| 蒋榕,周志国.28例鹦鹉热衣原体肺炎临床特征分析[J].安徽医药,待发表. |
| 28例鹦鹉热衣原体肺炎临床特征分析 |
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| 投稿时间：2022-12-06 录用日期：2023-01-26 |
| DOI： |
| 中文关键词: 鹦鹉热 衣原体 肺炎 临床特征 |
| 英文关键词: |
| 基金项目:长沙市自然科学基金 |
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| 中文摘要: |
| 【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患者的临床特点。方法 回顾性分析长沙市第一医院2019年10月1日至2022年4月1日采用mNGS诊断的28例鹦鹉热衣原体肺炎患者的诊治情况，对患者的职业史、临床症状、实验室检查结果、肺部CT特征、治疗及预后等情况进行综合分析。结果 28例患者中10例为女性，18例为男性，中位年龄60岁；27例患者有明确禽类接触史，仅有1例患者无明确禽类接触史。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患者。临床表现包括发热（100%）、畏寒（28.6%）、咳嗽、咳痰（71.4%）、气促（53.6%）。实验室检查中白细胞总数多在正常范围，96.4%的患者中性粒细胞比例增高、淋巴细胞比例降低；96.4%患者PCT升高，所检测患者中ESR和CRP升高者达100%；分别有71.4%和50%患者L-乳酸脱氢酶和肌酸激酶增高；有82.1%的患者谷草转氨酶增高，有78.6%的患者白蛋白降低。胸部 CT 表现中单侧病变有 25例（89.3%）、右侧肺野病变 19例（67.9%），最常见的影像改变是斑片状密度增高影（78.6%）、大片实变（21.4%），有57.1%患者伴有胸腔积液。治疗情况：单用氟喹诺酮类（莫西沙星或者左氧氟沙星）治疗的病例9例，单用多西环素治疗的病例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例患者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例患者均预后良好，无因该病死亡病例。结论 鹦鹉热衣原体肺炎患者的职业史、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检测确诊，快速过渡到精准治疗，能明显改善预后。 |
| 英文摘要: |
| 【Abstract】 Objective We collected the clinical data of 28 patients with Chlamydia psittaci pneumonia diagnosed by metagenomic next‐generation‐sequencing (mNGS) . Methods From October 1, 2019 to April 1, 2022, 28 cases of Psittacosis from The first hospital of chang sha were diagnosed via metagenomic next‐generation sequencing(mNGS). The data of all patients on occupational history, clinical manifestations, laboratory tests, chest computed tomography(CT)findings, treatment outcomes and prognosis were retrospectively analyzed. Results Among the 28 patients, there were18 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、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 were71.4% and50%, respectively.Aspartate aminotransferase increased in 82.1% of patients and albumin decreased in 78.6% of patients.Chest CT scans showed unilateral lung involvement in 25 cases(89.3%) and right lung field involvement in 19 cases(67.9%).The most common imaging change was patchy shadows with increased density（78.6%）and large patchy consolidation（21.4%）,with 16 cases (57.1%) having pleural effusion. In terms of treatment,9 patients were treated with fluoroquinolones alone,2 patients with doxycycline alone, and 13 patients with combined treatment. In 2 patients, the initial treatment with penicillins plus quinolones failed, but their symptoms were relieved after they were switched to doxycycline or combined doxycycline.All the 28 patients had a good prognosis, and there was no death due to the disease. Conclusions Chlamydia psittaci pneumonia showed unique features in the history of professional,clinical symptoms, laboratory tests and chest imaging.Clinical suspicious cases should be confirmed by mNGS detection as soon as possible, and rapid transition to precise treatment can significantly improve the prognosis. |
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