惠普尔养障体肺炎临床特征分析

Analysis of clinical features of Tropheryma whipplei pneumonia

目的 分析惠普尔养障体(Tropheryma whipplei, TW)肺炎患者的临床资料,总结TW肺炎的临床特点、诊断及治疗方法。方法 回顾性收集2021年1月1日-2022年10月1日湖南省3家医院TW肺炎患者的病历资料。分析纳入患者的临床症状、实验室检查结果、宏基因组二代测序结果、CT影像表现、诊疗经过和治疗效果。结果 共纳入患者4例。其中,男2例,女2例;以咳嗽、咳痰、发热、气促为主要表现;双肺弥漫性磨玻璃影2例,肺结节1例,肺空洞性病变1例,胸膜病变1例,肺部渗出性病变2例,纵隔淋巴结肿大1例。宏基因组二代测序结果显示,4例患者均检出TW,序列数的中位数(下四分位数,上四分位数)为1 528(1 480,1 576)条。经抗感染治疗,3例治疗有效,1例治疗效果不佳。结论 宏基因组二代测序是确诊TW肺炎的有效方法。测定血清乳酸脱氢酶水平,有助于病情评估及预后的判断。哌拉西林他唑巴坦、美罗培南、多西环素对该病有一定效果,而莫西沙星及甲氧苄啶/磺胺甲噁唑可能存在天然耐药性,不建议使用。

Objective To analyze the clinical data of patients with Tropheryma whipplei pneumonia,and summarize the clinical characteristics,diagnosis,and treatment methods of Tropheryma whipplei pneumonia.Methods The data of Tropheryma whipplei pneumonia patients from three hospitals in Hunan Province between January 1,2021 and October 1,2022 were retrospectively collected.The clinical symptoms,laboratory examination,metagenomics next-generation sequencing(mNGS),CT imaging features,diagnosis and treatments of the included patients were analyzed.ResultsA total of 4 patients were included.Among them,there were 2 males and 2 females.The main manifestations were cough,expectoration,fever,and shortness of breath.There were 2 cases of dffuse ground glass opacity in both lungs,I case of pulmonary nodule,I case of pulmonary cavity,1 case of pleural disease,2 cases of pulmonary exudative lesions,and 1 case of mediastinal lymphadenectasis.The mNGS results showed that Tropheryma whipplei was detected in all 4 patients,and the median number of serial number(lower quartile,upper quartile)was 1528(1480,1576).After anti infection treatment,3 cases were treated effectively,and 1 case had poor treatment effect.Conclusions mNGS is an effective method to diagnose Tropheryma whipplei pneumonia.The measurement of serum lactate dehydrogenase level is helpful to evaluate the disease and determine the prognosis.Piperacillin tazobactam,meropenem and doxycycline are effective for this disease,while moxifloxacin and trimethoprim/sulfamethoxazole are not recommended because they may be naturally resistant.Without active etiological treatment,the disease may persist in migration and lead to extrapulmonary involvement.