鹦鹉热衣原体肺炎21例临床特征分析

Chlamydia psittaci pneumonia:a clinical analysis of 21 patients

目的探讨鹦鹉热衣原体肺炎的临床诊疗特点。方法回顾性分析2020年1月—2023年3月在南京医科大学第一附属医院住院并经宏基因组二代测序(metagenomic next-generation sequencing,mNGS)确诊的21例鹦鹉热衣原体肺炎患者的临床资料。根据重症肺炎诊断标准分为重症组(10例)和非重症组(11例),分析两组临床表现、实验室检查、影像学特征、治疗及预后。结果21例患者中男11例,女10例,平均年龄(51.7±11.6)岁,均为急性起病,12例有禽类接触史。18例患者发病时间为秋冬季节。所有患者均有高热,其他常见症状包括咳嗽、咳痰、胸闷及乏力。重症组实验室检查提示白细胞、中性粒细胞计数、C反应蛋白、降钙素原、转氨酶、肌酸激酶、乳酸脱氢酶(lactic dehydrogenase,LDH)、脑钠肽前体及D-二聚体水平明显高于非重症组。影像学检查发现所有患者均出现不同程度实变影及斑片影,周围伴有渗出,重症组患者中更易出现双肺受累、双侧胸腔积液、空洞及纵隔淋巴结肿大。治疗方面,11例患者单用四环素类药物,3例患者单用大环内酯类,2例患者单用呼吸喹诺酮类,5例患者联合使用含四环素类在内的两种药物治疗。所有患者治疗后复查胸部CT均提示肺部病变吸收。结论鹦鹉热衣原体肺炎好发于秋冬季节,患者多有禽类接触史,其临床表现及影像学检查无明显特异性,mNGS可实现该病早期诊断,中性粒细胞计数与淋巴细胞计数的比值及LDH水平可帮助评估重症风险。

Objective To explore the clinical characteristics of Chlamydia psittaci pneumonia.Methods From January 2020 to March 2023,21 cases of Psittacosis from the First Affiliated Hospital of Nanjing Medical University were diagnosed via metagenomic next-generation sequencing(mNGS).They were divided into a severe group(n=10)and a non-severe group(n=11)based on diagnostic criteria for severe pneumonia,and the clinical presentation,secondary examination,treatment,and prognosis of the two groups were analyzed retrospectively.Results Among the 21 patients,there were 11 males and 10 females,with a mean age of(51.7±11.6)years.All patients had an acute onset and 12 had a confirmed history of exposure to poultry.The onset of the disease occurred in the autumn and winter seasons in 18 patients.All the patients were suffering from high fevers.Other symptoms included coughing,phlegm,tightness in the chest and fatigue.Laboratory examinations showed that the levels of leukocytes,neutrophil counts,C-reactive protein,procalcitonin,aminotransferase,creatine kinase,lactic dehydrogenase,brain natriuretic peptide precursors and D-dimer were significantly higher in the severe group than those in the non-severe group.Chest CT scans revealed varying levels of consolidation and spot shadowing with peripheral exudate in all patients.The patients in the severe group were more likely to have bilateral lung involvement,bilateral pleural effusion,cavity and mediastinal lymph node enlargement.Eleven patients received tetracycline alone,three received laudanum alone,two received respiratory quinolones alone,and five received a combination of two drugs including tetracycline.Chest CT at clinical follow-up showed absorption of lung lesions.Conclusions Chlamydia psittaci pneumonia usually occurs in the fall and winter,and most patients have a history of contact with poultry.Clinical presentation and imaging are not specified.The technology of mNGS enables early diagnosis of the disease,and neutrophil lymphocyte ratio,neutrophil-lymphocyte ratio and lactic dehydrogenase levels help assess the risk of severe disease.