鹦鹉热衣原体肺炎 28例临床特征分析

目的分析经宏基因组二代测序技术(metagenopmic next generation sequencing，mNGS)确诊的 28例鹦鹉热衣原体肺炎病人的临床特点。方法回顾性分析 2019年 10月 1日至 2022年 4月 1日长沙市第一医院采用 mNGS诊断的 28例鹦鹉热衣原体肺炎病人的诊治情况。结果 28例病人中 10例为女性， 18例为男性，中位年龄 60岁； 27例病人有明确禽类接触史， 1例无。重症病例占 32.1%，多为有慢性阻塞性肺疾病(COPD)糖尿病、高血压、冠心病或尿毒症等基础疾病病人。临床表现包括发热(100%)、畏寒(28.6%)、咳嗽、咳痰(71.4%)、气促(53.6%)。、外周血中白细胞总数多在正常范围， 96.4%的病人中性粒细胞比例增高、淋巴细胞比例降低； 96.4%病人 PCT升高，所检测病人中 ESR和 CRP升高者达 100%；分别有 71.4%和 50%病人乳酸脱氢酶和肌酸激酶增高；有 82.1%的病人谷草转氨酶增高，有 78.6%的病人白蛋白降低。胸部 CT表现单侧病变 25例、其中右肺病变 19例，常见影像改变是斑片状阴影(78.6%)、大片实变(21.4%)，26例伴有胸腔积液。治疗情况:单用氟喹诺酮类(莫西沙星或者左氧氟沙星)治疗 9例，单用多西环素治疗 2例；联合用药 13例，其中青霉素类(哌拉西林他唑巴坦或头孢哌酮舒巴坦钠)联用喹诺酮类有 10例，青霉素类联合多西环素 3例。有 2例病人初始选择青霉素类加喹诺酮类药物治疗无效，改用多西环素或联用多西环素后症状缓解。 28例病人均预后良好，无死亡病例。结论鹦鹉热衣原体肺炎病人的职业史、临床表现、实验室检查结果及肺部 CT具有一定的特点；临床对可疑病例应尽早行 mNGS检测，快速过渡到精准治疗，能明显改善预后。

Clinical analysis of 28 cases of Chlamydia psittaci pneumonia

Objective To analyze the clinical data of 28 patients with Chlamydia psittaci pneumonia diagnosed by metagenomic nextgeneration sequencing (mNGS). Methods The diagnosis and treatment of 28 cases of Chlamydia psittaci pneumonia diagnosed viametagenomic next-generation sequencing (mNGS) in The First Hospital of Changsha from October 1, 2019 to April 1, 2022 were retrospectively analyzed.Results Among the 28 patients, there were 18 males and 10 females, with a median age of 60 years. 27 patientshad a confirmed history of exposure to poultry.Only 1 patient had no definite history of poultry exposure. Severe cases accounted for32.1%, mostly patients with chronic obstructive pulmonary disease (COPD), diabetes, hypertension, coronary heart disease or uremiaand other basic diseases. Clinical manifestations included fever (100%), chills (28.6%), cough and sputum (71.4%,), and dyspnea(53.6%). Laboratory data showed that white blood cells were mostly in the normal range, and the proportion of neutrophil increased andlymphocyte decreased in 96.4% patients. PCT was elevated in 96.4% of patients, ESR and CRP were elevated in 100% of detected patients. Percentages of patients with increased lactate dehydrogenase and creatine kinase were 71.4% and 50%, respectively. Aspartateaminotransferase (AST) increased in 82.1% of patients and albumin decreased in 78.6% of patients. Chest CT scans showed unilaterallung involvement in 25 cases and right lung field involvement in 19 cases. The most common imaging changes were patchy shadowswith increased density (78.6%) and large patchy consolidation (21.4%), and there were 26 cases with pleural effusion. In terms of treatment, 9 patients were treated with fluoroquinolones alone, 2 patients with doxycycline alone, and 13 patients with combined treatmentincluding penicillin (piperacillin-tazobactam or cefoperazone sulbactam sodium) combined with quinolones in 10 patients and penicillin combined with doxycycline in 3 patients. In 2 patients, the initial treatment with penicillins plus quinolones failed, but their symptoms were relieved after they were switched to doxycycline or combined doxycycline. All the 28 patients had a good prognosis, andthere was no death due to the disease.Conclusions The professional history, clinical symptoms, laboratory tests and chest imaging ofchlamydia psittaci pneumonia have certain features. Clinical suspicious cases should be confirmed by mNGS detection as early as possible, and rapid transition to precise treatment can significantly improve the prognosis.