鹦鹉热衣原体肺炎22例临床分析

Chlamydia psittaci pneumonia: clinical analysis on 22 cases

目的分析鹦鹉热衣原体肺炎的临床表现、影像学表现、实验室指标及治疗方案。方法回顾性收集2019年9月至2022年6月郑州大学第一附属医院呼吸科收治的22例鹦鹉热衣原体肺炎患者的临床资料,分析其流行病学特点、实验室检查结果、影像学特点、治疗及预后。结果22例鹦鹉热衣原体肺炎患者常见症状为发热(22例)、咳嗽(15例)、乏力(11例)、呼吸困难(9例)、咳痰(7例)。22例患者白细胞计数正常,但C-反应蛋白(CRP)、降钙素原(PCT)、肌酸激酶(CK)、乳酸脱氢酶(LDH)、天冬氨酸转氨酶(AST)、D-二聚体及纤维蛋白原水平升高。22例患者CT表现为实变(22例),多叶分布(11例)及胸膜渗出(6例)。重症患者中性粒细胞百分比及CRP、PCT、LDH、CK水平显著升高,淋巴细胞百分比下降(P<0.05)。多西环素对22例患者治疗有效。5例行有创机械通气,其中2例给予静脉-静脉体外膜肺氧合治疗,发生感染性休克,需要血管活性药物治疗;1例患者行无创机械通气;3例患者行经鼻高流量湿化氧疗。22例患者中17例治愈,5例自动出院。结论鹦鹉热衣原体肺炎临床表现为高热、乏力伴大叶性肺炎,白细胞计数不高,淋巴细胞计数下降,炎症指标升高。重症患者症状不典型,但实验室结果有提示。多西环素治疗效果显著,预后较好。

Objective To analyze the clinical manifestations,imaging characteristics,laboratory indexes and treatment protocols of Chlamydia psittaci pneumonia.Methods The clinical data of 22 cases of Chlamydia psittaci pneumonia admitted to Department of Respiratory Medicine of the First Affiliated Hospital of Zhengzhou University from September 2019 to June 2022 were retrospectively collected.The epidemiological characteristics,results of laboratory tests,imaging characteristics,treatment protocols and prognosis were analyzed.Results Common symptoms in the 22 patients with Chlamydia psittaci pneumonia were fever(22 cases),cough(15 cases),fatigue(11 cases),dyspnea(9 cases),and sputum production(7 cases).Levels of leukocytes were normal,but levels of C-reactive protein(CRP),procalcitonin(PCT),creatine kinase(CK),lactate dehydrogenase(LDH),aspartate transaminase(AST),D-dimer,and fibrinogen increased in the 22 patients.CT in the 22 patients with Chlamydia psittaci pneumonia showed consolidation(22 cases),multilobar distribution(11 cases),and pleural effusion(6 cases).The percentage of neutrophils,CRP level,PCT level,LDH level,and CK level in severe patients significantly increased,and the percentage of lymphocytes decreased(P<0.05).Treatment with doxycycline is effective in the treatment of the 22 patients.Five patients underwent invasive mechanical ventilation,of them,2 cases treated by veno-venous extracorporeal membrane oxygenation had septic shock and required vasoactive therapy.One patient underwent non-invasive mechanical ventilation;and 3 patients underwent nasal high-flow humidified oxygen therapy.Seventeen of the 22 cases were cured,and 5 cases were automatically discharged.Conclusions Chlamydia psittaci pneumonia is characterized by high fever,fatigue and lobar pneumonia,low white blood cell count,decreased lymphocyte count and increased inflammatory markers.Symptoms are atypical in critically ill patients,but laboratory results suggest it.Doxycycline treatment has a significant effect and a good prognosis.