1例人偏肺病毒感染中年女性的临床分析  

Clinical analysis of a case of human metapneumovirus infection in a middle-aged woman

作　　者：于明霞 林蕊艳[2] 祝兆萌 YU Ming-xia;LIN Rui-yan;ZHU Zhao-meng(Liyuan Community Health Service Center,Tongzhou District,Beijing 101100,China)

机构地区：[1]北京市通州区梨园社区卫生服务中心,101100 [2]首都医科大学附属北京潞河医院呼吸与危重症医学科,101149

出　　处：《中国实用医药》2024年第8期156-160,共5页China Practical Medicine

摘　　要：患者女性,48岁,2023年6月13日主因新型冠状病毒肺炎住院,核酸转阴后,于6月19日出院。6月22日再次出现发热,体温最高38.1℃,伴畏寒,肌肉酸痛,胸部CT提示双肺多发斑片状磨玻璃影、实变影,部分较前吸收,部分较前新发,于6月25日再次入本科住院治疗。体格检查可闻及湿啰音及散在哮鸣音。血气分析(不吸氧):酸碱度(pH)7.41,动脉血二氧化碳分压(PaCO_(2))36 mm Hg(1 mm Hg=0.133 kPa),动脉血氧分压(PaO_(2))57 mm Hg,氧合指数(P/F ratio)282 mm Hg;血常规:白细胞计数(WBC)5.85×10^(9)/L,中性粒细胞百分比(NEU%)68%,淋巴细胞百分数(LYM)26%,血红蛋白(Hb)116 g/L;考虑社区获得性肺炎(CAP)。完善检查,呼吸道病毒十三项提示偏肺病毒核酸阳性,支气管镜灌洗液微生物二代基因测序(NGS)提示偏肺病毒序列数24469条。综合分析诊断为肺炎-人偏肺病毒(hMPV)感染。停用抗生素,予以对症治疗及中药治疗。复查胸部CT提示两肺散在斑片影明显吸收。说明随着宏基因组学的应用普及,越来越多社区获得性肺炎病原体得以明确。hMPV支气管炎或肺炎患者,病程多为自限性,继发细菌感染几率较低,治疗往往并不需要抗生素,可采用支持性治疗,目前尚无有效的抗病毒药物。The patient,a 48-year-old female,was hospitalized on June 13,2023,mainly due to novel coronavirus pneumonia.After nucleic acid turned negative,she was discharged on June 19.Fever occurred again on June 22,with the highest body temperature of 38.1℃,accompanied by chills and muscle soreness.Chest CT showed multiple patchy ground glass shadows and solid shadows in both lungs,some of which were more than the previous absorption and some were more than the previous new appearance.She was admitted to our department again for treatment on June 25.On physical examination,moist rales and sporadic wheezing sounds can be heard.Blood gas analysis(without oxygen inhalation):pH 7.41,arterial partial pressure of carbon dioxide(PaCO_(2))36 mm Hg(1 mm Hg=0.133 kPa),arterial partial pressure of oxygen(PaO_(2))57 mm Hg,oxygenation index(P/F ratio)282 mm Hg;Blood routine:white blood cell count(WBC)5.85×10^(9)/L,neutrophil percentage(NEU%)68%,lymphocyte percentage(LYM)26%,hemoglobin(Hb)116 g/L;Consider community-acquired pneumonia(CAP).Complete examination showed that 13 respiratory viruses showed positive metapneumovirus nucleic acid,and bronchoscopic lavage fluid next generation sequencing(NGS)showed 24469 metapneumovirus sequences.Comprehensive analysis,diagnosis of pneumonia,human metapneumovirus(hMPV)infection.Antibiotics were discontinued,and symptomatic treatment and traditional Chinese medicine were given.Reexamination of chest CT indicates obvious absorption of scattered spots in both lungs.With the popularization of metagenomics,more and more community-acquired pneumonia pathogens have been identified.In patients with hMPV bronchitis or pneumonia,the course of the disease is mostly self-limited,and the probability of secondary bacterial infection is low.The treatment often does not require antibiotics,and supportive treatment can be used.Currently,there are no effective antiviral drugs.

关 键 词：人偏肺病毒 胸部CT 社区获得性肺炎 

分 类 号：R563.1[医药卫生—呼吸系统]