军团菌肺炎26例分析并文献复习

Legionnaires Pneumonia:Report of 26 Cases and Review of the Literature

目的探讨军团菌肺炎的临床特点及治疗转归。方法回顾性分析我院26例军团菌肺炎患者的临床资料,并结合文献复习,总结该病临床特点及治疗转归。结果26例患者中有基础疾病11例,延迟诊治（16.4±3.5）d。所选患者伴有不同程度的发热（100%）、咯血（6%）、相对缓脉（62%）、精神神经症状（15%）、消化系统症状（31%）、肝脏功能异常（46%）、低钠血症（23%）。X线胸片或CT显示：一叶或段肺炎（42%）、双肺肺炎（15%）、单侧肺脓肿（4%）、伴胸腔积液（42%）及心包积液（4%）,血清抗体以Lp6及Lp1型为主。26例患者均用红霉素静脉滴注治疗（1.5-2.0g/d）,疗程（37.6±5.3）d,痊愈25例（占96%）,死亡1例（占4%）。结论军团菌肺炎患者诊断困难,临床表现多样,当出现相对缓脉、精神神经症状、消化系统症状、肝功能异常、低钠血症等肺外症状时,均应考虑该病的可能性。治疗时首选红霉素,中-重度患者联用利福平,不能耐受红霉素时,可考虑其他大环内酯类或喹诺酮类,疗程不短于3周。

Objective To explore the clinical characteristics and the treatment methods of legionnaires pneumonia （LP）. Methods The clinical data of 26 patients with LP in Bingjing hospital were analyzed and the literature was reviewed. Results Among 26 cases with LP, there were 11 cases had the predisposing diseases. The delayed time of diagnosis and treatment was （ 16. 4 ± 3.5 ） days. Fever was present in all patients; 6% and 62% of the patients occurred hemoptysis and pulse - temperature dissociation respectively; Extrapulmonary manifestations, including gastrointestinal, hepatic, neurologic abnormalities and hyponatremia, were 31% , 46% , 15% and 23% respectively; X - ray showed a lobe of patchy shadows and bilateral patchy shadows in 42% and 15% respectively, pleural effusion was more common （42%） , 4% and 4% of the patients showed pericardiac effusion and lung abscess respectively. The type of LP antibody showed that LP6 and LP1 were more common. 25 cases were cured after the treatment with erythromycin （ 1.5 - 2. 0 g/d） for （37.6 ± 5.3 ） days, one died of MODF. Conclusion LP is difficultly diagnosed and haS many clinical manifestations. When showing extrapulmonary manifestations such as pulse - temperature dissociation, neurologic, gastrointestinal, hepatic, abnormalities and hyponatremia ect, LP is considered. Erythromycin was firstly used for treating LP, moderate to severe cases together with rifampin, azithromycin or the quinolones. The course of treatment was more than 3 weeks.