二代测序技术诊断鹦鹉热衣原体肺炎8例  

Next-Generation Sequencing Technology for Diagnosis of Chlamydia Psittaci Pneumonia:A Report of eight Cases

作　　者：郑文川 吴敏丹 庄嘉[2] 吴树瀚 周琪鹏 蔡俊福 郑泓斌 张淇钏 ZHENG Wen-chuan;WU Min-dan;ZHUANG Jia;WU Shu-han;ZHOU Qi-peng;CAI Jun-fu;ZHENG Hong-bin;ZHANG Qi-chuan(Shantou University Medical College,Shantou 515000,Guangdong Province,China;Department of Respiratory and Critical Care Medicine,Shantou Central Hospital,Shantou 515000,Guangdong Province,China)

机构地区：[1]广东省汕头大学医学院,广东汕头515000 [2]广东省汕头市中心医院呼吸与危重症医学科,广东汕头515000

出　　处：《罕少疾病杂志》2024年第2期9-12,共4页Journal of Rare and Uncommon Diseases

基　　金：汕头市医疗卫生科技计划项目(汕府科[2019]106号-32,190917085269841)。

摘　　要：目的探索鹦鹉热衣原体肺炎的临床表现、实验室检查、影像学表现、治疗及随访情况。方法回顾性分析2021年1月至2022年8月经mNGS确诊为鹦鹉热衣原体肺炎的8例患者的临床资料。结果8例患者中男1例,女7例,年龄为33~81岁。4例有鸟类/家禽的接触史。临床表现主要为高热(8/8)、咳嗽(8/8)、咳痰(4/8)、神经系统症状(3/8)。实验室检查提示白细胞升高(4/8)、中性粒细胞比例均升高(8/8)、淋巴细胞比例均降低(8/8);所有患者的C反应蛋白、降钙素原明显升高伴有低蛋白血症(8/8);谷丙转氨酶(8/8)、谷草转氨酶(8/8)、肌酸激酶(4/8)、乳酸脱氢酶(6/8)升高;胸部影像学多表现为斑片状渗出实变(7/8)、团块状实变(1/8),累及单侧居多(7/8)。所有患者均由肺泡灌洗液mNGS确诊,确诊后调整为多西环素(4/8)或奥玛环素(2/8)或莫西沙星(2/8),所有患者均治愈出院。结论鹦鹉热衣原体肺炎有一定的特征性,但临床诊断仍然困难。mNGS检测快、准确性高,有助于早期明确诊断、尽早选用敏感抗菌药物、改善预后。Objective To investigate features of clinical manifestation,examination results and pulmonary imaging of Chlamydia psittaci pneumonia.Methods 8 patients with Chlamydia psittaci pneumonia diagnosed by mNGS were recruited from Shantou Central Hospital during January 2021 to August 2022 retrospectively.Results The 8 patients include 1 male and 7 females,age from 33 to 81 years.4 patients had a history of exposure to birds/poultry.The main clinical features were high fever(8/8),cough(8/8),expectoration(4/8),nervous system symptoms(3/8).The white blood counts were elevated(4/8)or normal(4/8).The proportion of neutrophils were all increased(8/8)while the proportion of lymphocytes were all decreased(8/8).Inflammatory markers such as C-reactive protein(8/8)and procalcitonin(8/8)were significantly increased.Albumin was all decreased(8/8).Liver enzymes such as alanine aminotransferase(8/8)and glutamic oxaloacetic transaminase(8/8)and myocardial enzymes such as creatine kinase(4/8)and lactate dehydrogenase(6/8)were elevated during disease monitoring process.Chest CT images showed patchy exudative consolidation(7/8)and mass lesions(1/8),mostly involving one side(7/8).All patients were diagnosed by alveolar lavage fluid mNGS.And they were treated with doxycycline(4/8)or omacycline(2/8)or moxifloxacin(2/8)after diagnosis.All patients were cured and discharged.Conclusion The clinical manifestations of Chlamydia psittaci pneumonia are diverse and its laboratory examination and chest imaging examination results are not specific,which make it difficult to diagnose.mNGS technology,which is fast and accurate,is helpful for early diagnosis,early selection of sensitive antibacterial agents and improvement of prognosis.

关 键 词：宏基因二代测序技术 鹦鹉热衣原体肺炎 临床特征 

分 类 号：R518.1[医药卫生—内科学]