咽峡炎链球菌群致类肺炎性胸腔积液39例临床分析  

Clinical analysis of 39 patients with parapneumonic pleural effusion caused by streptococcus anginosus group

作　　者：张友文 钱震雯[2] 付甜[3] 山凤莲[1] 蒋胜华[1] Zhang Youwen;Qian Zhenwen;Fu Tian;Shan Fenglian;Jiang Shenghua(Department of Respiratory and Critical Care Medicine,Affiliated Hospital of Jining Medical University,Jining 272013,China;Department of Inspection,Affiliated Hospital of Jining Medical University,Jining 272013,China;Department of Respiratory and Critical Care Medicine,Jining First People′s Hospital,Jining 272010,China)

机构地区：[1]济宁医学院附属医院呼吸与危重症医学一科,济宁272013 [2]济宁医学院附属医院检验科,济宁272013 [3]济宁市第一人民医院呼吸与危重症医学科,济宁272011

出　　处：《中国医师进修杂志》2022年第3期232-237,共6页Chinese Journal of Postgraduates of Medicine

基　　金：山东省卫生健康委员会中医药项目(2019-0488)。

摘　　要：目的探讨咽峡炎链球菌群致类肺炎性胸腔积液的临床特点、胸部影像学表现、RAPID评分及治疗情况,为临床早期诊断及治疗提供帮助。方法回顾性分析2015年1月至2020年5月济宁医学院附属医院和济宁市第一人民医院39例咽峡炎链球菌群致类肺炎性胸腔积液患者的临床资料。采用RAPID评分将患者进行风险分类。结果39例患者中男31例(79.5%),女8例(20.5%),年龄46~89(65.31±10.53)岁。发热27例(69.2%),胸痛19例(48.7%),呼吸困难18例(46.2%)。胸部CT主要表现为实变影30例(76.9%),包裹性胸腔积液21例(53.8%),磨玻璃影18例(46.2%),小结节12例(30.8%),肺不张8例(20.5%),气胸5例(12.8%)。胸腔积液属于复杂性类肺炎性胸腔积液23例(59.0%),脓胸16例(41.0%)。细菌培养结果为星座链球菌25例(64.1%),咽峡炎链球菌13例(33.3%),中间链球菌1例(2.6%)。患者经过综合治疗,好转36例(92.3%),死亡3例(7.7%)。根据RAPID评分低风险13例(33.3%),中风险16例(41.0%),高风险10例(25.7%)。低、中和高风险患者RAPID评分分别为(1.85±0.38)、(3.43±0.51)和(5.30±0.67)分,三者比较差异有统计学意义(F=124.88,P<0.05)。RAPID评分低、中和高风险患者住院时间分别为(16.84±5.57)、(16.56±7.05)和(28.20±17.97)d,三者比较差异有统计学意义(F=4.41,P<0.05),高风险患者住院时间明显长于低风险患者和中风险患者,差异有统计学意义(P<0.05),中风险患者与低风险患者比较差异无统计学意义(P>0.05)。结论咽峡炎链球菌群作为类肺炎性胸腔积液的重要致病菌,其感染容易形成复杂性类肺炎性胸腔积液,甚至液气胸。临床症状、影像学表现无特异性,临床上应予以重视。RAPID评分高风险患者的病情更为严重。Objective To explore the clinical characteristics,chest imaging manifestations,RAPID score and therapeutic situation in patients with parapneumonic pleural effusion(PPE)caused by streptococcus anginosus group(SAG),in order to provide help for the early diagnosis and treatment in clinical practices.Methods The clinical data of 39 patients with PPE caused by SAG from January 2015 to May 2020 in Affiliated Hospital of Jining Medical University and Jining First People′s Hospital were retrospectively analyzed.The patients were classified by RAPID score.Results Among 39 cases,males was in 31 cases(79.5%),females in 8 cases(20.5%),and aged 46 to 89(65.31±10.53)years old.Fever was in 27 cases(69.2%),chest pain in 19 cases(48.7%),and dyspnea in 18 cases(46.2%).The chest CT findings showed consolidation shadows was in 30 cases(76.9%),encapsulated pleural effusion in 21 cases(53.8%),ground glass shadow in 18 cases(46.2%),nodules in 12 cases(30.8%),atelectasis in 8 cases(20.5%),and pneumothorax in 5 cases(12.8%).The complexity PPE was in 23 cases(59.0%),and empyema in 16 cases(41.0%).The microbiological culture results showed that streptococcus constellatus was detected in 25 cases(64.1%),streptococcus anginosus in 13 cases(33.3%),and streptococcus intermadius in 1 case(2.6%).After comprehensive treatment,36 cases(92.3%)were improved,3 cases(7.7%)died.According to the RAPID score,low-risk was in 13 cases(33.3%),intermediate-risk in 16 cases(41.0%),and high-risk in 10 cases(25.7%).The RAPID score in patients with low-risk,intermediate-risk and high-risk was(1.85±0.38),(3.43±0.51)and(5.30±0.67)scores,and there was statistical difference(F=124.88,P<0.05).the length of stay in patients with low-risk,intermediate-risk and high-risk of RAPID score was(16.84±5.57),(16.56±7.05)and(28.20±17.97)d,and there was statistical difference(F=4.41,P<0.05);the length of stay in patients with high-risk was significantly longer than that in patients with low-risk and intermediate-risk,and there was statistical difference(P<0.05),there w

关 键 词：链球菌 咽峡炎 胸腔积液 RAPID评分 

分 类 号：R561.3[医药卫生—呼吸系统]