鹦鹉热衣原体肺炎13例临床分析  

Clinical characteristics of Chlamydia psittaci pneumonia:an analysis of 13 cases

作　　者：林娟 史永红[1] 瞿跃进[1] 卢芳 罗文[1] 徐颢[2] 林益华[1] Lin Juan;Shi Yonghong;Qu Yuejin;Lu Fang;Luo Wen;Xu Hao;Lin Yihua(Department of Respiratory and Critical Care Medicine,the First Affiliated Hospital of Xiamen University,Xiamen 361003,China;Intensive Care Unit,the First Affiliated Hospital of Xiamen University,Xiamen 361003,China)

机构地区：[1]厦门大学附属第一医院呼吸与危重症医学科,厦门361003 [2]厦门大学附属第一医院重症医学科,厦门361003

出　　处：《中华全科医师杂志》2022年第2期135-140,共6页Chinese Journal of General Practitioners

基　　金：厦门市医疗卫生指导性项目(3502Z20214ZD1005)。

摘　　要：目的探讨鹦鹉热衣原体肺炎的临床特征。方法回顾性分析厦门大学附属第一医院2018年11月至2021年2月连续收治的13例鹦鹉热衣原体肺炎患者的临床资料。结果13例患者均有发热,合并呼吸困难11例、咳嗽9例、乏力8例、头痛6例。所有患者就诊时序贯器官衰竭估计(SOFA)评分≥2分,肺炎严重指数(PSI)评分Ⅱ级者2例,PSI评分Ⅳ/Ⅴ级者11例。实验室检查结果显示,所有患者的C反应蛋白(CRP)、降钙素原(PCT)均升高,其中CRP≥100 mg/L者11例,PCT≥0.5 ng/ml者9例。合并呼吸衰竭者12例,转氨酶升高者12例。患者胸部CT多表现为多发的片状渗出影、局灶实变,可见空气支气管征,8例患者病变发生于下肺。所有患者经宏基因二代测序技术确诊并及时调整以多西环素为基础的药物治疗方案及积极器官支持后病情好转,病灶可完全吸收,预后均良好。结论鹦鹉热衣原体肺炎患者常表现为脓毒症,病情进展迅速,宏基因二代测序技术对于早期诊断鹦鹉热衣原体肺炎具有重要意义,确诊后及时调整治疗预后良好。Objective To analyze the clinical characteristics of pneumonia caused by Chlamydia psittaci(C.psitttaci).Methods A retrospective analysis was performed on the clinical data of 13 consecutive patients with C.psitttaci pneumonia admitted to the First Affiliated Hospital of Xiamen University from November 2018 to February 2021.Results All 13 cases had symptoms of fatigue and 6 cases had headache.At consultation,theΔSequential Organ Failure Assessment(SOFA)scores of all patients were≥2 points.According to the Pneumonia Severity Index(PSI)score,2 patients were gradeⅡand the other 11 patients were gradeⅣorⅤ.Laboratory tests showed that C-reactive protein(CRP)and procalcitonin(PCT)levels were elevated in all patients;CRP≥100 mg/L was found in 11 cases and PCT≥0.5 ng/ml was found in 9 cases.There were 12 cases with respiratory failure and 12 cases with elevated transaminase.Chest CT scans showed multiple patchy exudative shadow,focal consolidation and air bronchial sign;and the lesions were mainly in the lower lungs(8 cases).C.psitttaci infections were confirmed by metagenomics next-generation sequencing(mNGS)and the patients′conditions improved rapidly after timely adjustment of doxycycline based drug treatment and active organ support.The lesions were completely absorbed without residual fibrous cord changes and the prognosis was good.Conclusions Pneumonia caused by C.psitttaci usually presents sepsis,and the disease progresses rapidly.The mNGS is of value for the early diagnosis of C.psitttaci pneumonia.Timely adjustment of antibiotics treatment after etiological diagnosis can lead to a good prognosis.

关 键 词：鹦鹉热 衣原体 肺炎 宏基因组 多西环素 

分 类 号：R563.1[医药卫生—呼吸系统]