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肺炎:12例患者的临床分析

pneumonia: a clinical analysis of 12 patients.

作者信息

Huang Yubo, Zheng Wenzheng, Gan Wenlei, Zhang Tiantuo

机构信息

Department of Pulmonary and Critical Care Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.

出版信息

Ann Transl Med. 2023 Feb 15;11(3):144. doi: 10.21037/atm-22-6624. Epub 2023 Feb 5.

Abstract

BACKGROUND

We conducted a retrospective analysis to explore the clinical characteristics, laboratory examination, imaging features, treatment outcomes, and prognosis of the () pneumonia, aiming to improve early diagnosis and treatment.

METHODS

The clinical data of 12 patients with pneumonia diagnosed by metagenomic next-generation sequencing (mNGS) in our hospital were retrospectively analyzed. These data included baseline information, epidemiological history, clinical symptoms and signs, laboratory and chest computed tomography (CT) examination findings, treatment schemes, and prognosis.

RESULTS

The average age of the 12 patients was 58.25±13.27 years, and there were 7 (58.3%) males and 5 (41.7%) females in this cohort. Five patients had clear exposure to poultry or birds. The main clinical manifestations included fever (12/12, 100.0%), cough (12/12, 100.0%), expectoration (10/12, 83.3%), and dyspnea (10/12, 83.3%). Laboratory examination showed marked elevation of the total white blood cell (WBC) count, neutrophil (NEUT) count, C-reactive protein (CRP), procalcitonin (PCT), D-dimer, aspartate aminotransferase (AST), alanine aminotransferase (ALT), serum creatinine, and creatine kinase (CK) levels; as well as decreased hemoglobin (HGB), blood platelet (PLT), and albumin (ALB) levels. Arterial blood gas analysis showed that the average value of the oxygenation index (PO/FiO) was 290.9±83.1, which was less than 300 in 6 cases (50.0%). The main chest CT features were patchy or consolidation in the bilateral or unilateral lungs, and the boundary was not clear but showed a bronchial inflation sign. Also, some of the cases were accompanied by pleural effusion. Once the etiology was obtained, the patients were quickly treated with doxycycline combined with other antibiotics. All 12 patients improved and were discharged from the hospital. However, two severe patients were admitted to the intensive care unit (ICU) and received ventilation and monitoring treatment. There were no deaths.

CONCLUSIONS

pneumonia is an atypical community-acquired pneumonia (CAP) caused by infection, with its own laboratory and imaging characteristics. In this study, diagnosis was established based on the application of mNGS owing to the absence of easily available conventional pathogenic evidence. In addition, an aggressive and precise treatment strategy can help achieve a favorable prognosis for patients.

摘要

背景

我们进行了一项回顾性分析,以探讨()肺炎的临床特征、实验室检查、影像学特征、治疗结果和预后,旨在改善早期诊断和治疗。

方法

回顾性分析我院12例经宏基因组下一代测序(mNGS)诊断为肺炎的患者的临床资料。这些数据包括基线信息、流行病学史、临床症状和体征、实验室及胸部计算机断层扫描(CT)检查结果、治疗方案和预后。

结果

12例患者的平均年龄为58.25±13.27岁,该队列中有7例(58.3%)男性和5例(41.7%)女性。5例患者有明确的家禽或鸟类接触史。主要临床表现包括发热(12/12,100.0%)、咳嗽(12/12,100.0%)、咳痰(10/12,83.3%)和呼吸困难(10/12,83.3%)。实验室检查显示白细胞(WBC)总数、中性粒细胞(NEUT)计数、C反应蛋白(CRP)、降钙素原(PCT)、D-二聚体、天冬氨酸转氨酶(AST)、丙氨酸转氨酶(ALT)、血清肌酐和肌酸激酶(CK)水平显著升高;以及血红蛋白(HGB)、血小板(PLT)和白蛋白(ALB)水平降低。动脉血气分析显示氧合指数(PO/FiO)平均值为290.9±83.1,6例(50.0%)低于300。胸部CT主要表现为双侧或单侧肺部斑片状或实变影,边界不清但可见支气管充气征。部分病例伴有胸腔积液。一旦明确病因,患者迅速接受多西环素联合其他抗生素治疗。12例患者均好转出院。然而,2例重症患者被收入重症监护病房(ICU),接受通气和监测治疗。无死亡病例。

结论

肺炎是由感染引起的非典型社区获得性肺炎(CAP),有其自身的实验室和影像学特征。在本研究中,由于缺乏易于获得的传统病原学证据,基于mNGS的应用得以确诊。此外,积极精准的治疗策略有助于患者获得良好预后。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/12c5/9951019/6673dda63e5f/atm-11-03-144-f1.jpg

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