诊断性支气管镜检查对重症鹦鹉热衣原体肺炎早期病原体的快速评估  

Rapid evaluation of the early pathogen of severe Chlamydophila psittaci pneumonia by diagnostic bronchoscopy

作　　者：李婧文 李生全 刘娜[3] 宋甜甜 赵立孝 王雪莉[2] 郭孟亚 高亚梅 万秋风 徐思成[1] Li Jingwen;Li Shengquan;Liu Na;Song Tiantian;Zhao Lixiao;Wang Xueli;Guo Mengya;Gao Yamei;Wan Qiufeng;Xu Sicheng(Department of RICU,Center of Pulmonary and Critical Care Medicine,the First Affiliated Hospital of Xinjiang Medical University,Urmqi 830054,Xinjiang Uygur Autonomous Region,China;Department of MICU,the First People's Hospital of Aksu District,Aksu 843000,Xinjiang Uygur Autonomous Region,China;Department of EICU,the First Division Hospital of Xinjiang Production and Construction Corps,Aksu 843000,Xinjiang Uygur Autonomous Region,China)

机构地区：[1]新疆医科大学第一附属医院呼吸与危重症医学中心RICU,乌鲁木齐830054 [2]新疆阿克苏地区第一人民医院MICU,新疆阿克苏843000 [3]新疆生产建设兵团第一师医院EICU,新疆阿克苏843000

出　　处：《中华危重病急救医学》2023年第1期37-42,共6页Chinese Critical Care Medicine

基　　金：新疆维吾尔自治区临床重点专科建设项目(2016-56)。

摘　　要：目的:探讨床边诊断性支气管镜检查对重症鹦鹉热衣原体肺炎早期病原体的快速评估,旨在宏基因组二代测序(mNGS)检测结果出来前开始有效的抗感染治疗。方法:回顾性分析2020年10月至2021年6月新疆医科大学第一附属医院、新疆阿克苏地区第一人民医院以及新疆生产建设兵团第一师医院成功救治的3例重症鹦鹉热衣原体肺炎患者的临床资料,包括床边诊断性支气管镜检查对病原体的快速评估结果以及开始抗感染的抗菌药物使用情况。结果:3例患者均为男性,年龄分别为63、45和58岁;发病前均有明确的鸟类接触史;临床表现主要为发热、干咳、气短及呼吸困难,其中1例伴嗜睡、腹痛。实验室检查结果显示,入院后及入重症监护病房(ICU)时,2例患者外周血白细胞计数(WBC)偏高〔(10.2~11.9)×10^(9)/L〕,3例患者中性粒细胞百分比均升高(85.2%~94.6%),淋巴细胞百分比均降低(3.2%~7.7%)。3例患者入院后降钙素原(PCT)升高,至入ICU时仍升高(0.3~4.8 ng/L);C-反应蛋白(CRP)均升高(58.0~162.0 mg/L),红细胞沉降率(ESR)均升高(36.0~90.0 mm/1 h)。入院后血清丙氨酸转氨酶(ALT)升高2例(136.7 U/L、220.5 U/L),天冬氨酸转氨酶(AST)升高2例(249.6 U/L、164.2 U/L);入ICU时3例患者ALT(162.2~267.9 U/L)、AST(189.8~223.2 U/L)均升高。3例患者入院后、入ICU时血肌酐(SCr)均正常。3例患者胸部CT表现为急性间质性肺炎、支气管肺炎以及肺实变,以1个肺叶为主的多肺叶受累,其中2例伴少量胸腔积液,1例伴较多规则的小气囊。3例患者入ICU时氧合指数(PaO_(2)/FiO_(2))分别为100.0、57.5和105.4 mmHg(1 mmHg≈0.133 kPa),符合中重度急性呼吸窘迫综合征(ARDS),均接受气管插管机械通气。3例患者床边支气管镜下均可见黏膜明显充血、水肿,无脓性分泌物,有1例黏膜出血。3例患者床边诊断性支气管镜检查病原体评估结果可能为非典型病原体感染,分别快速给予莫西Objective To explore the rapid evaluation of the early pathogen of severe Chlamydophila psittaci pneumonia by bedside diagnostic bronchoscopy,so as to start effective anti-infection treatment before the results of macrogenome next generation sequencing(mNGS)test.Methods The clinical data of three patients with severe Chlamydophila psittaci pneumonia who were successfully treated in the First Affiliated Hospital of Xinjiang Medical University,the First People's Hospital of Aksu District,and the First Division Hospital of Xinjiang Production and Construction Corps from October 2020 to June 2021 were retrospectively analyzed,including the rapid assessment of early pathogens by bedside diagnostic bronchoscopy and the use of antibiotics to start anti-infection treatment.These patients were successfully treated.Results The three patients were male,aged 63,45 and 58 years old,respectively.Before the onset of the penumonia,they had a clear medical history of bird exposure.The clinical manifestations mainly included fever,dry cough,shortness of breath and dyspnea.One case had abdominal pain and lethargy.The results of laboratory examination indicated that the peripheral blood white blood cell count(WBC)of two patients were high[(10.2-11.9)×10^(9)/L],the percentage of neutrophils increased(85.2%-94.6%)and the percentage of lymphocytes decreased(3.2%-7.7%)in all 3 patients after admission to hospital and entering into intensive care unit(ICU).The procalcitonin(PCT)of 3 patients increased after admission,and still increased when entering ICU(0.3-4.8 ng/L),so did C-reactive protein(CRP,58.0-162.0 mg/L)and erythrocyte sedimentation rate(ESR,36.0-90.0 mm/1 h).After admission,serum alanine transaminase(ALT)increased in 2 cases(136.7 U/L,220.5 U/L),so did aspartate transaminase(AST)in 2 cases(249.6 U/L,164.2 U/L).ALT(162.2-267.9 U/L)and AST(189.8-223.2 U/L)increased in 3 patients when they entered ICU.The level of serum creatinine(SCr)of 3 patients were normal after admission and entering ICU.The chest computed tomography(CT)fin

关 键 词：肺炎 鹦鹉热衣原体 支气管镜检查 宏基因组二代测序 

分 类 号：R563.1[医药卫生—呼吸系统]