惠普尔养障体肺炎的临床特点及诊治分析  

Analysis of clinical features,diagnosis and treatments of Tropheryma Whipplei's Pneumonia

作　　者：马大文 王宏俊 Ma Dawen;Wang Hongjun(Department of respiratory and critical care medicine,Pukou branch of Jiangsu Province Hospital,Nanjing,Jiangsu 211800,China)

机构地区：[1]江苏省人民医院浦口分院,江苏南京211800

出　　处：《首都食品与医药》2022年第18期41-44,共4页Capital Food Medicine

摘　　要：目的分析总结惠普尔养障体肺炎临床资料、诊断及有效治疗方法.方法对5例确诊惠普尔养障体肺炎患者的临床症状、影像学特点、诊断及治疗方法作回顾性分析.结果5例中4例起病隐匿,1例急性起病,3例有轻微咳嗽咳少量白黏痰,2例无咳嗽咳痰,5例均有胸闷气喘症状,3例有发热,2例有胸膜炎性胸痛,1例痰中带血丝,1例有肌肉酸痛,4例纳差,3例有饮酒史.实验室检查4例低氧血症,1例I型呼吸衰竭,胸部CT薄层扫描显示5例均有斑片状或团状密度增高影,3例有支气管扩张,3例有网格样改变,1例合并胸腔积液.5例均行支气管镜检查BALF-mNGS(肺泡灌洗液-宏基因组测序),发现是惠普尔养障体(序列数30-76063),诊断为惠普尔养障体肺炎.治疗1例调整为亚胺培南西司他定,1例调整为头孢曲松,均联合多西环素(3例),或复方磺胺甲噁唑片(2例),治疗后无发热、胸闷气喘症状缓解后出院.结论惠普尔养障体肺炎起病隐匿,主要临床症状不典型,大多有胸闷气喘及不同程度的低氧血症或Ⅰ型呼吸衰竭,常规检查难以确诊,胸部CT大多合并支气管扩张或网格样改变,但缺乏特异性.对患者的BALF-mNGS检测大大提高了惠普尔养障体肺炎的早期诊断,对该病预后有着重要的作用,亚胺培南西司他定、头孢曲松、多西环素、复方磺胺甲噁唑片治疗有效常需初期联合用药.Object ive To analyze and summarize the clinical data,diagnosis and effective treatment of Tropheryma Whipplei's Pneumonia.Methods A retrospective analysis of the clinical symptoms,imaging features,diagnosis and treatments of 5 patients diagnosed with Tropheryma Whipplei's Pneumonia was made.Results Of the 5 cases,4 had insidious onset,1 had acute onset,3 had mild cough and a small amount of white sticky sputum,2 had no cough and sputum,5 had symptoms of chest tightness and asthma,3 had fever,and 2 had pleurisy.Chest pain,bloodshot in sputum in 1 case,muscle soreness in 1 case,anorexia in 4 cases,and history of drinking in 3 cases.Laboratory examination showed 4 cases of hypoxemia,1 case of type 1 respiratory failure,chest CT thin-section scan showed that all 5 cases had patchy or globular increased density,3 cases had bronchiectasis,and 3 cases had grid-like changes,1 case with pleural effusion.All 5 cases underwent bronchoscopy with BALF-mNGS(alveolar lavage fluid-metagenome sequencing),all of which were found to be Tropheryma Whipplei(serial number 30-76063),and were diagnosed as Tropheryma Whipplei's Pneumonia.One case was adjusted to imipenem and cilastatin,and one case was adjusted to ceftriaxone,both of which were combined with doxycycline(3 cases)or compound sulfamethoxazole tablets(2 cases),without fever and chest tightness after treatment asthma symptoms relieved and discharged.Conc lus ion The onset of Tropheryma Whipplei's Pneumonia is insidious,and the main clinical symptoms are atypical.Most of them have chest tightness,asthma,hypoxemia or type I respiratory failure.Routine examination is difficult to diagnose.Most of the chest CT is combined with bronchiectasis or grid-like changes,but lacks specificity.The BALF-mNGS detection of patients has greatly improved the early diagnosis of Tropheryma Whipplei's Pneumonia and has an important role in the prognosis of the disease.Imipenem cilastatine,ceftriaxone,doxycycline,and compound sulfamethoxazole often require initial combination therapy to be effecti

关 键 词：惠普尔养障体 肺炎 宏基因组测序 多西环素 复方磺胺甲噁唑片(SMZ-TMP) 

分 类 号：R563.1[医药卫生—呼吸系统]