Takayanagi Noboru, Ishiguro Takashi, Matsushita Aya, Yoshii Yutaka, Kagiyama Naho, Miyahara Yousuke, Yoneda Koichiro, Tokunaga Daidou, Aoki Fumiaki, Saito Hiroo, Ubukata Mikio, Kurashima Kazuyoshi, Yanagisawa Tsutomu, Sugita Yutaka
Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center.
Nihon Kokyuki Gakkai Zasshi. 2009 Jul;47(7):558-68.
The aim of the current study was to investigate the lethal complications of Legionella pneumonia. Severe complications and their outcomes in 65 patients with Legionella pneumonia were studied. All patients who eventually had a fatal outcome or who had severe complications received antimicrobial agents active against Legionella on the admission day. Many patients in the severe complication category had multiple severe complications. Six deaths occurred (mortality rate 9.2%), 4 of which were due to septic shock/multiple organ dysfunction syndrome (MODS) (2 patients) or interstitial pneumonia/pulmonary fibrosis after Legionella pneumonia (2 patients), whereas the other 2 deaths were due to causes unrelated to Legionella pneumonia. Mortality rates for each severe complication were as follows: acute respiratory distress syndrome 27.3% (3 of 11); renal failure 33.3% (2 of 6); disseminated intravascular coagulation 33.3% (2 of 6); severe sepsis 0% (0 of 1); septic shock/MODS 66.7% (2 of 3); interstitial pneumonia/pulmonary fibrosis 50% (2 of 4). Despite prompt diagnosis and appropriate treatment with antimicrobial agents active against Legionella, the lethal complications of Legionella pneumonia are septic shock/MODS and interstitial pneumonia/pulmonary fibrosis.
本研究的目的是调查军团菌肺炎的致死性并发症。对65例军团菌肺炎患者的严重并发症及其结局进行了研究。所有最终出现致命结局或有严重并发症的患者在入院当天均接受了针对军团菌的抗菌药物治疗。严重并发症组中的许多患者有多种严重并发症。发生了6例死亡（死亡率9.2%），其中4例是由于感染性休克/多器官功能障碍综合征（MODS）（2例患者）或军团菌肺炎后的间质性肺炎/肺纤维化（2例患者），而另外2例死亡是由于与军团菌肺炎无关的原因。每种严重并发症的死亡率如下：急性呼吸窘迫综合征27.3%（11例中的3例）；肾衰竭33.3%（6例中的2例）；弥散性血管内凝血33.3%（6例中的2例）；严重脓毒症0%（1例中的0例）；感染性休克/MODS 66.7%（3例中的2例）；间质性肺炎/肺纤维化50%（4例中的2例）。尽管及时诊断并使用针对军团菌的抗菌药物进行了适当治疗，但军团菌肺炎的致死性并发症仍是感染性休克/MODS和间质性肺炎/肺纤维化。
