32例单增李斯特菌菌血症临床和实验室特征  

Clinical and laboratory characteristics of 32 patients with Listeria monocytogenes bacteremia

作　　者：杨铭 白蕊艳 台锦阁 郭鹏娟 董轲 YANG Ming;BAI Rui-yan;TAI Jin-ge;GUO Peng-juan;DONG Ke(Tangdu Hospital of Air Force Military Medical University,Xi’an 710038,China)

机构地区：[1]空军军医大学唐都医院,西安710038

出　　处：《中国人兽共患病学报》2024年第7期652-655,共4页Chinese Journal of Zoonoses

基　　金：社会人才基金资助项目(No.2021SHRC059)。

摘　　要：目的分析单核细胞增生李斯特菌菌血症的临床和实验室特点,为其诊断和治疗提供依据。方法回顾性分析2012年9月至2022年4月唐都医院单核细胞增生李斯特菌菌血症患者病例资料,分析其年龄、性别、基础疾病、治疗和预后等资料。并统计分析其治疗前后白细胞计数、单核细胞百分比、中性粒细胞百分比、单核细胞/中性粒细胞比值、C反应蛋白和降钙素原等指标变化。结果32例单核细胞增生李斯特菌菌血症病例中,患者平均年龄为31.9岁,其中65岁以上3例,占9.4%。患者发病时间夏季最多(11例,34.4%),其次为春季(9例,28.1%)。24例(75.0%)患者合并有基础疾病。29例患者治疗方案调整为以青霉素类(17例,53.1%)和碳青霉烯类(12例,37.5%)为主的目标性抗菌治疗,治疗后中性粒细胞、淋巴细胞和CRP水平均明显低于治疗前(P<0.05)。29例(90.6%)患者好转出院,1例死亡,2例预后不良。结论自身免疫病、肿瘤、妊娠为单核细胞增生李斯特菌感染的高危因素。青霉素类药物是李斯特菌病有效的经验治疗首选药物,明确病原诊断,选择合适的抗生素对单核细胞增生李斯特菌抗感染治疗尤为重要。This study was aimed at analyzing the clinical and laboratory characteristics of patients with Listeria monocytogenes bacteremia,to provide evidence for its diagnosis and treatment.A retrospective analysis was conducted on the clinical data for patients with L.monocytogenes bacteremia at Tangdu Hospital between September 2012 and April 2022.The data included age,sex,underlying diseases,treatments,and prognosis.Changes in indicators such as white blood cell(WBC)count,monocyte percentage,neutrophil percentage,monocyte/neutrophil ratio(M/N),C-reactive protein(CRP),and procalcitonin before and after treatment were statistically analyzed.Among the 32 patients with L.monocytogenes bacteremia,the average age was 31.9 years,and three patients were older than 65 years.The incidence rate was highest in summer(11 patients,34.4%),followed by spring(9 patients,28.1%).A total of 24 patients(75.0%)had underlying diseases.After accurate diagnosis,the treatment plans of 29 patients were adjusted to target antibacterial therapy consisting primarily of penicillins(17 patients,53.1%)and carbapenems(12 patients,37.5%).After treatment,the levels of neutrophils,lymphocytes,and CRP were significantly lower than those before treatment(P<0.05).A total of 29 patients(90.6%)improved and were discharged,one patient died,and two patients had poor prognosis.The primary risk factors for L.monocytogenes infection were autoimmune diseases,tumors,and pregnancy.Penicillin was the first choice effective empirical treatment for listeriosis.A clear diagnosis of the pathogen and appropriate choice of antibiotics were particularly important for the treatment of L.monocytogenes infection.

关 键 词：单增李斯特菌 菌血症 临床特征 

分 类 号：R378.99[医药卫生—病原生物学]