7例Q热患者的临床特征分析及其诊治

Clinical characteristics,diagnosis and treatment of 7 patients with Q fever

目的分析Q热患者的临床特征,总结其诊断及治疗方法,提高临床对该病的认识。方法通过回顾性分析2021年7月-2024年2月新疆维吾尔自治区人民医院经宏基因组二代测序(mNGS)技术辅助诊断为Q热的7例患者临床资料,进行归纳总结,提取该病的共同特征加以分析。结果7例患者中男5例,女2例,年龄28~68岁,住院时间为9~34 d。其中6例以发热、1例以腹胀为首发症状,可伴有肌痛、头痛、乏力、胸闷、气憋等症状。3例伴有脾大,1例伴有腋窝增大淋巴结,1例腹水征阳性。仅1例有明确疫区居住史。1例患者出现白细胞计数升高,5例中性粒细胞百分比升高,6例炎性指标C反应蛋白、降钙素原呈不同程度的升高,3例白细胞介素-6升高,5例丙氨酸氨基转移酶及天冬氨酸氨基转移酶升高。1例超声心动图提示主动脉瓣赘生物形成,1例头颅MRI提示双侧软脑膜可疑强化,存在脑膜脑炎;1例腹部B超提示大量腹水;1例胸部CT提示肺部炎症。7例患者均经mNGS技术检出贝纳特柯克斯体有效序列(5~3880条),明确诊断为Q热,经多西环素、或联合美罗培南(1例)治疗好转出院。结论Q热通常无特异性临床特征、影像学表现,mNGS检测可助其快速诊疗。

Objective To analyze the clinical features of patients with Q fever,summarize its diagnosis and treatment,and promote the recognition of clinical features of this disease.Method The hospitalization data of 7 patients diagnosed with Q fever by metagenomic next⁃generation sequencing(mNGS)technology in the People's Hospital of Xinjiang Uygur Autonomous Region from July 2021 to February 2024 were retrospectively analyzed,and their common clinical characteristics were summarized.Results A total of 7 patients were enrolled,including 5 males and 2 females,aged 28-68 years old.The duration of hospitalization was 9 to 34 days.The main symptom of 6 cases was fever,1 case had an initial symptom of abdominal distension,accompanied by myalgia,headache,fatigue,chest tightness and dyspnea.3 cases had splenomegaly,1 case presented with enlarged axillary nodes,and 1 case was positive for ascites.Only 1 case had a definite history of residing in the epidemic area.The clinical biochemical results showed that the counts of white blood cells were increased in 1 patient,the percentage of neutrophil was increased in 5 patients,the inflammatory indexes C⁃reactive protein,procalcitonin were increased in 6 patients,interleukin⁃6 was increased in 3 patients,and alanine aminotransferase and aspartic transaminase were increased in 5 patients.Imaging examination revealed that 1 case of echocardiography showed the formation of aortic valve neoplasms,1 case of head MRI showed suspicious bilateral pia enhancement with meningoencephalitis,1 case of abdominal B⁃ultrasonography showed massive ascites,and 1 case of chest CT showed pulmonary inflammation.All the 7 patients were diagnosed with Q fever by mNGS technique,5~3880 valid sequences of benatcox body were detected,and were treated with doxycycline or combined with meropenem(1 case).Conclusion Q fever lacked specific clinical manifestations and imaging features,and mNGS could provide a better option for the identification of Q fever which was difficult to diagnose.