慢性Q热12例临床特征分析

Clinical characteristics of chronic Q fever:an analysis of 12 cases

目的总结和分析慢性Q热的临床特点,以提高对该病的认识。方法本研究为回顾性横断面研究。收集北京协和医院2008年1月至2022年12月确诊的慢性Q热患者的临床资料,回顾性分析其流行病学特点、临床表现、实验室检查结果、诊治及预后。结果共12例患者确诊为慢性Q热。男性11例,女性1例。诊断时患者中位年龄58(47,68)岁,从出现症状到确诊中位时间9.5(4.0~28.5)个月。10例患者有发热,其他常见症状包括虚弱(6例)、体重下降(5例)、胸闷气短(3例),肝脾大患者7例。1例患者心脏瓣膜和动脉同时受累,8例患者有感染性心内膜炎,1例患者有动脉瘤,2例患者未找到明确感染部位。7例患者血肌酐升高。8例患者检测类风湿因子,水平均升高。9例患者给予多西环素/米诺环素+羟氯喹两药联合治疗,3例应用多西环素/米诺环素单药治疗。随访时间3个月~14年,7例经抗菌药物治疗12~30个月后停药,体温正常;1例因心力衰竭于诊断6个月后死亡;1例失访;2022年诊断的3例患者仍继续口服药物治疗,目前病情稳定。结论慢性Q热临床表现缺乏特异性,感染性心内膜炎、动脉瘤是慢性Q热的常见表现。对于长期发热,伴有新发心脏瓣膜功能受损或感染性动脉瘤的患者,需要考虑到慢性Q热的可能。

ObjectiveTo analyze the clinical characteristics of chronic Q fever.MethodsThe epidemiological characteristics,clinical manifestations,laboratory results,diagnosis,treatment and prognosis of 12 patients with chronic Q fever admitted in Peking Union Medical College Hospital from January 2008 to December 2022 were analyzed retrospectively.ResultsOf the12 cases,there were 11 males and 1 female with a median age at diagnosis of 58 years(47-68).The median time interval between the onset of symptoms and diagnosis was 9.5 months(4.0-28.5).Ten patients had fever,and the common symptoms included weakness(n=6),weight loss(n=5)and shortness of breath(n=3).Seven patients presented with hepatomegaly and splenomegaly.Among the 12 patients,1 patient suffered from cardiac valve and artery involvement at the same time,8 patients suffered from infective endocarditis,and 1 patient suffered from aneurysm.No definite infection site was found in 2 patients.Seven of the 12 patients(58.3%)had elevated serum creatinine.Rheumatoid factors were detected in 8 patients,all of which were elevated.Nine patients were treated with doxycycline/minocycline plus hydroxylchloroquine and 3 patients were treated with doxycycline/minocycline.Patients were followed up for 3 months to 14 years,7 patients stopped antibiotics after 12 to 30 months and were in stable condition.One patient died of heart failure 6 months after diagnosis and 1 patient lost follow-up.Three patients diagnosed in 2022 were still under treatment and in stable condition.ConclusionsThe clinical manifestations of chronic Q fever lack of specificity and may involve multiple systems.Endocarditis and mycotic aneurysm are common complications.For long-term fever with new heart valve function damage or mycotic aneurysm patients,chronic Q fever should therefore be considered.