目的探讨鹦鹉热衣原体肺炎的临床特点、影像学、实验室检查及治疗策略。
方法回顾性分析中国大陆地区11家医院2019年1月1日至2021年1月20日采用宏基因组二代测序技术诊断的48例鹦鹉热衣原体肺炎的诊治过程，记录患者职业史、临床表现、实验室检查、胸部CT表现和治疗及预后情况。
结果48例患者中男性29例，女性19例，年龄（57.1±10.3）岁，30例有明确禽类接触史；从发病到入院的时间为（6.5±3.2）d，住院时间为（12.4±4.8）d。临床表现包括发热（100%，48/48）、相对缓脉（71%，34/48）、咳嗽（54.2%，26/48）、咯痰（27.1%，13/48）、乏力（16.7%，8/48）、头痛和谵妄（20.8%，9/48）、消化道症状（16.7%，8/48）。实验室检查中白细胞总数（8.0±3.8）×10 9/L，44例患者中性粒细胞比例增高；C反应蛋白（155.3±74.1）mg/L，59.5%患者PCT>0.5 μg/L，分别有82.9%和45.2%患者乳酸脱氢酶和肌酸激酶增高。胸部CT表现中单侧34例（70.8%）、单叶27例（56.3%），最常见的影像改变是实变，其中大叶性实变影38例（79.2%）。治疗情况中，单用氟喹诺酮类药物25例，单用多西环素6例，联合用药组13例，联合用药组与单用多西环素组在体温恢复正常时间相当，均优于单用氟喹诺酮类。入住ICU者11例，出现休克5例，给予呼吸支持治疗11例，仅有1例死亡。
结论鹦鹉热衣原体肺炎是一种动物源性感染性疾病，具有一定的临床症状、实验室检查和影像学特点，合适的治疗能明显缩短病程及改善预后。
ObjectiveTo explore the clinical characteristics, imaging findings, laboratory tests and treatment strategies for Chlamydia psittaci pneumonia.
MethodsFrom January 1, 2019 to January 20, 2021, 48 cases of Psittacosis from 11 hospitals in China were diagnosed via metagenomic next-generation sequencing(mNGS). The data of all patients on occupational history, clinical manifestations, laboratory tests, chest computed tomography(CT)findings, treatment outcomes and prognosis were retrospectively analyzed.
ResultsAmong the 48 patients, there were 29 males and 19 females, with a mean age of (57.1±10.3) years. Thirty patients had a confirmed history of exposure to poultry. The onset to admission interval was (6.5±3.2) days, and hospital stay was (12.4±4.8) days. Clinical manifestations included fever (100%, 48/48), relative bradycardia (71%, 34/48), cough (54.2%, 26/48), sputum (27.1%, 13/48), fatigue (16.7%, 8/48), headache and delirium (20.8%, 9/48), and gastrointestinal symptoms (16.7%, 8/48). Laboratory data showed that white blood cells were (8.0±3.8)×10 9/L, and the proportion of neutrophils increased in 44 patients. The level of C-reactive protein was (155.3±74.1)mg/L, and that of procalcitonin (PCT)in 59.5% of patients was more than 0.5 μg/L. Percentages of patients with increased lactate dehydrogenase and creatine kinase were 82.9% and 45.2%, respectively. Chest CT scans showed unilateral lung involvement in 34 cases(70.8%) and single lobe involvement in 27 cases(56.3%).The most common imaging change was consolidation, with 38 cases (79.2%) showing lobar consolidation. In terms of treatment, 25 patients were treated with fluoroquinolones alone, 6 patients with doxycycline alone, and 13 patients with combined treatment. The combined-treatment group and the doxycycline alone group were similar in the course of defervescence. The combined treatment group and the doxycycline alone group were both superior to the fluoroquinolones alone group. However, 11 patients were admitted to ICU, all of them received artificial ventilation, and 5 cases developed shock, and one died.
Conclusions Chlamydia psittaci pneumonia is an animal-derived infectious disease with unique features in clinical symptoms, laboratory tests and chest imaging. Appropriate treatment is able to significantly shorten the course of disease and improve the prognosis.
Shen Ling, Tian Xianjiang and Liang Rongzhang are contributed equally to the article
沈凌,田贤江,梁荣章,等. 鹦鹉热衣原体肺炎48例临床特征分析[J]. 中华结核和呼吸杂志,2021,44(10)：886-891.
DOI:10.3760/cma.j.cn112147-20210127-00082田贤江、梁荣章：论文撰写，数据收集；程瑗、孔祥龙、何飞、张超、张国安、李森华、陆华东、孙思庆：数据收集；沈凌：论文撰写、论文修改、经费支持
沈凌、田贤江、梁荣章对本文有同等贡献
沈凌, 田贤江, 梁荣章, 等. 鹦鹉热衣原体肺炎48例临床特征分析[J]. 中华结核和呼吸杂志, 2021, 44(10): 886-891. DOI: 10.3760/cma.j.cn112147-20210127-00082.
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