产单核李斯特菌侵袭性感染57例分析  

Analysis of 57 cases of invasive infection with Listeria monocytogenes

作　　者：卢兴兵[1] 戴仲秋 李天立 敖茂程 王彦兮 熊丽[1] 谢轶[1] Lu Xingbing;Dai Zhongqiu;Li Tianli;Ao Maocheng;Wang Yanxi;Xiong Li;Xie Yi(Department of Laboratory Medicine,West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院实验医学科,成都610041

出　　处：《中华检验医学杂志》2021年第5期421-425,共5页Chinese Journal of Laboratory Medicine

基　　金：国家重点研发计划(2019FY101211)。

摘　　要：目的分析成人(非孕妇)感染产单核李斯特菌的特点,为该病的诊治提供依据。方法纳入2008年1月至2020年4月华西医院收治的产单核李斯特菌感染成人(非孕妇)患者57例。回顾性分析患者的年龄、症状、基础疾病和预后等临床资料,以及白细胞(WBC)、中性粒细胞与淋巴细胞比值(NLR)、降钙素原(PCT)、白细胞介素-6(IL-6)和C反应蛋白(CRP)等实验室结果,分析其临床感染和预后特点。结果57例患者年龄18~83(52.8±15.9)岁,60岁以上占35.09%(20/57)。季节分布以夏季发病最高(45.61%,26/57)。48例合并基础疾病;31例发生脓毒症,18例脑膜炎。李斯特菌病确诊时间为(6.1±2.9)d,确诊后调整以碳青霉烯类(26.32%,15/57)、青霉素类(22.81%,13/57)为主的目标性治疗。住院治疗的47例患者治疗后的WBC[6.77(2.99,9.54)×10^(9)/L比10.23(6.71,16.55)×10^(9)/L]、NLR[3.07(1.66,8.16)比11.26(5.66,20.08)]和CRP[40.7(16.9,91.9)g/L比92.8(59.9,142.7)g/L]水平明显低于治疗前(P均<0.05)。38例患者根据指南治疗后,33例好转,2例预后不佳,2例死亡。结论成人(非孕妇)产单核李斯特菌感染的主要风险因素为其基础疾病,特别是自身免疫性疾病和肺部感染疾病。青霉素类可作为经验治疗首选药物,碳青霉烯类、红霉素等可联合足疗程治疗。Objective To analyze the characteristics of adults(non-pregnant women)infected with Listeria monocytogenes and to provide evidence for diagnosis and treatment of this disease.Methods Patients admitted in West China Hospital of Sichuan University between January 2008 and April 2020 with Listeriadisease were enrolled in this study.The clinical data of patients including age,symptoms,underlying diseases and prognosis,as well as the laboratory results of WBC,neutrophil ratio(N%),procalcitonin(PCT),interleukin-6(IL-6)and C-reactive protein(CRP),were obtained for analyzing the clinical infection and prognosis characteristics of the patients.Results A total of 57 patients were included,patients were 18-83(52.8±15.9)years old,percent of over 60 years old patients accounted for 35.09%(20/57).The incidence rate in summer season was the highest(45.61%,26/57).There were 48 cases with comorbidities,sepsis occurred in 31 cases and meningitis in 18 cases.The time of diagnosis of Listeriosis was(6.1±2.9)days.After diagnosis,the target therapy was applied:such as carbapenem(26.32%,15/57)and penicillins(22.81%,13/57).The levels of WBC(6.77[2.99,9.54]×10^(9)/L vs 10.23[6.71,16.55]×10^(9)/L),NLR(3.07[1.66,8.16]vs 11.26[5.66,20.08])and CRP(40.7[16.9,91.9]g/L vs 92.8[59.9,142.7]g/L)were significantly lower after treatment than those before treatment in 47 hospitalized patients(all P<0.05).Thirty-eight patients were treated according to the guidelines,33 cases improved,2 cases had poor prognosis and 2 cases died.Conclusion The main risk factors of Listeria monocytogenes infection in adults(non-pregnant women)are underlying diseases,especially autoimmune diseases and pulmonary infections.Penicillins can be used as the first choice for empirical therapy.Carbapenems and erythromycin serve as the combination medications during the full course of treatment.

关 键 词：李斯特菌病 产单核李斯特菌 脓毒症 脑膜炎 抗菌药 

分 类 号：R515[医药卫生—内科学]