鹦鹉热衣原体肺炎48例临床特征分析  

Clinical and imaging features of Chlamydia psittaci pneumonia:an analysis of 48 cases in China

作　　者：沈凌 田贤江[2] 梁荣章 程瑗 孔祥龙 何飞 张超 王国安[8] 李森华 陆华东[10] 孙思庆 Shen Ling;Tian Xianjiang;Liang Rongzhang;Cheng Yuan;Kong Xianglong;He Fei;Zhang Chao;Wang Guoan;Li Senhua;Lu Huadong;Sun Siqing(Department of Pulmonary and Critical Care Medicine,Hangzhou First People′s Hospital,Zhejiang University School of Medicine,Hangzhou 310006,China;Department of Infectious Disease,the First People′s Hospital of Xiaoshan District,Hangzhou 311201,China;Department of Pulmonary and Critical Care Medicine,the First Hospital of Longyan Affiliated to Fujian Medical University,Longyan 364000,Fujian Province,China;Department of Infectious Diseases,Hunan University of Traditional Medicine Affiliated Ningxiang People′s Hospital,Ningxiang 410600,Hunan Province,China;Department of Pulmonary and Critical Care Medicine,Changsha First Hospital,Changsha 410005,China;Department of Pulmonary and Critical Care Medicine,Affiliated Hangzhou Chest Hospital,Zhejiang University School of Medicine,Hangzhou 310003,China;Institute of Respiratory Disease,China Three Gorges University,Yichang Central People′s Hospital,Yichang 443003,Hubei Province,China;Department of Pulmonary and Critical Care Medicine,Ningbo Medical Center Li Huili Hospital,Ningbo 315040,China;Department of Pulmonary Medicine,Hangzhou Ninth People′s Hospital,Hangzhou 311225,China;Department of Respiratory and Critical Care,Huzhou Central Hospital,Huzhou 313000,Zhejiang Province,China;Department of General Medicine,Nanjing Second Hospital,Nanjing 210003,China)

机构地区：[1]浙江大学医学院附属杭州市第一人民医院呼吸与危重症医学科,310006 [2]浙江省杭州市萧山区第一人民医院感染科,311201 [3]福建医科大学附属龙岩第一医院呼吸与危重症医学科,364000 [4]湖南省宁乡市人民医院感染科,410600 [5]湖南省长沙市第一医院呼吸与危重症医学科,410005 [6]浙江大学医学院附属杭州市胸科医院呼吸与危重症医学科,310003 [7]湖北省宜昌市中心人民医院呼吸与危重症医学科,443003 [8]浙江省宁波市医疗中心李惠利医院呼吸与危重症医学科,315040 [9]浙江省杭州市第九人民医院呼吸科,311225 [10]浙江省湖州市中心医院呼吸与危重症医学科,313000 [11]江苏省南京市第二医院全科医学科,210003

出　　处：《中华结核和呼吸杂志》2021年第10期886-891,共6页Chinese Journal of Tuberculosis and Respiratory Diseases

摘　　要：目的探讨鹦鹉热衣原体肺炎的临床特点、影像学、实验室检查及治疗策略。方法回顾性分析中国大陆地区11家医院2019年1月1日至2021年1月20日采用宏基因组二代测序技术诊断的48例鹦鹉热衣原体肺炎的诊治过程,记录患者职业史、临床表现、实验室检查、胸部CT表现和治疗及预后情况。结果48例患者中男性29例,女性19例,年龄(57.1±10.3)岁,30例有明确禽类接触史;从发病到入院的时间为(6.5±3.2)d,住院时间为(12.4±4.8)d。临床表现包括发热(100%,48/48)、相对缓脉(71%,34/48)、咳嗽(54.2%,26/48)、咯痰(27.1%,13/48)、乏力(16.7%,8/48)、头痛和谵妄(20.8%,9/48)、消化道症状(16.7%,8/48)。实验室检查中白细胞总数(8.0±3.8)×109/L,44例患者中性粒细胞比例增高;C反应蛋白(155.3±74.1)mg/L,59.5%患者PCT>0.5μg/L,分别有82.9%和45.2%患者乳酸脱氢酶和肌酸激酶增高。胸部CT表现中单侧34例(70.8%)、单叶27例(56.3%),最常见的影像改变是实变,其中大叶性实变影38例(79.2%)。治疗情况中,单用氟喹诺酮类药物25例,单用多西环素6例,联合用药组13例,联合用药组与单用多西环素组在体温恢复正常时间相当,均优于单用氟喹诺酮类。入住ICU者11例,出现休克5例,给予呼吸支持治疗11例,仅有1例死亡。结论鹦鹉热衣原体肺炎是一种动物源性感染性疾病,具有一定的临床症状、实验室检查和影像学特点,合适的治疗能明显缩短病程及改善预后。Objective To explore the clinical characteristics,imaging findings,laboratory tests and treatment strategies for Chlamydia psittaci pneumonia.Methods From January 1,2019 to January 20,2021,48 cases of Psittacosis from 11 hospitals in China were diagnosed via metagenomic next-generation sequencing(mNGS).The data of all patients on occupational history,clinical manifestations,laboratory tests,chest computed tomography(CT)findings,treatment outcomes and prognosis were retrospectively analyzed.Results Among the 48 patients,there were 29 males and 19 females,with a mean age of(57.1±10.3)years.Thirty patients had a confirmed history of exposure to poultry.The onset to admission interval was(6.5±3.2)days,and hospital stay was(12.4±4.8)days.Clinical manifestations included fever(100%,48/48),relative bradycardia(71%,34/48),cough(54.2%,26/48),sputum(27.1%,13/48),fatigue(16.7%,8/48),headache and delirium(20.8%,9/48),and gastrointestinal symptoms(16.7%,8/48).Laboratory data showed that white blood cells were(8.0±3.8)×109/L,and the proportion of neutrophils increased in 44 patients.The level of C-reactive protein was(155.3±74.1)mg/L,and that of procalcitonin(PCT)in 59.5%of patients was more than 0.5μg/L.Percentages of patients with increased lactate dehydrogenase and creatine kinase were 82.9%and 45.2%,respectively.Chest CT scans showed unilateral lung involvement in 34 cases(70.8%)and single lobe involvement in 27 cases(56.3%).The most common imaging change was consolidation,with 38 cases(79.2%)showing lobar consolidation.In terms of treatment,25 patients were treated with fluoroquinolones alone,6 patients with doxycycline alone,and 13 patients with combined treatment.The combined-treatment group and the doxycycline alone group were similar in the course of defervescence.The combined treatment group and the doxycycline alone group were both superior to the fluoroquinolones alone group.However,11 patients were admitted to ICU,all of them received artificial ventilation,and 5 cases developed shock,and one died.Conclusio

关 键 词：鹦鹉热 衣原体 鹦鹉 社区获得性感染 宏基因组二代测序 

分 类 号：R563.1[医药卫生—呼吸系统]