摘要
目的分析鹦鹉热衣原体肺炎患者的临床特征,探讨血清炎症标志物与疾病严重程度的关系。方法选取2020年1月至2021年7月惠州市中心人民医院收治的16例鹦鹉热衣原体肺炎患者为研究对象,重症10例,轻症6例;收集并分析患者的一般情况、症状和体征、实验室检查及胸部影像学特征等临床资料。结果①16例鹦鹉热衣原体肺炎患者中有13例有鸟类或家禽接触史,常见症状包括高热、畏寒、咳嗽、乏力及纳差(16例),呼吸困难(12例)及其他系统症状。②外周血常规检查可见白细胞计数(WBC)正常(10例)及淋巴细胞计数(LYM)减少(13例),大多数患者超敏C-反应蛋白(hs-CRP,16例)、D-二聚体(15例)水平明显升高,多数患者出现乳酸脱氢酶(LDH,13例)、天冬氨酸转氨酶(AST,16例)、丙氨酸转氨酶(ALT,12例)水平升高及白蛋白(Alb,15例)下降,多数患者CD3+、CD4+T细胞减少(均为10例)。③重症鹦鹉热衣原体肺炎患者D-二聚体、白细胞介素(IL-2、IL-6、IL-10)水平显著高于轻症患者〔D-二聚体(μg/L):10257±4203比1085±642,IL-2(ng/L):1.1(0.8,1.7)比0.3(0.1,0.7),IL-6(ng/L):315(182,505)比75(18,131),IL-10(ng/L):7.0±4.1比2.3±0.7〕,但LYM明显低于轻症患者(×109/L:0.4±0.1比1.1±0.4),差异均有统计学意义(均P<0.05)。④胸部影像以渗出性病变与肺大片实变为特征,部分重症患者可出现双肺大面积实变。结论鹦鹉热衣原体肺炎主要与鸟类或家禽接触有关,常见表现为高热、呼吸困难、白细胞正常或轻度升高,影像学表现为肺大片实变;血中LYM、D-二聚体、IL-2、IL-6及IL-10水平有助于疾病严重程度分型。
Objective To analyze the clinical characteristics of Chlamydia psittaci pneumonia and to investigate the correlation between serum inflammatory biomarkers and severity of the disease.Methods Sixteen patients with Chlamydia psittaci pneumonia admitted to the Huizhou Municipal Central Hospital from January 2020 to July 2021 were selected as the study subjects,including 10 severe cases and 6 mild cases.Clinical data were collected and analyzed,such as baseline characteristics,clinical symptoms,laboratory inspection and chest imaging manifestations.Results①Thirteen Chlamydia psittaci pneumonia were associated with a definite bird or poultry contact history.Common symptoms included high fever,chill,cough,fatigue,and anorexia(16 cases),dyspnoea(12 cases),and other systemic symptoms.②Laboratory test results showed normal white blood cell count(WBC,10 cases),decreased lymphocyte count(LYM,13 cases),increased high sensitive C-reactive protein(hs-CRP,16 cases),D-dimer(15 cases),lactate dehydrogenase(LDH,13 cases),aspartate aminotransferase(AST,16 cases)and alanine aminotransferase(ALT,12 cases)levels,however,the albumin(Alb,15 cases)lever was decreased.The numbers of CD3+T cells and CD4+T cells decreased in 10 patients.③The levels of D-dimer,interleukins(IL-2,IL-6,IL-10)in severe Chlamydia psittaci pneumonia were significantly higher than those in mild Chlamydia psittaci pneumonia[D-dimer(μg/L):10257±4203 vs.1085±642,IL-2(ng/L):1.1(0.8,1.7)vs.0.3(0.1,0.7),IL-6(ng/L):315(182,505)vs.75(18,131),IL-10(ng/L):7.0±4.1 vs.2.3±0.7],but the LYM was lower(×109/L:0.4±0.1 vs.1.1±0.4),with significant differences(all P<0.05).④Chest imaging manifestations were exudative lesions and large consolidation of lungs.Large consolidation of both lungs can occur in some critically ill patients.Conclusions Chlamydia psittaci pneumonia is mainly associated with a bird or poultry contact history.The clinical manifestations usually present high fever,dyspnea,normal or slightly increased leucocytes,and lung consolidation.The levels of LYM,D-dimer,IL-2,IL-6 and IL-10 in serum are expected to predict the severity of the Chlamydia psittaci pneumonia.
作者
方昌全
徐丽敏
卢健聪
谢燕君
谭洪毅
林俊鸿
Fang Changquan;Xu Limin;Lu Jiancong;Xie Yanjun;Tan Hongyi;Lin Junhong(Department of Respiratory and Critical Care Medicine,Huizhou Municipal Central Hospital,Huizhou 516000,Guangdong,China;Department of Geriatrics,Huizhou First People's Hospital,Huizhou 516000,Guangdong,China)
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2021年第11期1366-1369,共4页
Chinese Critical Care Medicine
基金
广东省惠州市科技专项(2020Y105)。
关键词
鹦鹉热衣原体
肺炎
炎性因子
临床特征
Chlamydia psittaci
Pneumonia
Inflammatory cytokine
Clinical feature
