鹦鹉热衣原体重症肺炎的胸部HRCT特征  

Chest HRCT manifestations of severe chlamydia psittaci pneumonia

作　　者：刘靖[1] 刘海峰[2] 张东友[2] 范学鹏 胡述立[3] 吴艳霞[1] 阳义[2] 龙斌[2] 柏玉涵[2] 姜琼[2] 尹龙[2] 赵明[2] LIU Jing;LIU Hai-feng;ZHANG Dong-you(Department of General Medical,Wuhan NO.1 Hospital(Wuhan Hospital of Traditional Chinese and Western Medicine),Wuhan 430022,China)

机构地区：[1]武汉市第一医院(武汉市中西医结合医院)综合医疗科,武汉430022 [2]武汉市第一医院(武汉市中西医结合医院)放射影像科,武汉430022 [3]武汉市第一医院(武汉市中西医结合医院)重症医学科,武汉430022

出　　处：《放射学实践》2023年第5期571-575,共5页Radiologic Practice

摘　　要：目的:总结分析鹦鹉热衣原体重症肺炎的临床及胸部HRCT影像特征。方法:回顾性分析2021年5月-2022年2月基于病原宏基因组学检测诊断的5例鹦鹉热衣原体重症肺炎患者的临床及影像资料,并复习相关文献。结果:5例患者临床均以高热为初期表现,早期白细胞(WBC)正常或升高[(4.53~16.3)×109/L],中性粒细胞(NEUT)百分比升高(69.4%~87.6%),淋巴细胞(LYM)百分比降低(7.0%~35.6%),C反应蛋白(CRP)与DD二聚体进行性升高(CPR 78~207 mg/L,DD 1.13~8.69 mg/L),部分心肌酶谱升高(100~268 IU/L),肝功能减低(ALT 33~122 IU/L,AST 48~376 IU/L)。胸部HRCT主要表现为早期单侧肺叶实变伴磨玻璃样改变,均可见含气支气管征;进展期病灶发展快速,很快累及整个或双侧多个肺叶,可出现散在磨玻璃斑片影,可伴有纵隔淋巴结增大,双侧胸腔积液伴随病程发展出现,针对性抗生素治疗后病灶吸收明显。结论:鹦鹉热衣原体重症肺炎的胸部HRCT主要表现为实变及磨玻璃影,影像特异性差,病原学诊疗不明时病灶进展迅速,容易发展为重症,针对性抗生素治疗效果明显,需结合临床接触史及基因组学检测尽快发现病原体。Objective:To analyze and summarize chest HRCT manifestations and clinical features of severe Chlamydia psittaci pneumonia.Methods:A retrospective analysis was conducted on the clinical features and chest HRCT manifestations of 5 cases with severe Chlamydia psittaci pneumonia diagnosed based on pathogen metagenomic sequencing from May 2021 to February 2022,and relevant literature was also reviewed.Results:All the 5 patients initially presented with high fever,with normal or increased white blood cell(WBC)levels(4.53~16.3×109/L)and increased percentage of neutrophils(69.4%~87.6%).The percentage of lymphocytes(LYM)decreased(7.0%~35.6%),and C-reactive protein(CRP)and D dimer progressively increased(CPR 78~207mg/L,DD 1.13~8.69mg/L).Some myocardial enzymes increased(100~268IU/L),and liver function decreased(ALT 33~122IU/L,AST 48~376IU/L).Chest HRCT showed unilateral lobe consolidation with ground-glass-like changes in the early stage,with air bronchogram signs.The lesions then rapidly progressed to affect multiple lung lobes of both sides,with scattered patchy ground-glass opacities observed with or without enlarged mediastinal lymph nodes.Bilateral pleural effusion appeared as the disease progressed,but the lesions were absorbed significantly after targeted antibiotic treatment.Conclusion:The chest HRCT of severe Chlamydia psittaci pneumonia is mainly manifested as consolidation and ground-glass opacity,with poor imaging specificity.Without clear etiological diagnosis and targeted treatment,the lesions may progress rapidly,and the disease can easily become severe.Therefore,early identification of the pathogens through contact history analysis and genomics testing is crucial as targeted antibiotic treatment is effective.

关 键 词：鹦鹉热衣原体 重症肺炎 病原宏基因组学 体层摄影术 X线计算机 胸部 

分 类 号：R518.1[医药卫生—内科学] R563.1[医药卫生—临床医学] R814.42