44例被误诊为普通性肺炎的Q热柯克斯体肺炎病人的回顾性分析

Looking Back Analysis for Q Fever Coxiella Burnetü which be Misdiagnosis Common Pneumonia of 44 Examples

通过对44例被误诊为普通性肺炎的Q热柯克斯体肺炎患者的回顾性分析,加强对Q热柯克斯体感染引起肺炎重要性的认识。收集2001年11月至2002年6月从全国选择出的12所三甲医院CAP患者共500例。使用ELISA试剂盒分别检测患者急性期及恢复期Q热柯克斯体特异性IgG抗体含量,对检测出的Q热柯克斯体的患者的性别、年龄等情况进行统计分析。然后把Q热柯克斯体感染患者按照是否合并细菌感染分成两组:单纯Q热柯克斯体感染组与混合细菌感染组。把单纯Q热柯克斯体感染组与在这同一批流行病学调查中检测出的单纯肺炎链球菌感染患者分别从一般情况、住院情况、临床表现、治疗结局、影像学表现、实验室检查等方面进行比较。共检测出Qfever感染阳性44例,可疑阳性病例4例;单纯Q热柯克斯体感染与肺炎链球菌感染患者在年龄、性别、住院时间、基础疾病及肺炎PORT分级方面均无差别,但在BMI方面有显著差别,单纯Q热柯克斯体感染患者BMI指数较肺炎链球菌感染患者高;在临床表现上,两者在咳嗽、咳痰、湿罗音的严重程度上均无差别,但在喘息方面两者有明显差别,Q热柯克斯体感染患者喘息明显加重(p<0.01),单纯Q热柯克斯体感染患者收缩压较肺炎链球菌感染患者高,而发热较肺炎链球菌感染患者轻(p<0.0001);在实验室检查方面,单纯Q热柯克斯体感染患者血小板计数明显较肺炎链球菌感染患者高(p<0.05);在治疗结局上单纯Q热柯克斯体感染与肺炎链球菌感染患者治疗结局无明显差别;影像学方面两者在受影响的肺叶数方面亦无明显差异;在治疗上,抗生素治疗对单纯Q热柯克斯体感染患者的影响,结果发现无论是否正确使用抗生素,在缩短住院时间方面均无显著性差别。高BMI患者易感染Q热柯克斯体,Q热柯克斯体肺炎患者发热体温较低而喘息明显,实验室检查中血小板明显偏高,抗生素治疗对缩短单纯Q热柯克斯体感染患者住院时间方面无明显效果。

To emphasis the impo tance of Q fever Coxiella burnetii,44 case of Q fever pneumonia to be misdiagnosis common pneumonia is retrospected. Collect 500 CAP cases from 12 territory hospital from china from November 2001 to June 2002. Use ELISA kit to detect each patient＇ s content of Q fever Coxiella burnetii specific IgG antibody in acute stage and restoration period, and statistical analysis the Q fever patients＇ sex, age and other information. And then subgroup two groups on whether or not combine bacterial infection ： purely Q fever Coxiella burnetii infection group and mix infection group . To compare the two group from general state of health, hospital frequency, clinical manifestation, termination, imageology appearance and experiment examination . It is Result ： altogether 44 cases of Q fever Coxiella burnetii masculine patients and 4 probable positive patients. There are no obviously difference in two group in age , sex , length of stay in hospital , foundament disease and PORT grade, but there are obvious difference in BMI, high BMI patients susceptive to Q fever Coxiella burnetii（p 〈0. 01 ）. In clinical manifestation, two group have no obvious difference in cough ,expectoration and bubble, but in gasp two group have obvious difference （p 〈 0. 01 ）, Q fever Coxiella burnetii patients＇ gasp is more Severity than common bacterial infection. Purely Q fever Coxiella burnetii infection patients have a higher contractive（p 〈0. 05） and lower fever body temperature （p 〈 0. 0001 ） than bacterial infection. In experiment examination, purely Q fever infection patients have a higher blood platelets counts （p 〈 0.05 ）. There are no difference in imageology appearance in two group . And antibiotics treatment have no influence to length of stay in hospital （p 〉 0. 05）. Is is Conclused ： that high BMI patients susceptive to Q fever Coxiella burnetii, Q fever patients have a lower fever but gastp severely ;in experiment examination, purely Q fever infection patients have a higher blood platelets counts. , and antibiotics treatment have no effect to length of stay in hospital.