老年鹦鹉热衣原体肺炎患者临床分析  

Clinical analysis of Chlamydia psittaci pneumonia in the elderly

作　　者：胡立红[1] 郑艳文[1] 曹建华[1] 林丽[1] 李勇诚[1] 邬海燕[1] Hu Lihong;Zheng Yanwen;Cao Jianhua;Lin Li;Li Yongcheng;Wu Haiyan(Department of Respiratory and Critical Care Medicine,the First People′s Hospital of Xiaoshan District,Hangzhou 311200,China)

机构地区：[1]杭州市萧山区第一人民医院呼吸与危重症医学科,杭州311200

出　　处：《中华全科医师杂志》2022年第8期737-742,共6页Chinese Journal of General Practitioners

摘　　要：目的探讨通过肺泡灌洗液二代测序技术明确诊断的老年鹦鹉热衣原体肺炎的临床特点,并分析其严重程度相关指标。方法回顾性分析2019年1月至2021年1月杭州师市萧山区第一人民医院呼吸与危重症医学科收治的32例年龄≥60岁的鹦鹉热衣原体肺炎患者,依据社区获得性肺炎及重症肺炎的诊断标准,分为普通组(17例)和重症组(15例)。比较分析两组患者的肝功能、肌酶、影像及淋巴细胞亚群水平。结果两组患者年龄、性别及基础疾病比较差异均无统计学意义(均P>0.05)。两组患者禽类接触史、弛张热和干咳症状发生率差异无统计学意义(均P>0.05),但精神症状和消化道症状的发生率差异有统计学意义(P=0.032、0.018)。普通组鹦鹉热衣原体肺炎患者以下指标水平均低于重症组:丙氨酸转氨酶、天冬氨酸转氨酶、乳酸脱氢酶、肌酸激酶、肌酸激酶同工酶MB、C反应蛋白、B型利钠肽前体、肌钙蛋白-T、降钙素原(Z值分别为17.02、21.14、20.13、24.95、7.35、11.51、38.91、15.64、9.84,均P<0.001);两组白细胞升高均不明显。普通组患者影像表现以单叶受累多见,而重症肺炎组以多叶受累及胸水多见,差异有统计学意义(P=0.043、0.015、0.023)。两组患者淋巴细胞绝对值、T淋巴细胞值、CD4^(+)T、CD8^(+)T、CD4^(+)/CD8^(+)比值、NK细胞、B细胞,CD4^(+)CD8^(+)双阳性T细胞均有下降,且重症组下降明显,差异有统计学意义(均P<0.05);普通组CD4^(-)CD8^(-)双阴性T细胞较重症组低(P<0.001)。其中CD4^(+)/CD8^(+)T细胞比值、CD4^(-)CD8^(-)双阴性T细胞与肺炎严重度指数PSI和CURB-65有相关性(P<0.05)。结论鹦鹉热衣原体肺炎患者肝功能、肌酶及淋巴细胞免疫功能均受到损害,重症患者损害明显;影像以多叶浸润及降钙素原明显升高提示重症可能;CD4^(+)/CD8^(+)T细胞比值、CD4^(-)CD8^(-)双阴性T细胞与肺炎严重性相关,提示上述这些指标对诊断�Objective To analyze the clinical characteristics of Chlamydia psittaci pneumonia in the elderly,and factor related to the disease severity.Methods Clinical data of 32 elderly patients with Chlamydia pneumoniae pneumonia admitted in the First People′s Hospital of Xiaoshan District from January 2019 to January 2021 were retrospectively analyzed.The patients were diagnosed by the second generation sequencing using bronchoalveolar lavage fluid(BALF)samples.There were 17 patients in moderate group and 15 patients in severe group;the liver function,muscle enzymes,imaging and lymphocyte subsets of the two groups were compared.Results There were no significant differences in the age,gender and basic diseases,bird contact history,flaccid fever and dry cough symptoms between two groups,while there were significant differences in mental symptoms and gastrointestinal symptoms between the two groups(P=0.032,0.018).There were significant differences in ALT,AST,LDH,CK,CK-MB,CRP,BNP,troponin-T and PCT between the two groups(all P<0.001).The increase of leukocytes was not significant in both groups.The moderate group was dominated by single lobe involvement,while the severe group was dominated by multi lobe involvement and pleural effusion(P=0.043,0.015,0.023).The total lymphocytes,T lymphocytes,CD4^(+)T cells,CD8^(+)T cells,CD4^(+)/CD8^(+)ratio,NK cells,B cells,CD4^(+)CD8^(+)double positive T cells decreased in both groups,while those in the severe group decrease more markedly(P<0.05).CD4^(-)CD8^(-)double negative T cells were higher in the severe group than those in the moderate group(P<0.001).CD4^(+)/CD8^(+)ratio and CD4^(-)CD8^(-)double negative T cells were correlated with severity index PSI and CURB-65(P<0.05).Conclusions The liver function,muscle enzyme,lymphocyte immune function in patients with Chlamydia psittaci pneumonia are impaired,which were more markedly in severe patients.The multileaf infiltration and increased procalcitonin may indicate the severe pneumonia.CD4^(+)/CD8^(+)ratio and CD4^(-)CD8^(-)double negati

关 键 词：老年人 鹦鹉热衣原体肺炎 淋巴细胞亚群 

分 类 号：R563.1[医药卫生—呼吸系统]