鹦鹉热衣原体肺炎临床特征分析  

Analysis of Clinical Features of Chlamydia Psittaci Pneumonia

作　　者：陈明诚[1] 郑彩云 余丽芳 CHEN Mingcheng;ZHENG Caiyun;YU Lifang(Department of Respiratory and Critical Care Medicine,Fuqing Hospital Affiliated to Fujian Medical University,Fuzhou 350300,China;Department of Clinical Pharmacology,Fuqing Hospital Affiliated to Fujian Medical University,Fuzhou 350300,China)

机构地区：[1]福建医科大学附属福清市医院呼吸与危重症医学科,福州350300 [2]福建医科大学附属福清市医院临床药学科,福州350300

出　　处：《中国医药指南》2024年第21期1-6,共6页Guide of China Medicine

基　　金：福建医科大学启航基金项目(2020QH1346);福州市卫生健康科技计划项目(2022-S-wq1)。

摘　　要：目的综合分析25例确诊为社区获得性鹦鹉热衣原体肺炎患者的临床特征及诊治过程,为高效诊治鹦鹉热,降低并发症,提高重症患者的生存率提供科学依据。方法回顾性分析2020年9月至2023年2月由我院收治的25例鹦鹉热衣原体肺炎患者的临床资料,总结鹦鹉热衣原体肺炎的临床特征及诊治要点。结果25例患者,其中男性15例,女性10例,中位数年龄为69岁(41~80岁),主要临床表现为高热、咳嗽、气喘、乏力,均有鸟类或家禽类接触史,从起病到就诊时间为4 d(1~10 d)。患者白细胞基本正常,常规CRP、降钙素原(PCT)明显升高。15例患者进行细胞免疫检查,其中13例CD4、CD8细胞数量降低。气管镜检查主要表现为气道黏膜充血水肿,气道中痰液较少。患者存在低氧血症,严重者出现呼吸衰竭,医师对患者经验性使用抗菌药物治疗效果不佳。利用宏基因组二代测序(mNGS)技术及时调整以四环素类药物为基础的治疗方案后病情好转,缩短了鹦鹉热衣原体肺炎的诊断时间和病程。结论有鸟类或家禽类接触史的社区获得性肺炎患者,利用mNGS可提高鹦鹉热衣原体肺炎诊断的准确性,尽早启动以四环素为基础的治疗方案治疗效果显著,但仍需警惕在病程中继发细菌感染及其他并发症的风险。Objective To comprehensively analyze the clinical characteristics and treatment process of 25 patients with community-acquired chlamydia psittaci pneumonia,so as to provide scientific basis for efficient diagnosis and treatment of psittacosis,reducing complications and improving the survival rate of severe patients.Methods The clinical data of 25 patients with chlamydia psittaci pneumonia admitted to our hospital from September 2020 to February 2023 were analyzed,and the clinical characteristics and key points of chlamydia psittaci pneumonia were summarized.Results Twenty-five patients,15 male,10 female,median age of 69 years(41-80 years),the main clinical manifestations were high fever,cough,asthma,fatigue,all had a history of exposure to birds or poultry,from onset to visit time 4 days(1-10 days).The patient's white blood cells were basically normal,and the C-reactive protein and procalcitonin(PCT)were significantly increased.Fifteen cases on cellular immune examination,13 cases had reduced numbers of CD4 and CD8 cells.The tracheoscopy mainly showed congestion and edema of the airway mucosa with less sputum in the airway.The patient has hypoxemia,respiratory failure in severe cases,and the empirical use of antimicrobial drugs is not effective.The diagnosis time and course of chlamydia psittaci pneumonia were shortened after the tetracycline drug based treatment was adjusted by metagenomic next-generation sequencing(mNGS)technology.Conclusions For community-acquired pneumonia patients with a history of bird or poultry contact,mNGS can improve the accuracy of the diagnosis of chlamydia psittaci pneumonia,and start the tetracyclinebased treatment regimen as soon as possible,but it is still necessary to be alert to secondary bacterial infection and other complications in the course of the disease.

关 键 词：鹦鹉热衣原体 肺炎 宏基因组二代测序 多西环素 

分 类 号：R374.2[医药卫生—病原生物学] R518.1[医药卫生—基础医学]