沙眼衣原体肺炎合并肺不张患儿56例临床特征分析

Retrospective clinical analysis of infants with chlamydia trachomatis pneumonia and atelectasis in 56 cases

目的:探讨3个月以内小婴儿沙眼衣原体肺炎合并肺不张病例的临床特征,提高对小婴儿沙眼衣原体肺炎的认识和预防。方法:应用实时荧光定量聚合酶链反应(PCR)检测患儿呼吸道标本中的DNA,回顾性分析56例患儿的病史特点,临床表现、实验室检查、影像学特点、治疗及转归情况。结果:小婴儿沙眼衣原体肺炎主要表现为发病缓慢的断续咳嗽,鼻塞、多无发热、外周血白细胞总数正常或升高、并常见嗜酸性粒细胞升高。影像学表现较临床症状和体征更为突出,给以阿奇霉素序贯治疗,多数治愈或好转,但发生肺不张后治疗时间长,容易造成持续的气道损害。结论:小婴儿沙眼衣原体肺炎发生较早,缺少特异临床表现,容易误诊,应尽早进行病原学检查,早期治疗,预防肺不张等并发症,阿奇霉素序贯治疗是有效的治疗方法。

Objective： To analyze clinical features of infants with chlamydia trachomatis pneumonia and atelectasis so as to improve clinical management and preventive measure. Methods： Data of 56 infant patients were retrospectively reviewed in terms of history characteristics,clinical manifestations,laboratory features,imaging,treatment and prognosis. Real-time polymerase chain reaction（ PCR） was employed for detection of DNA in deep respiratory samples. Results： The main clinical manifestations were： intermittent cough,nasal congestion（ mostly no fever）,normal or increased peripheral blood white blood cell count,and often increased eosinophil count. Imaging manifestation was more evident than clinical symptom. After being treated with azithromycin sequentially,most patients with pneumonia were cured or improved,but the treatment time is relatively long if atelectasis occurred,which often resulted in persistent airway damage. Conclusion： The onset of infant chlamydia trachomatis pneumonia is relatively early,and is easily misdiagnosed. Pathogen check should be done as soon as possible to improve diagnosis and treatment,and prevent complications such as atelectasis. Treatment with azithromycin in a sequential way is effective.