窘迫综合征继发多器官衰竭救治成功一例[J/OL]. 中华肺部疾病杂志(电子版), 2025, 18(05): 844-846.
[12] 刘虹, 李国蓉, 战祥哲, 高海燕, 刘洪千, 赵永辉. 高频胸壁振荡排痰与传统气道廓清术在治疗重症肺炎中的临床分析[J/OL]. 中华肺部疾病杂志(电子版), 2025, 18(05): 802-806.
[13] 李娜, 栾亮, 张苗, 李萌, 毛琪, 李亮. 外周血心型脂肪酸结合蛋白与重症肺炎患者心肌损伤及预后的相关性[J/OL]. 中华肺部疾病杂志(电子版), 2025, 18(05): 768-772.
[14] 高兴梅, 周洁容, 杨溢, 张孟祥, 张仲谋, 李斌. 重症肺炎患者血磷水平轨迹与短期预后之间的关系[J/OL]. 中华临床医师杂志(电子版), 2025, 19(07): 479-485.
[15] 扈姝琴, 曹丹, 丁亚艳. 专科护士主导的医疗游戏护理模式对重症肺炎支原体肺炎患儿纤维支气管镜检查依从性的影响[J/OL]. 中华卫生应急电子杂志, 2025, 11(05): 278-283.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?