宏基因高通量测序辅助诊断鹦鹉热衣原体引起肺炎的价值

The value of metagenomic high-throughput sequencing in the auxiliary diagnosis of pneumonia caused by Chlamydia psittaci

目的鹦鹉热衣原体感染人类后可引起严重的临床表现,宏基因高通量测序的方法可以为鹦鹉热衣原体引起的肺炎的诊断提供了重要的价值。方法对浙江省台州恩泽医疗集团附属台州医院及恩泽医院2019年12月—2021年10月收治的4例鹦鹉热衣原体感染肺炎患者进行回顾性分析,分析4例患者的临床表现、与禽类是否有接触史、实验室检查的相关指标、不同时期影像学的特征、宏基因高通量测序的结果、临床的治疗经过及治疗结果等,从而为鹦鹉热衣原体肺炎的诊疗提供临床经验。结果4例患者实验室检查指标:白细胞计数(WBC)轻微升高或正常;降钙素原(PCT)以及中性粒细胞比例(Neut比例)均增高;C-反应蛋白(CRP)明显增高,丙氨酸氨基转移酶(ALT)及天冬氨酸氨基转移酶(AST)等心肌酶指标均有不同程度的升高;影像学结果显示:胸部CT表现为肺部有不同程度的斑片实变影,部分患者有少许胸腔积液,多数患者为单侧病变,也可为双侧病变。经过对症治疗数日后,对4例患者复查胸部CT,结果显示病变部位明显缩小,治疗有效。对所有的患者进行宏基因高通量病原微生物DNA的基因检测,结果均检测出鹦鹉热衣原体。患者经3 d~4 d的抗感染治疗后,体温降至正常,总病程19 d~31 d。结论鹦鹉热衣原体引起的肺炎患者病情严重,辅助宏基因高通量基因测序检测后,经合理救治,患者愈后良好。

Objective Chlamydia psittaci can cause severe clinical manifestations after infection in humans.The method of metagenomic high-throughput sequencing can provide important value for the diagnosis of pneumonia caused by Chlamydia psittaci.Methods A retrospective analysis was performed on 4 patients with Chlamydia psittaci infected pneumonia who were admitted to Taizhou Hospital Affiliated to Taizhou Enze Medical Group and Enze Hospital in Zhejiang Province from December2019 to October 2021.The clinical manifestations,contact history with poultry,related laboratory examination indicators,imaging characteristics at different periods,metagenomic high-throughput sequencing results,clinical treatment and treatment results of the four patients were analyzed,so as to provide clinical experience for the diagnosis and treatment of Chlamydia psittaci pneumonia.Results Laboratory test indicators of four patients with Chlamydia psittaci pneumonia were presented as:white blood cell count(WBC)was slightly increased or normal;the proportion of procalcitonin(PCT)and neutrophil ratio(Neut ratio)were increased;C-reactive protein(CRP)was significantly increased,alanine aminotransferase(ALT)and aspartate aminotransferase(AST)and other myocardial enzymes were increased to varying degrees.Imaging results showed that:chest CT presented varying degrees of patchy consolidation in lungs,and some patients had a little pleural effusion,most patients were with unilateral lesions or bilateral lesions.After several days of symptomatic treatment,chest CT was re-performed in 4 patients,and the results showed that the lesion site was significantly reduced,and the treatment was effective.High-throughput genetic testing of metagenomic pathogenic microorganism DNA was performed on all patients,and Chlamydia psittaci was detected.The body temperature returned to normal after 3 d-4 d of anti-infective treatment,and the total disease duration was 19 d-31 d.Conclusion The patients with Chlamydia psittaci pneumonia is in a serious condition.Auxiliary metagenomic high-throughput sequencing and reasonable treatment contribute to the patients’expected prognosis.