216例社区获得性肺炎并发肝损伤患者的临床特征、诊断及治疗分析

Clinical Features,Diagnosis and Treatment of 216 Community Acquired Pneumonia Patients Complicated with Liver Injury

目的分析216例社区获得性肺炎(CAP)并发肝损伤患者的临床特征、诊断及治疗情况。方法选择2012—2014年在上海交通大学医学院附属苏州九龙医院呼吸内科住院治疗的CAP患者2 104例,其中216例(10.3%)合并肝损伤,回顾性分析其临床资料。结果 (1)临床症状和体征:发热192例(88.9%),阵发性咳嗽182例(84.3%),出现肺外表现107例(49.5%)。(2)实验室检查:C反应蛋白(CRP)升高者201例(93.1%),丙氨酸氨基转移酶(ALT)和/或天冬氨酸氨基转移酶(AST)升高≤1倍参考值上限者123例(56.9%)、升高≤2倍参考值上限者61例(28.3%)、升高>2倍参考值上限者32例(14.8%);病原体以非典型病原体为主,尤其是肺炎支原体,占39.8%,细菌性感染相对较少,仅34例(15.7%)。(3)影像学检查:CT检查示病变为单侧者147例(68.1%)。(4)临床疗效:216例患者给予头孢呋辛/头孢曲松联合氟喹诺酮类药物抗感染及保肝治疗,153例(70.8%)患者72 h内体温恢复正常和/或咳嗽、咳痰症状减轻。结论 CAP并发肝损伤的主要临床症状和体征为发热、阵发性咳嗽,大多数患者会出现CRP、ALT和/或AST升高,病原体以非典型病原体为主,尤其是肺炎支原体,CT检查示病变多为单侧,经抗生素治疗患者临床疗效较好。

Objective To analyze the clinical features,diagnosis and treatment of 216 community acquired pneumonia patients complicated with liver injury. Methods From 2012 to 2014,a total of 2 104 patients with community acquired pneumonia were enrolled, thereinto 216 cases occurred liver injury （ accounted for 10. 3%）, their clinical data was retrospectively analyzed. Results Clinical symptom and signs：192 cases occurred pyrexia（ accounted for 88. 9%）,182 cases occurred paroxysmal cough （ accounted for 84. 3%）, 107 cases occurred extra - pulmonary manifestation （ accounted for 49. 5%）. Laboratory examination：201 cases occurred elevated CRP （ accounted for 93. 1%）;123 cases occurred elevated ALT/AST≤1 times of URL（accounted for 56. 9%）,61 cases occurred elevated ALT/AST≤2 times of URL（accounted for 28. 3%）,32 cases occurred elevated ALT/AST〉2 times of URL （ accounted for 14. 8%）;the pathogene were atypical, mainly were mycoplasma pneumoniae（ accounted for 39. 8%）,bacterial infections were relatively less（ accounted for 15. 7%）. CT findings：147 cases occurred one-sided lesions. Clinical effect：all of the 216 patients were given cefuroxime/ ceftriaxone combined with fluoroquinolones to control infections,with liver protection therapy,153 patients′body temperature returned to normal,cough and expectoration relieved within 72 hours. Conclusion The main clinical symptom and signs of community acquired pneumonia patients complicated with liver injury include pyrexia and paroxysmal cough,most of them occur elevated CRP,ALT/AST,and the pathogene are atypical（ mainly are mycoplasma pneumoniae）,CT finding usually show one-sided lesions,antibiotics are effective.