老年鹦鹉热衣原体肺炎患者的临床特征分析

Analysis of clinical features of elderly patients with Chlamydia psittaci pneumonia

目的探讨老年鹦鹉热衣原体肺炎患者的临床特点、影像学、实验室检查及治疗策略。方法回顾性分析2020年1月-2021年10月福建医科大学附属龙岩第一医院采用宏基因组二代测序(mNGS)技术诊断的14例老年鹦鹉热衣原体肺炎患者的诊治过程,记录患者临床表现、实验室检查、影像学表现和治疗及预后情况。结果14例患者平均年龄(68.9±5.9)岁,7例有明确禽类接触史;临床主要表现包括发热(100.0%,14/14)、乏力(71.4%,10/14)、Ⅰ型呼吸衰竭(50.0%,7/14)。实验室检查白细胞(WBC)有6例高于9.95×10^(9)/L,中性粒细胞比例(NR)多数增高,13例NR高于75%。所有病例均表现为C反应蛋白(CRP)明显增高。最常见的影像改变是实变,表现为大叶性肺炎,下叶及单肺叶大叶性肺炎常见(57.1%,8/14),常伴胸腔积液(71.4%,10/14)。治疗过程中,用药方案主要为单用莫西沙星、多西环素联合莫西沙星或者多西环素联合其他用药。最终出现休克2例,给予呼吸支持治疗2例,仅有1例死亡,其他均好转。结论老年鹦鹉热衣原体肺炎较易出现低氧血症,甚至呼吸衰竭,经恰当的治疗,总体预后良好,能取得明显的效果。

Objective To investigate the clinical features,imaging characteristics,laboratory tests and treatment strategies of elderly patients with Chlamydia psittaci pneumonia.Methods A retrospective analysis of 14 elderly patients with Chlamydia psittaci pneumonia diagnosed by macrogenomic second-generation sequencing technology from January,2020 to October,2021 in Longyan First Hospital Affiliated to Fujian Medical University.The patients' clinical features,laboratory tests,imaging manifestations and the treatment and prognosis were recorded.Results There were 14 cases with average age of(68.9±5.9)years old,and 7 cases with clear poultry exposure history.The main clinical features included fever(100.0%,14/14),malaise(71.4%,10/14),Ⅰ respiratory failure(50.0%,7/14)etc.The white blood cell count was above 9.95×10^(9)/L in 6 patients,and the neutrophil ratio(NR)was mostly increased,with 13 patients having a NR above 75%.All cases showed a significant increase in C-reactive protein.The most common imaging change was consolidation,which was manifested as lobar pneumonia.Lobar pneumonia in lower and single lobe was common(57.1%,8/14),often accompanied by pleural effusion(71.4%,10/14).In treatment,the main medication regimens were moxifloxacin alone,doxycycline combined with moxifloxacin or doxycycline combined with other drugs.There were 2 cases developed shock,and 2 cases were given respiratory support treatment.Only 1 case died,and the others cases were all improved.Conclusions Elderly patients with Chlamydia psittaci pneumonia were more likely to develop hypoxaemia or even respiratory failure.After appropriate treatment,the overall prognosis was positive and significant results could be achieved.