结合宏基因组二代测序诊断的鹦鹉热衣原体肺炎临床特征分析

Clinical characteristics analysis of Chlamydia psittaci pneumonia detected by metagenomic next-generation sequencing

目的 分析鹦鹉热衣原体肺炎临床特征,提高临床医生对此病的认识和诊治水平。方法 回顾性分析2020年9月—2022年1月西南医科大学附属医院收治的经宏基因组二代测序辅助诊断的39例鹦鹉热衣原体肺炎患者的临床资料。结果 89.7%(35例)患者有禽类接触史,典型的临床表现为高热(92.3%,36例)、咳嗽(76.9%,30例)、肌肉酸痛(48.7%,19例)、头痛(38.5%,15例)等。实验室检查提示:76.9%白细胞数正常,76.9%淋巴细胞数下降,多伴有C-反应蛋白(100%)、降钙素原(97.4%)、白介素-6(95.8%)、白介素-10(95.8%)、谷丙转氨酶(74.4%)、谷草转氨酶(84.6%)升高。单因素分析提示重症组与非重症组谷草转氨酶、血尿素氮、C-反应蛋白、降钙素原差异有统计学意义(P<0.05),多因素Logistic回归分析显示血尿素氮升高(OR=4.899)对预测患者并发重症肺炎具有指导意义。53.6%鹦鹉热衣原体肺炎支气管镜下未见异常。影像学表现多呈大叶性肺炎(61.5%)、气管充气征阳性(94.9%)。治疗上其对四环素类、大环内酯类和氟喹诺酮类敏感,最终84.6%(33例)患者好转出院。结论 鹦鹉热衣原体肺炎是一种人畜共患传染病,可使用宏基因组二代测序协助诊断。血尿素氮升高对预测患者并发重症肺炎具有指导意义,治疗上可经验性选用以多西环素为基础的方案。

Objective To analyze the clinical characteristics of Chlamydia psittaci pneumonia and improve the diagnosis and treatment skills of clinicians on this disease.Methods The clinical data of thirty-nine Chlamydia psittaci pneumonia cases detected by metagenomic next-generation sequencing(mNGS)from September 2020 to January 2022 at the Affiliated Hospital of Southwest Medical University were retrospectively analyzed.Results There was a history of poultry exposure in 89.7%(35 cases)of the patients.The most common clinical manifestations were high fever(92.3%,36),cough(76.9%,30),muscle soreness(48.7%,19),headache(38.5%,15),etc.Laboratory examinations showed 76.9%of patients had a normal leukocyte count,and 76.9%had decreased lymphocyte count,often accompanied by elevated C-reactive protein(100%),procalcitonin(97.4%),interleukin-6(95.8%),interleukin-10(95.8%),alanine aminotransferase(74.4%),and aspartate aminotransferase(84.6%).Univariate analysis indicated that there were statistically significant differences in the levels of aspartate transaminase,blood urea nitrogen,C-reactive protein,and procalcitonin between severe pneumonia patients and nonsevere pneumonia patients(P<0.05).Multivariate logistic regression analysis showed that an elevated blood urea nitrogen(OR=4.899)had guiding significance for predicting the occurrence of severe pneumonia.Bronchoscopy examination showed no abnormalities in 53.6%of the patients.The imaging manifestations of pulmonary lesions were mainly lobar pneumonia(61.5%)and air bronchograms(94.9%).Therapeutically,it was sensitive to tetracyclines,macrocyclic lactones,and fluoroquinolones.A total of 84.6%(33 cases)of the patients were cured and discharged from the hospital at the end of the treatment.Conclusion Chlamydia psittaci pneumonia is a zoonotic disease that can be detected by mNGS.An elevated blood urea nitrogen level has guiding significance for predicting the occurrence of severe pneumonia.Empirically-selected regimens based on doxycycline are effective for the treatment of Chlamydia psittaci pneumonia.