重症鹦鹉热衣原体肺炎诊治分析  

Diagnosis and Treatment of Severe Chlamydia Psittaci Pneumonia

作　　者：高流芳[1] 张民伟[1] 宁耀贵[1] GAO Liufang;ZHANG Minwei;NING Yaogui(Department of Critical Care Medicine,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重症医学科,福建厦门361003

出　　处：《中国医药指南》2022年第36期1-4,共4页Guide of China Medicine

基　　金：福建省自然科学基金面上项目(编号:2020J011237)。

摘　　要：目的分析重症鹦鹉热衣原体肺炎患者的临床表现和诊治经过,提高对该病认识。方法收集15例重症鹦鹉热衣原体肺炎患者,对其临床特点及诊治经过进行回顾分析。结果15例患者均经宏基因测序(metagenomic next-generation sequencing,mNGS)确诊,表现为高热、白细胞正常或轻度升高(中位数9.06×10^(9)/L),中性粒细胞比例、CRP明显升高,淋巴细胞计数降低,PCT升高(5.19±4.14)ng/L,AST、LDH升高,白蛋白水平降低。胸部CT均表现为大片斑片实变影,常见多肺叶受累和胸腔积液。合并休克患者mNGS送检距发热时间更短[(6.33±0.82)d vs.(8.56±2.51)d,P=0.06],白蛋白水平显著较低[23.8(21,25)vs.26.9(26.3,29.8),P=0.03],喹诺酮类药物的疗程更长[(20.00±9.21)vs.(7.67±9.47),P=0.03)]。结论鹦鹉热衣原体肺炎的临床表现缺乏特异性,易被延误诊治,多数患者病情进展至重症才借助mNGS检测得以明确诊断。一旦给予正确药物治疗,大多数患者反应良好,重点在于提高对该病的认识。Objective To describe the clinical characteristics of severe chlamydia psittaci pneumonia to enhance physicians’ understanding of the disease.Methods Fifteen patients with severe chlamydia psittaci pneumonia were collected and their clinical characteristics,diagnosis and treatment were retrospectively analyzed.Results All 15 patients were diagnosed by metagenomic next-generation sequencing(mNGS) and presented with high fever,normal or mildly elevated leukocytes(median 9.06×10^(9)/L),significantly elevated neutrophil ratio,CRP,decreased lymphocyte count,elevated PCT(5.19±4.14) ng/L,elevated AST,LDH,and decreased albumin level.All chest CTs show large patchy solid shadows,commonly with multi-lobe lung involvement and pleural effusion.Patients with combined shock had shorter time to fever for mNGS delivery [(6.33±0.82) d vs.(8.56±2.51) d,P=0.06],significantly lower albumin levels [23.8(21,25) vs.26.9(26.3,29.8),P=0.03],and longer course of quinolones [(20.00±9.21) vs.(7.67±9.47),P=0.03)].Conclusions Diagnosis and treatment of psittaci pneumonia is delayed due to its atypical manifestation.Most patients are diagnosed using mNGS after the disease has severely progressed.However,the patients respond well after being given the right medication.

关 键 词：鹦鹉热 重症肺炎 

分 类 号：R563.1[医药卫生—呼吸系统]