24例鹦鹉热衣原体肺炎临床特征分析

Clinical characteristics analysis of chlamydia psittaci pneumonia and mycoplasma pneumonia

目的分析24例鹦鹉热衣原体肺炎患者临床特征。方法选取2019年1月至2021年1月间安徽医科大学第二附属医院收治的鹦鹉热衣原体肺炎患者24例作为鹦鹉热衣原体肺炎组,另选取同期肺炎支原体肺炎患者34例作为肺炎支原体肺炎,比较两组一般情况、临床表现、实验室指标、胸部CT特征。结果鹦鹉热衣原体肺炎组年龄、住院天数、发热峰值均高于肺炎支原体肺炎组,鹦鹉热衣原体肺炎组发热首发、畏寒、听诊湿啰音比例高于肺炎支原体组,而咳嗽、鼻塞流涕比例低于肺炎支原体组;鹦鹉热衣原体肺降钙素原(PCT)、白介素-6(IL-6)、C反应蛋白(CRP)、中性粒细胞计数(Neut)、中性粒细胞百分比(Neut%)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、直接胆红素(DBiL)高于肺炎支原体肺炎组,嗜酸粒细胞计数(Eos)、嗜碱粒细胞计数(Baso)低于肺炎支原体肺炎组,以上差异均具有统计学意义(P<0.05);ROC曲线分析结果显示,炎症指标CRP、IL-6、PCT、Neut%、Neut的ROC曲线下面积(AUC)分别为0.984、0.921、0.914、0.834、0.673,对鹦鹉热衣原体肺炎的诊断有统计学意义。与肺炎支原体肺炎组胸部CT相比,鹦鹉热衣原体肺炎组多表现为实变影、支气管充气征、胸腔积液、心包积液,较少表现左下肺叶累及、磨玻璃影、支气管壁增厚、间质增厚、树芽征,差异均有统计学意义(P<0.05)。结论鹦鹉热衣原体肺炎在发病年龄、最高体温上高于肺炎支原体肺炎,炎症指标、转氨酶、直接胆红素水平高于支原体肺炎,Eos、Baso较低,影像学多表现为实变影、支气管充气征、胸腔积液、心包积液,较少表现左下肺叶累及、磨玻璃影、支气管壁增厚、间质增厚、树芽征。

Objective To analyze the clinical characteristics of patients with chlamydia psittaci pneumonia.Methods A total of 24 patients with chlamydia parsitti pneumonia admitted to the Second Affiliated Hospital of Anhui Medical University from January 2019 to January 2021 were enrolled as the case group,and 34 patients with mycoplasma pneumonia during the same period were enrolled as the control group.The general conditions,clinical manifestations,laboratory examination and chest CT characteristics were compared.Results There were statistically significant differences in age,length of hospital stay and peak fever between the two groups(P<0.05).Fever onset,chills,chest tightness,crackles,cough,nasal congestion and runny nose were statistically significant differences(P<0.05).There were statistically significant differences in PCT,IL-6,CRP,neutrophil count(Neut),lymphocyte count(Lymph),acidophilic granulocyte count(Eos),basophilic granulocyte count(Baso),neutrophil percentage(Neut%),D-dimer,albumin,alanine aminotransferase(ALT),aspertate aminotransferase(AST),direct bilirubin(DBiL),sodium and chloride between the two groups(P<0.05).ROC curve showed that the area under ROC curve(AUC)of CRP,IL-6,PCT,Neut%and Neut were 0.984,0.921,0.914,0.834 and 0.673,respectively,which had statistical significance for the diagnostic of Psittacosis.There were statistically significant differences in the involvement of CT lesions in the left lower lobe between the two groups(P<0.05).The incident rates of large area of consolidation shadow,ground glass shadow,air bronchogram,pleural effusion,bronchial wall thickening,interstitial thickening,tree bud sign and pericardial effusion were statistically significant differences(P<0.05).Conclusion Chlamydia pneumonia is mainly saw middle-aged and elderly,with contact history with poultry.Fever is the first symptom,inflammatory indicators are significantly increased,WBC is not high,Eos are decreased,Baso are normally low,often accompanied by abnormal liver function indicators,electrolyte disorder,imaging manifestations of large area of consolidation shadow,air bronchogram,pleural effusion rate is high.