急性Q热10例临床特征分析

Analysis of clinical features of 10 cases of acute Q fever

目的探讨急性Q热的临床特征,以提高对该病的认识。方法收集2020年11月—2023年12月南通大学附属医院收治的10例急性Q热患者的临床资料,回顾性分析一般资料、流行病学特点、临床表现、实验室检查结果、影像学表现、治疗方案及转归。结果10例患者中男性7例,女性3例,年龄(58.30±6.41)岁。3例与羊、1例与禽类有接触史,6例无明确流行病学史。临床表现主要为发热、畏寒、乏力、咳嗽、头痛、恶心等。实验室检查中血常规白细胞计数略偏高1例,下降2例,中性粒细胞比例偏高3例,淋巴细胞计数下降2例;降钙素原升高6例;C反应蛋白、D-二聚体、丙氨酸氨基转移酶、门冬氨酸氨基转移酶、乳酸脱氢酶均升高。10例患者均通过宏基因二代测序技术(metagenome next-generation sequencing,mNGS)检测到贝纳柯克斯体。明确诊断后10例患者均调整治疗方案,采取多西环素/米诺环素单用或联合治疗,患者均好转出院。结论急性Q热患者常无明确流行病学史,缺乏特征性临床表现,常规实验室检查难以确诊,对可疑病例mNGS检查可提供病原学诊断依据,以多西环素或米诺环素为基础的综合治疗,疗效良好。

Objective To explore the clinical characteristics of acute Q fever to improve the understanding of the disease.Methods The clinical data of 10 patients with acute Q fever admitted to the Affiliated Hospital of Nantong University from November 2020 to December 2023 were collected,and the general data,epidemiological characteristics,clinical manifestations,laboratory test results,imaging manifestations,treatment plans,and outcomes were retrospectively analyzed.Results Among the 10 patients,there were 7 males and 3 females,with an average age of(58.30±6.41)years.Three patients had contact history with sheep,one with poultry,and six without clear epidemiological history.The main clinical manifestations were fever,chills,fatigue,cough,headache,nausea,etc.Laboratory tests showed slight leukocytosis in one case,leukopenia in two cases,elevated neutrophil ratio in three cases,and lymphopenia in two cases;procalcitonin was elevated in six cases;C-reactive protein,D-dimer,alanine aminotransferase,aspartate aminotransferase,and lactate dehydrogenase were elevated in all cases;Coxiella burnetii was detected in all 10 patients by metagenomic next-generation sequencing(mNGS).Upon diagnosis,treatment regimens were adjusted for all patients,using doxycycline or minocycline either alone or in combination,and all patients recovered and were discharged from the hospital.Conclusions Acute Q fever patients often have no clear epidemiological history and lack characteristic clinical manifestations,making conventional laboratory tests insufficient for diagnosis.mNGS examination can provide a basis for etiological diagnosis of suspected cases,and comprehensive treatment based on doxycycline or minocycline shows good efficacy.