宏基因组学二代测序诊断鹦鹉热衣原体肺炎26例的临床分析  

Clinical analysis of 26 cases of Chlamydia psittaci pneumonia confirmed using metagenomic next-generation sequencing

作　　者：徐丽敏 方昌全 麦辉[1] 谭小颖[1] 杜玉斌[1] Xu Limin;Fang Changquan;Mai Hui;Tan Xiaoying;Du Yubin(Department of Geriatrics,Huizhou First People′s Hospital,Huizhou 516003,Guangdong Province,China;Department of Pulmonary and Critical Care Medicine,Huizhou Municipal Central People′s Hospital,Huizhou 516008,Guangdong Province,China)

机构地区：[1]惠州市第一人民医院老年医学科,惠州516003 [2]惠州市中心人民医院呼吸与危重症医学科,惠州516008

出　　处：《中华传染病杂志》2022年第11期663-667,共5页Chinese Journal of Infectious Diseases

基　　金：惠州市科技专项(2020Y105)。

摘　　要：目的探讨通过宏基因组学二代测序诊断的鹦鹉热衣原体肺炎患者的临床特征及治疗策略。方法选择2020年1月至2021年12月由惠州市中心人民医院和惠州市第一人民医院收治的26例鹦鹉热衣原体肺炎患者, 收集其临床资料, 包括一般情况、临床表现、实验室检查、胸部计算机断层成像、宏基因组学二代测序结果、治疗用药及预后等。结果 26例患者中, 20例(76.9%)有鸟或家禽接触史, 发病季节以冬季[57.7%(15/26)]最多见。26例患者均出现高热、畏寒、纳差、乏力和咳嗽, 21例(80.8%)出现呼吸困难, 19例(73.1%)有相对缓脉, 12例(46.2%)出现头痛、肌肉酸痛, 7例(26.9%)有意识障碍。26例患者中, 白细胞计数正常17例(65.4%), 淋巴细胞计数减少21例(80.8%)。26例患者超敏C反应蛋白、降钙素原均有升高, D-二聚体升高24例(92.3%), 天冬氨酸转氨酶升高18例(69.2%), 丙氨酸转氨酶升高15例(57.7%)。胸部计算机断层成像检查以肺实变为主要表现, 20例(76.9%)为多肺叶病变, 18例(69.2%)病灶主要位于肺下叶。26例患者的宏基因组学二代测序检测结果中, 9例(34.6%)只检出鹦鹉热衣原体, 余17例(65.4%)除检出鹦鹉热衣原体外, 还检出了其他病原微生物。经过针对性抗感染治疗后, 除2例因多脏器功能衰竭死亡外, 其余24例均好转。结论鹦鹉热衣原体肺炎常见表现为高热、呼吸困难、相对缓脉, 白细胞计数多正常, 肺部影像学表现为肺实变, 宏基因组学二代测序有助于疾病早期诊断, 经过及时、有效的治疗后患者预后良好。Objective To explore the clinical characteristics and treatment strategies for Chlamydia psittaci pneumonia confirmed using metagenomic next-generation sequencing(mNGS).Methods A total of 26 patients with Chlamydia psittaci pneumonia admitted to the Huizhou Municipal Central People′s Hospital and Huizhou First People′s Hospital from January 2020 to December 2021 were enrolled.The clinical data were collected,including basic information,clinical manifestations,laboratory examinations,chest computed tomography(CT)findings,mNGS results,treatment outcomes and prognosis.Results Twenty(76.9%)of the 26 cases with Chlamydia psittaci pneumonia had a definite bird or poultry contact history.The onset season was mostly in winter(57.7%,15/26).All 26 cases had symptoms of high fever,chill,fatigue,anorexia and cough,21 cases(80.8%)had dyspnea,19 cases(73.1%)had relative infrequent pulse,12 cases(46.2%)had headache,myalgia,and seven cases(26.9%)had disturbance of consciousness.Among the 26 cases,the white blood cell count was normal in 17 cases(65.4%),and the lymphocyte count was decreased in 21 cases(80.8%).All 26 cases had increased hypersensitive C-reactive protein and procalcitonin.D-dimer was elevated in 24 cases(92.3%),aspartate aminotransferase was elevated in 18 cases(69.2%),and alanine aminotransferase was elevated in 15 cases(57.7%).Chest CT mainly showed lung consolidation,and 20 cases(76.9%)had multiple lobes of the lungs involved,18 cases(69.2%)had the lower lobe of the lung as the main lesion.Among the results of mNGS of 26 cases,nine cases(34.6%)had only Chlamydia psittaci detected,and 17 cases(65.4%)had other pathogenic microorganisms detected.After targeted anti-infection treatment,two cases died of multiple organ failure and the remaining 24 patients recovered.Conclusions The common manifestations of Chlamydia psittaci pneumonia are high fever,dyspnea,relative bradycardia,normal white blood cell count,and lung consolidation.mNGS is helpful for early diagnosis of disease,and appropriate treatment can improv

关 键 词：鹦鹉衣原体 鹦鹉热 肺炎 二代测序 影像学表现 

分 类 号：R518.1[医药卫生—内科学]