鹦鹉热衣原体肺炎的临床特征及胸部CT表现  

Clinical features and chest CT findings of Chlamydia psittaci pneumonia confirmed by mNGS

作　　者：王迪[1] 胡维娟[1] 贾科峰[1] 叶玉冰 吕蓉[1] WANGDi;HU Wei-juan;JIA Ke-feng(Department of Radiology,the Third Central Hospital of Tianjin,Tianjin Institute of Hepatobiliary Disease,Tianjin Key Laboratory of Artificial Cell,Artificial Cell Engineering Technology Research of Public Health Ministry,Tianjin 300170,China)

机构地区：[1]天津市第三中心医院放射科/天津市肝胆疾病研究所/天津市人工细胞重点实验室/卫生部人工细胞工程技术研究中心,天津300170

出　　处：《放射学实践》2024年第12期1593-1597,共5页Radiologic Practice

基　　金：天津市医学重点学科(专科)建设项目(TJYXZDXK-074C)。

摘　　要：目的:探讨经mNGS确诊的鹦鹉热衣原体肺炎临床特点及胸部CT表现。方法:回顾性分析2020年8月-2023年10月在本院经mNGS确诊的48例鹦鹉热衣原体肺炎患者的临床资料、首次及1个月内胸部CT表现。结果:48例均有发热症状,其中40例(83.3%)有禽类接触史;白细胞计数轻度升高12例(25%),中性粒细胞百分数升高33例(68.8%);C反应蛋白升高42例(87.5%),其中29例(60.4%)C反应蛋白>100 mg/L。首次胸部CT检查显示病变位于下叶41例(85.4%),35例(72.9%)累及单个肺叶,均沿胸膜下或支气管血管束周围分布,最常见表现为实变(97.9%,47/48),且实变多伴随空气支气管征(97.9%,46/47)及晕征(74.5%,35/47),18例(37.5%)有细网格征,18例(37.5%)病变同侧可见胸腔积液。经抗生素治疗后45例复查CT显示病灶好转30例(66.7%),10例(22.2%)出现纤维灶,18例(40.0%)晕征及14例(31.1%)细网格征吸收消失。结论:鹦鹉热衣原体肺炎的胸部CT多表现为下叶为主实变伴空气支气管征及周围磨玻璃影,常合并细网格征及胸腔积液。Objective:The purpose of this study was to investigate the clinical features and chest CT findings of Chlamydia psittaci pneumonia confirmed by metagenomic next-generation sequencing(mNGS).Methods:The clinical data and chest CT findings(the first CT and follow-up CT within one month)of 48 patients in our hospital with Chlamydia psittaci pneumonia confirmed by mNGS between August 2020 and October 2023 were retrospectively analyzed.Results:Among the 48 patients,40 cases(83.3%)had an exposure history to poultry.All cases had fever.White blood cells were elevated in 12 cases(25.0%),proportion of neutrophils was elevated in 33 cases(68.8%),and C-reactive protein was elevated in 42 cases(87.5%),with C-reactive protein>100mg/L in 29 cases(60.4%).The first chest CT scan showed that the lesion was located in the lower lobe in 41 cases,single lobe involvement in 35 cases(72.9%),all the lesions were peripheral distribution or along the bronchovascular bundle,the most common finding was consolidation(97.9%,47/48)with air bronchogram(97.9%,46/47)and halo sign(74.5%,35/47),crazy-paving appearance in 18 cases(37.5%),ipsilateral pleural effusion in 18 cases(37.5%).After adjustment of antibiotic treatment,the follow-up CT of 45 cases showed improved in 30 cases(66.7%),fibrous lesions in 10 cases(22.2%).The halo sign and crazy-paving appearance were absorbed in 18 cases(40.0%)and 14 cases(31.1%)on the follow-up CT images.Conclusion:The chest CT manifestations of Chlamydia psittaci pneumonia are mostly showed as consolidation in the lower lobes with air bronchogram sign and halo sign,often accompany with crazy-paving appearance and pleural effusion.

关 键 词：鹦鹉热衣原体 肺炎 宏基因组二代测序 体层摄影术 X线计算机 

分 类 号：R814.42[医药卫生—影像医学与核医学] R563.3[医药卫生—放射医学]