10例重症鹦鹉热衣原体肺炎合并急性呼吸窘迫综合征的临床特征及预后分析  

Clinical characteristics and outcomes of acute respiratory distress syndrome caused by severe Chlamydia psittaci pneumonia

作　　者：赵智玲[1] 唐晓[1] 何蔡为 刘雅兰[1] 李绪言[1] 王睿[1] 李影 曹偲妤 孙兵 童朝晖[1] Zhao Zhiling;Tang Xiao;He Caiwei;Liu Yalan;Li Xuyan;Wang Rui;Li Ying;Cao Siyu;Sun Bing;Tong Zhaohui(Department of Respiratory and Critical Care Medicine,Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital,Capital Medical University,Beijing 100020,China;Department of Respiratory and Critical Care Medicine,Beijing Prevention and Treatment Hospital of Occupational Disease for Chemical Industry,Beijing 100093,China)

机构地区：[1]首都医科大学附属北京朝阳医院-北京市呼吸疾病研究所,呼吸与危重症医学科,北京100020 [2]北京市化工职业病防治院呼吸与危重症医学科,北京100093

出　　处：《中华结核和呼吸杂志》2022年第10期1015-1021,共7页Chinese Journal of Tuberculosis and Respiratory Diseases

基　　金：国家自然科学基金面上项目(82070005);首都临床特色应用研究与成果推广(Z151100004015049)。

摘　　要：目的探讨重症鹦鹉热衣原体肺炎合并急性呼吸窘迫综合征(ARDS)的临床特点及预后。方法收集2016年6月至2021年1月入住首都医科大学附属北京朝阳医院呼吸与危重症医学科重症监护室的10例重症鹦鹉热衣原体肺炎合并ARDS病例, 根据临床信息、实验室检查、影像学等资料, 分析总结患者的临床特征及预后。结果 10例患者均由宏基因组二代测序技术(mNGS)确诊。中位年龄为59(46, 67)岁, 临床主要表现为高热、咳嗽、咳痰、呼吸困难等, 可伴有多器官受累。6例外周血白细胞计数升高, 10例B型利钠肽升高, 7例天冬氨酸氨基转移酶/丙氨酸氨基转移酶升高, 9例低钠血症, 3例肌酐升高, 影像学表现为双肺多叶段实变伴支气管充气征、渗出影, 5例伴胸腔积液。所有病例均合并呼吸衰竭, 6例使用有创机械通气。9例使用莫西沙星, 1例使用阿奇霉素, 中位住ICU时间为13.5(11, 16.7)d, 所有患者均好转出院。9例患者完成1个月后随访, 复查影像学均明显吸收。结论重症鹦鹉热衣原体肺炎可合并呼吸衰竭和(或)多器官受累, 对于有病禽接触史的重症肺炎, 应考虑鹦鹉热衣原体感染可能, 可采用mNGS技术协助病原学诊断;本研究病例经合理治疗后均预后良好。Objective To investigate the clinical characteristics and outcomes of acute respiratory distress syndrome(ARDS)caused by Chlamydia psittaci pneumonia.Methods From June 2016 to January 2021,10 cases were diagnosed as severe Chlamydia psittaci pneumonia induced ARDS in Intensive Care Unit of Respiratory and Critical Care Medicine Department(RICU)of Beijing Chao-Yang Hospital Affiliated to Capital Medical University.We collected the clinical data including clinical features,laboratory tests,imaging and outcomes of the patients.Results The pathogenic diagnosis was confirmed by metagenomic Next-generation Sequencing(mNGS)in these 10 patients,with a median age of 59(46,67)years.In addition to high fever,cough and dyspnea,the patients also had multiple organ involvement.Six patients had elevated peripheral leukocyte count,10 cases had increased type B natriuretic peptide,7 cases had increased aspartate aminotransferase/alanine aminotransferase,9 cases had hyponatremia and 3 cases had elevated creatinine.The imaging findings were bilateral consolidation with air bronchogram and infiltrates,and pleural effusion were found in 5 cases.All cases were combined with respiratory failure.Six patients received invasive mechanical ventilation.Nine patients received moxifloxacin and one patient was administrated with Azithromycin.All the patients were improved and discharged after the treatment,and the mean duration of RICU stay was 13.5(11,16.7)days.One month follow-up of nine patients showed significant improvement in lung lesions.Conclusions Severe Chlamydia psittiaci pneumonia may be complicated with respiratory failure and/or multiple organ involvement.For severe pneumonia with an exposure history of sick birds,the possibility of Chlamydia psittaci infection should be considered.mNGS may help etiological diagnosis.All patients in this study had a good prognosis after targeted treatment.

关 键 词：鹦鹉热 衣原体 鹦鹉 衣原体 肺炎 呼吸窘迫综合征 成人 宏基因组二代测序 

分 类 号：R563.8[医药卫生—呼吸系统] R518.1[医药卫生—内科学]