基于宏基因组二代测序诊断15例鹦鹉热衣原体肺炎临床特征与诊治分析  

Clinical features,diagnosis,and treatment of chlamydia psittaci pneumonia based on metagenomic next-generation sequencing:an analysis of 15 cases

作　　者：刘彦权 林洁[1] 朱宏泉[1] 许庆林[1] Liu Yanquan;Lin Jie;Zhu Hongquan;Xu Qinglin(Department of Intensive Medicine(Comprehensive ICU),The First Affiliated Hospital of Gannan Medical University,Jiangxi Provincial Key Clinical Specialized Department of Intensive Medicine)

机构地区：[1]赣南医学院第一附属医院重症医学科(综合ICU)/江西省临床重点专科重症医学科,赣州341000

出　　处：《重庆医科大学学报》2023年第6期715-720,共6页Journal of Chongqing Medical University

基　　金：江西省科技厅科技计划资助项目(编号:20133BBG70093);江西省赣州市科技计划重点研发计划资助项目(编号:2022XM038904);江西省卫健委科技计划资助项目(编号:20155442);江西省高校科技落地资助项目(编号:KJD14083)。

摘　　要：目的:探讨和分析少见鹦鹉热衣原体肺炎的临床特征、诊治及预后,以期提升临床相关学科领域对该病的认识。方法:回顾性研究赣南医学院第一附属医院2017年1月至2022年12月确诊的15例鹦鹉热衣原体肺炎患者的临床资料,总结并分析该病的临床特征、诊断与鉴别要点,同时检索国内外文献资料对鹦鹉热衣原体肺炎的最新诊疗进展予以系统性讨论。结果:纳入本研究的15例鹦鹉热衣原体肺炎患者中,男性10例(66.67%),女性5例(33.33%),年龄62(32~79)岁,禽类接触史14例(93.33%),基础疾病史8例(53.3%),转化为重症肺炎5例(33.33%)。15例患者中,白细胞计数(white blood cell count,WBC)正常8例(53.3%),WBC升高5例(33.3%),WBC减低2例(13.3%);血红蛋白(hemoglobin,HGB)正常9例(60.0%),减低6例(40.0%);中性粒细胞百分比(neutrophils,NE)升高13例(86.7%);所有患者(100.0%)C反应蛋白(C-reactive protein,CRP)均显著升高;13例(86.67%)患者降钙素原(procalcitonin,PCT)升高;12例(80.0%)患者乳酸脱氢酶(lactate dehydrogenase,LDH)升高;11例(73.33%)肝功能异常;8例(53.33%)肾功能异常;6例(40.0%)凝血功能异常;13例(86.7%)电解质紊乱。此外,11例(73.33%)患者动脉血气分析显示不同程度血氧分压降低,8例(53.33%)氧合指数(oxygenation index,OI)低于300 mmHg,4例(26.67%)患者无明显呼吸困难,未进行动脉血气分析检查。本研究所有患者均已完善经支气管镜检查,并获取支气管肺泡灌洗液(bronchoalverolar lavage fluid,BALF)行宏基因组二代测序(metagenomic next-generation sequencing,mNGS)检测,检出的病原体除鹦鹉热衣原体外,所有患者均合并多种病原体感染。15例患者均已完善肺部电子计算机断层扫描(computed tomography,CT)等影像学检查,单侧肺部实变7例(46.67%),双侧实变8例(53.33%);9例(60.0%)患者伴有胸腔积液,部分患者可以表现出多种影像学表现,包括实变影、磨玻璃影、团块样实变影、反晕征、纵隔和肺�Objective:To investigate the clinical features,diagnosis and treatment,and prognosis of rare chlamydia psittaci pneumonia,and to improve the understanding of this disease in related clinical fields.Methods:A retrospective analysis was performed for the clinical data of 15 patients who were diagnosed with chlamydia psittaci pneumonia in The First Affiliated Hospital of Gannan Medical University from January 2017 to December 2022,and the clinical features,diagnosis,and key points for differential diagnosis were summarized and analyzed.Meanwhile,related articles in China and globally were searched to systematically discuss the latest advances in the diagnosis and treatment of chlamydia psittaci pneumonia.Results:Among the 15 patients with chlamydia psittaci pneumonia included in this study,there were 10 male patients(66.67%)and 5 female patients(33.33%),with an aged of 62(32-79)years.Among these patients,14(93.33%)had poultry contact history,8(53.3%)had the history of underlying diseases,and 5(33.33%)developed severe pneumonia.Among the 15 patients,8 had normal white blood cell count(WBC)(53.3%),5 had elevated WBC(33.3%),and 2(13.3%)had a reduction in WBC;9(60.0%)had normal hemoglobin,and 6(40.0%)had a reduction in hemoglobin;13(86.7%)had an increase in the percentage of neutrophils;all patients(100.0%)had a significant increase in C-reactive protein;13(86.67%)had an increase in procalcitonin,and 12(80.0%)had an increase in lactate dehydrogenase;11(73.33%)had abnormal liver function,8(53.33%)had abnormal renal function,and 6(40.0%)had abnormal coagulation function;13(86.7%)had electrolyte disturbance.In addition,arterial blood gas analysis showed varying degrees of reduction in the partial pressure of blood oxygen in 11 patients(73.33%),and 8 patients(53.33%)had an oxygenation index lower than 300 mmHg;4 patients(26.67%)had no obvious dyspnea and thus did not undergo arterial blood gas analysis.All patients in this study underwent bronchoscopy,with bronchoalveolar lavage fluid obtained for metagenomic next-generatio

关 键 词：鹦鹉热衣原体肺炎 临床特征 诊断 鉴别诊断 预后 

分 类 号：R518.1[医药卫生—内科学]