10例鹦鹉热衣原体肺炎的临床特征分析  

Analysis on clinical characteristics of 10 cases of chlamydia psittaci pneumonia

作　　者：李静[1] 王开金[2] LI Jing;WANG Kaijin(Department of Respiratory and Critical Care Medicine,Affiliated Jiangjin Hospital of Chongqing University,Chongqing 402260,China;Department of Respiratory and Critical Care Medicine,Affiliated Bishan Hospital of Chongqing Medical University,Chongqing 402760,China)

机构地区：[1]重庆大学附属江津医院呼吸与危重症医学科,重庆402260 [2]重庆医科大学附属璧山医院呼吸与危重症医学科,重庆402760

出　　处：《重庆医学》2024年第8期1231-1236,共6页Chongqing medicine

摘　　要：目的分析鹦鹉热衣原体肺炎的临床特征,以提高临床医生对该类疾病的早诊早治水平。方法回顾性分析2020年3月至2022年4月重庆大学附属江津医院收治的经宏基因组二代测序(mNGS)诊断的10例鹦鹉热衣原体肺炎患者的临床资料,收集患者基本情况、临床表现、实验室检查[WBC、淋巴细胞计数(LYM)、中性粒细胞百分比、C反应蛋白(CRP)、降钙素原(PCT)、红细胞沉降率(ESR)、Fe 2+、AST、ALT、脑钠肽(BNP)、尿白蛋白]、影像学表现、mNGS检测结果、治疗及转归并总结归纳。结果10例鹦鹉热衣原体肺炎患者中男6例,女4例,年龄47~90岁,中位年龄57.5岁;主要表现为发热10例(其中5例高热),咳嗽7例,相对缓脉7例,头痛5例,咯痰4例;80%的病例有明确鸟类或家禽类接触史。8例WBC正常,7例LYM降低,8例中性粒细胞百分比升高,9例CRP升高(5例>200 mg/L),6例PCT正常,10例血Fe 2+降低。9例肺部表现为边界模糊的斑片实变影,1例表现为反晕征,所有患者病灶均累及胸膜,但胸腔积液者仅3例。10例患者均以支气管肺泡灌洗液(BALF)作为标本,经mNGS检出鹦鹉热衣原体序列,经喹诺酮类、阿奇霉素等抗菌药物治疗后好转出院。结论鹦鹉热衣原体肺炎患者均有发热且多以发热为首发症状,除呼吸系统症状,常有肺外表现,发病前有鸟类或家禽类接触史及典型的影像学改变可以提示诊断,尽快采集BALF进行mNGS检测,可及早明确诊断。Objective To analyze the clinical characteristics of chlamydia psittaci pneumonia so as to increase the clinical doctor’s early diagnosis and early treatment level to this disease.Methods The clinical data of 10 patients with chlamydia psittaci pneumonia diagnosed by metagenomic next-generation sequencing(mNGS)in the Affiliated Jiangjin Hospital of Chongqing University from March 2020 to April 2022 were retrospectively analyzed.The basic situation,clinical manifestations,laboratory detection[WBC,lymphocytes count(LYM),neutrophile granulocyte ratio,C reactive protein(CRP),procalcitonin(PCT),erythrocyte sedimentation rate(ESR),Fe 2+,AST,ALT,brain natriuretic peptide(BNP),urine albumin],imageologic manifestations,mNGS detection result,treatment and outcome were collected and summarized.Results Among 10 patients with chlamydia psittaci pneumonia,6 cases were males and 4 cases were females with a median age of 57.5 years old.The main manifestations were fever in 10 cases(high fever in 5 cases),cough in 7 cases,relatively slow pulse in 7 cases,headache in 5 cases and phlegm in 4 cases.80%of the cases had a clear contact history of birds or poultry.WBC was normal in 8 cases,LYM was decreased in 7 cases,neutrophile granulocyte ratio was increased in 8 cases,CRP was increased in 9 cases(5 cases>200 mg/L),PCT was normal in 6 cases and blood Fe 2+decrease was in 10 cases.The lungs in 9 cases showed solid shadow with blurred edges,and 1 case showed anti-halo sign,the lesions in all cases involved in the pleura,but only 3 cases had pleural effusion.Bronchoalveolar lavage fluid(BALE)in 10 cases all served as specim en.Chlamydia psittaci sequences were detected by mNGS,and all cases were treated with quindones,azithromycin and other antibiotics and were discharged with improvement.Conclusion Chlamydia psittaci pneumonia has fever,moreover most of the first symptoms are fever,in addition to respiratory symptoms,the extrapulmonary manifestations are common,there is birds or poultry contact history before onset and the typical i

关 键 词：鹦鹉热衣原体肺炎 临床特征 宏基因组学二代测序 支气管肺泡灌洗液 

分 类 号：R518.1[医药卫生—内科学]