鹦鹉热衣原体肺炎8例临床诊治及文献复习  

Clinical diagnosis and treatment of 8 cases of chlamydia psittaci pneumonia and literature review

作　　者：陈国华 苏士成[1] CHEN Guohua;SU Shicheng(Kunshan Hospital of Chinese Medicine,Kunshan 215300,China)

机构地区：[1]昆山市中医医院,江苏昆山215300

出　　处：《临床医学研究与实践》2024年第17期5-8,共4页Clinical Research and Practice

摘　　要：目的探讨肺泡灌洗液宏基因组二代测序技术(mNGS)对鹦鹉热衣原体肺炎的诊断情况,以加深对该病的诊治认识。方法选取2020年9月至2023年9月于我院住院且经肺泡灌洗液mNGS确诊为鹦鹉热支原体肺炎的8例患者。统计分析患者的一般资料、实验室、胸部CT、支气管镜、肺泡灌洗液mNGS检查结果及治疗经过、治疗结局。结果8例患者中位年龄56(55,57)岁;临床表现为发热、咳嗽、气喘、乏力。所有患者中性粒细胞百分比及C反应蛋白(CRP)、D-二聚体(D-D)水平均升高,4例患者降钙素原(PCT)水平升高,5例患者合并呼吸衰竭,3例患者为重症肺炎。8例患者的影像学表现主要为实变影伴或不伴磨玻璃影,1例表现为单纯性磨玻璃影,4例合并胸腔积液。所有患者确诊后均接受以多西环素为基础的抗感染治疗且均好转出院,出院后复查胸部CT显示吸收好转。结论鹦鹉热衣原体肺炎具有一定的特征性,以高热多见,实验室检查通常存在中性粒细胞百分比及CRP升高,影像学主要表现为实变影,可快速进展出现呼吸衰竭,甚至重症肺炎,经针对性抗感染及支持治疗,通常预后良好。Objective To investigate the diagnosis of chlamydia psittaci pneumonia by metagenomic next-generation sequencing(mNGS)of alveolar lavage fluid,and to deepen the understanding of the diagnosis and treatment of the disease.Methods Eight patients who were hospitalized in our hospital from September 2020 to September 2023 diagnosed as chlamydia psittaci pneumonia by mNGS of alveolar lavage fluid were selected.The general data,laboratory,chest CT,bronchoscopy,alveolar lavage fluid mNGS examination results and treatment process,treatment outcome of patients were statistically analyzed.Results The median age of 8 patients was 56(55,57)years old;the clinical manifestations were fever,cough,asthma and fatigue.The percentage of neutrophils and the levels of C-reactive protein(CRP)and D-dimer(D-D)were increased in all patients,the level of procalcitonin(PCT)was increased in 4 patients,5 patients were complicated with respiratory failure,and 3 patients were severe pneumonia.The imaging findings of 8 patients were mainly consolidation shadow with or without ground glass shadow,1 case showed simple ground glass shadow,and 4 cases were combined with pleural effusion.All patients received doxycycline-based anti-infective treatment after diagnosis and were discharged from hospital,after discharge,chest CT showed that the absorption was improved.Conclusion Chlamydia psittaci pneumonia has certain characteristics,which is more common in high fever.Laboratory tests usually have elevated neutrophil percentage and CRP.The imaging findings are mainly consolidation shadows,which can rapidly progress to respiratory failure and even severe pneumonia.After targeted anti-infection and supportive treatment,the prognosis is usually good.

关 键 词：鹦鹉热衣原体 肺炎 宏基因组二代测序技术 

分 类 号：R518.1[医药卫生—内科学]