社区获得性军团菌肺炎21例临床分析

目的探讨社区获得性军团菌肺炎（CALP）的临床特征、诊断及治疗。方法分析我院2003年1月～2006年10月经免疫荧光法及血微量凝集法（MAT）检测军团菌血清抗体诊断明确的21例CAI。P的临床症状，实验室检查，影像学改变，阿奇霉素或莫西沙星的疗效。结果①21例CALP患者中，重症肺炎占57％。无基础疾病11例，糖尿病患者4例，慢性阻塞性肺病病患者4例。②主要临床症状发热≥38．0℃，干咳，头痛，肌肉关节酸痛，胸痛，多汗，腹痛、腹泻。血白细胞〉10×10^9／L72．7％，CRP〉100mg90．9％，低钠血症及丙氨酸转氨酶、天冬氨酸转氨酶、乳酸脱氢酶、血尿素氮增高〈50．0％。③胸部CT表现为肺实变、间质改变、渗出、网织状阴影及胸腔积液。病变累及2叶以上多见。④21例CALP患者经血清抗体检测分别为血清型Lp6，Lp3，Lp1，Lp4。⑤21例CALP患者（包括12例重症肺炎）经阿奇霉素500mg／d或莫西沙星400mg／d序贯治疗后痊愈。结论当重症社区获得性肺炎合并多系统损害时要考虑军团菌肺炎的可能。早诊断，尽早选用合适的抗菌药治疗至关重要，新大环内酯类抗生素和呼吸喹诺酮类抗菌药物是治疗军团菌肺炎的一线用药。

Clinical analysis of 21 patients with community-acquired Legionella pneumonia

Objective To explore the diagnosis, treatment and clinical features of community-acquired Legionella pneumonia （CALP）. Methods A prospective study was carried out in 21 patients with CALP in our hospital from January 2003 to October 2006. Immunofluoreseent assay and mieroagglutination method （MAT） were preformed respectively. The clinical, laboratory, radiologieal data and treatment outcome were analyzed. Results （1） 57% of the 21 CALP patients had severe pneumonia. Eleven eases did not have any underlying condition. The underlying conditions were diabetes （4/21）, chronic obstructive pulmonary disease （4/21） ; （2） The clinical features were fever≥38.0 ℃, dry cough, chest pain, hemoptysis, sweating, abdominal pain, diarrhea, muscular pain, and arthralgia. WBC〉 10 × 10^9/L 72.7%, CRP〉 100 mg 90.90%, hyponatremia, high ALT, AST, LDH, BUN were also found. （3） Chest CT showed lung consolidation, infiltration, pleural effusion, interstitial changes, and reticular shadow. More than two lung lobes were involved in most cases. （4） Serogroup Lp6, Lp3, Lp1, and Lp4 were identified in the 21 Legionella pneumonia patients. （5） All the 21 CALP patients （including the 12 severe cases） were cured with parenteral azithromyein 500 mg/d or moxifloxaein 400 mg/d sequential therapy. Conclusions Legionella pneumonia should be considered if CAP is severe and/or complicated with multiple organ lesions. It＇s important to make diagnosis and choose appro- priate antibiotic as soon as possible. Newer maerolides and fluoroquinolones are currently among the first-line therapies for Legionella infections.