23例鹦鹉热肺炎临床特征分析  

Analysis of clinical features of 23 patients with psittacosis pneumonia

作　　者：刘辉[1] 叶静[1] 杨进[1] 许知礼[1] 郑凌[1] 陆友金[1] 赵卉[1] 赵大海[1] LIU Hui;YE Jing;YANG Jin;XU Zhi-li;ZHENG Ling;LU You-jin;ZHAO Hui;ZHAO Da-hai(Department of Respiratory and Critical Care Medicine,the Second Affiliated Hospital of Anhui Medical University,Hefei,Anhui 230601,China)

机构地区：[1]安徽医科大学第二附属医院呼吸与危重症医学科,安徽合肥230601

出　　处：《临床肺科杂志》2022年第3期346-350,共5页Journal of Clinical Pulmonary Medicine

基　　金：安徽医科大学基础与临床合作研究提升计划项目(No.2019xkjT027)。

摘　　要：目的分析鹦鹉热肺炎的临床特征,提高临床医生对该病的诊治水平。方法回顾性分析2019年11月至2021年1月于安徽医科大学第二附属医院呼吸与危重症医学科,经宏基因二代测序(Metagenomic next-generation sequencing,mNGS)确诊的23例鹦鹉热肺炎患者的流行病学特点、临床表现、实验室检查、影像学特点、治疗及预后。结果所有鹦鹉热肺炎患者均有禽类或鸟类接触史,高热为主要临床表现。与非重症患者相比,重症患者淋巴细胞下降更加明显,谷丙转氨酶、谷草转氨酶及尿素氮升高,均较非重症患者更显著,重症患者CRP、PCT、LDH升高明显。胸部CT多呈大叶性肺炎表现,病灶周围界限清晰,可伴有少量胸腔积液,所有患者支气管充气征阳性,无空洞形成。莫西沙星联合米诺环素方案治疗有效。结论鹦鹉热肺炎特征性临床表现为高热伴大叶性肺炎,白细胞计数不高,淋巴细胞计数下降,炎症指标升高,重症患者脏器损伤更明显,莫西沙星联合米诺环素治疗效果显著,预后较好。Objective To analyze the clinical characteristics of psittacosis pneumonia,and to improve the diagnosis and treatment level of this disease among clinicians.Methods The epidemiological characteristics,clinical manifestations,laboratory examination,imaging features,treatment,and prognosis of 23 patients with psittacosis pneumonia confirmed by mNGS in the Department of Respiratory and Critical Care Medicine of the Second Affiliated Hospital of Anhui Medical University from November 2019 to January 2021 were retrospectively analyzed.Results All patients with psittacosis pneumonia had a history of birds or fowls exposure,and the main clinical manifestation was high fever.Compared with non-critical patients,the decrease of lymphocytes was more obvious in severe patients,and the increase of alanine aminotransferase,aspartate aminotransferase,and urea nitrogen were more significant in severe patients.CRP,PCT,and LDH were significantly increased in severe patients.Chest CT mostly showed lobar pneumonia,with clear boundaries around the lesions,accompanied by a small amount of pleural effusion.All patients had positive bronchial inflation signs and no cavities were formed.Moxifloxacin combined with minocycline was effective.Conclusion The characteristic clinical manifestations of psittacosis pneumonia are high fever with lobar pneumonia,low white blood cell count,decreased lymphocyte count,increased inflammatory index.In severe patients,organ injury is more obvious.Moxifloxacin combined with minocycline has a significant therapeutic effect and a good prognosis.

关 键 词：肺炎 鹦鹉热衣原体 临床特征 宏基因二代测序 

分 类 号：R563.1[医药卫生—呼吸系统]