鹦鹉热衣原体肺炎28例临床特征分析  

Clinical analysis of 28 cases of Chlamydia psittaci pneumonia

作　　者：蒋榕 汤渝玲 文隆 孔祥龙 李慧 姜迪譞 周志国 JIANG Rong;TANG Yuling;WEN Long;KONG Xianglong;LI Hui;JIANG Dixuan;ZHOU Zhiguo(Department of Respiratory and Critical Care Medicine,The First Hospital of Changsha,Changsha,Hu´nan 410005,China)

机构地区：[1]长沙市第一医院呼吸与危重症医学科,湖南长沙410005

出　　处：《安徽医药》2024年第7期1348-1352,共5页Anhui Medical and Pharmaceutical Journal

基　　金：长沙市自然科学基金(kq2202002)。

摘　　要：目的分析经宏基因组二代测序技术(metagenopmic next generation sequencing,mNGS)确诊的28例鹦鹉热衣原体肺炎病人的临床特点。方法回顾性分析2019年10月1日至2022年4月1日长沙市第一医院采用mNGS诊断的28例鹦鹉热衣原体肺炎病人的诊治情况。结果28例病人中10例为女性,18例为男性,中位年龄60岁;27例病人有明确禽类接触史,1例无。重症病例占32.1%,多为有慢性阻塞性肺疾病(COPD)、糖尿病、高血压、冠心病或尿毒症等基础疾病病人。临床表现包括发热(100%)、畏寒(28.6%)、咳嗽、咳痰(71.4%)、气促(53.6%)。外周血中白细胞总数多在正常范围,96.4%的病人中性粒细胞比例增高、淋巴细胞比例降低;96.4%病人PCT升高,所检测病人中ESR和CRP升高者达100%;分别有71.4%和50%病人乳酸脱氢酶和肌酸激酶增高;有82.1%的病人谷草转氨酶增高,有78.6%的病人白蛋白降低。胸部CT表现单侧病变25例、其中右肺病变19例,常见影像改变是斑片状阴影(78.6%)、大片实变(21.4%),26例伴有胸腔积液。治疗情况:单用氟喹诺酮类(莫西沙星或者左氧氟沙星)治疗9例,单用多西环素治疗2例;联合用药13例,其中青霉素类(哌拉西林他唑巴坦或头孢哌酮舒巴坦钠)联用喹诺酮类有10例,青霉素类联合多西环素3例。有2例病人初始选择青霉素类加喹诺酮类药物治疗无效,改用多西环素或联用多西环素后症状缓解。28例病人均预后良好,无死亡病例。结论鹦鹉热衣原体肺炎病人的职业史、临床表现、实验室检查结果及肺部CT具有一定的特点;临床对可疑病例应尽早行mNGS检测,快速过渡到精准治疗,能明显改善预后。Objective To analyze the clinical data of 28 patients with Chlamydia psittaci pneumonia diagnosed by metagenomic next generation sequencing(mNGS).Methods The diagnosis and treatment of 28 cases of Chlamydia psittaci pneumonia diagnosed via metagenomic nextgeneration sequencing(mNGS)in The First Hospital of Changsha from October 1,2019 to April 1,2022 were retrospectively analyzed.Results Among the 28 patients,there were 18 males and 10 females,with a median age of 60 years.27 patients had a confirmed history of exposure to poultry.Only 1 patient had no definite history of poultry exposure.Severe cases accounted for 32.1%,mostly patients with chronic obstructive pulmonary disease(COPD),diabetes,hypertension,coronary heart disease or uremia and other basic diseases.Clinical manifestations included fever(100%),chills(28.6%),cough and sputum(71.4%,),and dyspnea(53.6%).Laboratory data showed that white blood cells were mostly in the normal range,and the proportion of neutrophil increased and lymphocyte decreased in 96.4%patients.PCT was elevated in 96.4%of patients,ESR and CRP were elevated in 100%of detected patients.Percentages of patients with increased lactate dehydrogenase and creatine kinase were 71.4%and 50%,respectively.Aspartate aminotransferase(AST)increased in 82.1%of patients and albumin decreased in 78.6%of patients.Chest CT scans showed unilateral lung involvement in 25 cases and right lung field involvement in 19 cases.The most common imaging changes were patchy shadows with increased density(78.6%)and large patchy consolidation(21.4%),and there were 26 cases with pleural effusion.In terms of treatment,9 patients were treated with fluoroquinolones alone,2 patients with doxycycline alone,and 13 patients with combined treatment including penicillin(piperacillin-tazobactam or cefoperazone sulbactam sodium)combined with quinolones in 10 patients and penicillin combined with doxycycline in 3 patients.In 2 patients,the initial treatment with penicillins plus quinolones failed,but their symptoms were relieved

关 键 词：鹦鹉热 鹦鹉衣原体 喹诺酮类 肺炎 临床特征 

分 类 号：R563.19[医药卫生—呼吸系统]