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中华肺部疾病杂志(电子版)

中华肺部疾病杂志(电子版) ›› 2026, Vol. 19 ›› Issue (03) : 444 -450. doi: 10.3877/cma.j.issn.1674-6902.2026.03.014

论著

54例重症鹦鹉热衣原体肺炎临床特征及预后回顾性分析
王家瑶1,2, 叶开婷1, 祝清清1, 费黎明1, 董佳慧1,†()   
  1. 1230022　合肥，安徽医科大学第一附属医院呼吸与危重症医学科
    2610041　成都，四川大学华西临床医学院
  • 收稿日期:2026-02-24 出版日期:2026-06-25
  • 通信作者: 董佳慧
  • 基金资助:
    安徽医科大学"早期接触科研"计划(2021-ZQKY-106)

Retrospective analysis of clinical characteristics and prognosis of 54 cases with severe Chlamydia psittaci pneumonia

Jiayao Wang1,2, Kaiting Ye1, Qingqing Zhu1, Liming Fei1, Jiahui Dong1,†()   

  1. 1Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Anhui Medical University, Anhui 230022, China
    2West China School of Medicine, Chengdu 610041, China
  • Received:2026-02-24 Published:2026-06-25
  • Corresponding author: Jiahui Dong
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引用本文：

王家瑶, 叶开婷, 祝清清, 费黎明, 董佳慧. 54例重症鹦鹉热衣原体肺炎临床特征及预后回顾性分析[J/OL]. 中华肺部疾病杂志(电子版), 2026, 19(03): 444-450.

Jiayao Wang, Kaiting Ye, Qingqing Zhu, Liming Fei, Jiahui Dong. Retrospective analysis of clinical characteristics and prognosis of 54 cases with severe Chlamydia psittaci pneumonia[J/OL]. Chinese Journal of Lung Diseases(Electronic Edition), 2026, 19(03): 444-450.

目的

分析重症鹦鹉热衣原体肺炎临床潜在危险因素及影像学特征。

方法

选取安徽医科大学第一附属医院2020年6月至2025年5月收治的54例鹦鹉热衣原体肺炎患者临床资料进行回顾性汇总分析。患者经支气管镜肺泡灌洗液人类宏基因组测序(metagenomic next generation sequencing, mNGS)确诊。根据患者是否接受重症监护室治疗分为重症21例为重症组，非重症33例为对照组。比较两组临床资料，采用多因素Logistic回归分析重症鹦鹉热衣原体肺炎相关危险因素。

结果

重症组入院后发热天数为8 d长于对照组2 d(P<0.05)；患者就诊主诉以发热为主，重症组喘息4例，对照组无喘息症状(P<0.05)。首发症状中，重症组畏寒9例(42.86%)多于对照组4例(12.12%)(P<0.05)。重症组淋巴细胞、血氧分压、单核细胞、白蛋白和血小板低(P<0.05)；重症组白细胞、中性粒细胞、中性粒细胞与淋巴细胞比值、乳酸脱氢酶、谷草转氨酶、直接胆红素、间接胆红素、脑钠肽、降钙素原、凝血酶原时间、纤维蛋白降解产物、D-二聚体水平和C反应蛋白恢复天数高于对照组(P<0.05)。CT影像学提示，重症组出现实变影、支气管充气征、胸腔积液及多肺叶病变明显多于对照组(P<0.05)。在治疗过程中，重症组21例(100.00%)采用呼吸支持治疗高于对照组15例(45.45%)(P<0.05)；重症组使用经鼻高流量吸氧17例(80.95%)、有创呼吸机治疗12例(57.14%)高于对照组1例(3.03%)、0(0.00%)(P<0.05)。经多因素Logistic回归分析显示入院后发热天数(OR＝1.460，95%CI：1.151~1.852，P<0.05)、首发症状畏寒(OR＝5.473，95%CI：1.401~21.109，P<0.05)、中性粒细胞计数≥9.5×109/L(OR＝10.500，95%CI：2.555~43.143，P<0.05)、白细胞计数≤1.1×109/L(OR＝4.952，95%CI：1.489~16.466，P<0.05)、直接胆红素≥19 μmol/L(OR＝4.667，95%CI：1.410~15.448，P<0.05)、乳酸脱氢酶≥100 U/L(OR＝7.286，95%CI：1.775~29.907，P<0.05)、降钙素原≥13 ng/ml(OR＝4.062，95%CI：1.115~6.131，P<0.05)、凝血酶原时间≥4 s(OR＝4.250，95%CI：1.169~15.454，P<0.05)、CT影像支气管充气征改变(OR＝6.538，95%CI：1.793~23.843，P<0.05)、胸腔积液(OR＝2.854，95%CI：1.329~21.109，P<0.05)是重症鹦鹉热衣原体肺炎独立危险因素。

结论

鹦鹉热衣原体肺炎临床表现不典型，尽早行支气管镜送检肺泡灌洗液mNGS有助于疾病早期诊断，临床指标、化验指标和CT影像学改变为重症鹦鹉热衣原体肺炎危险因素。

关键词: 重症鹦鹉热衣原体肺炎, 临床特征, 宏基因组测序, 肺部影像学, 预后
Objective

To analyze the potential clinical risk factors and imaging characteristics of severe Chlamydia psittaci pneumonia.

Methods

A retrospective analysis was conducted on the clinical data of 54 patients with Chlamydia psittaci pneumonia admitted to the First Affiliated Hospital of Anhui Medical University from June 2020 to May 2025. All patients were diagnosed via metagenomic next-generation sequencing (mNGS) of bronchoalveolar lavage fluid. Patients meeting the inclusion criteria were divided into a severe group (requiring intensive care unit treatment) and a non-severe group. Clinical data were compared between the two groups. Multivariate logistic regression was used to identify risk factors associated with severe Chlamydia psittaci pneumonia.

Results

The duration of fever after admission was significantly longer in the severe group compared to the non-severe group (P<0.05). The severe group had a higher prevalence of wheezing as a chief complaint and chills as an initial symptom (P<0.05). Compared to the non-severe group, the severe group had significantly lower levels of lymphocytes, partial pressure of oxygen, monocytes, albumin, and platelets (P<0.05). Conversely, the severe group exhibited significantly higher levels of white blood cells, neutrophils, neutrophil-to-lymphocyte ratio, lactate dehydrogenase, aspartate aminotransferase, direct bilirubin, indirect bilirubin, brain natriuretic peptide, procalcitonin, prothrombin time, fibrin degradation products, D-dimer, and a longer recovery time for C-reactive protein (CRP) (P<0.05). CT imaging revealed that the severe group had significantly more consolidations, air bronchograms, pleural effusions, and multilobar lesions compared to the non-severe group (P<0.05). During treatment, the severe group required respiratory support at a higher rate (P<0.05). Multivariate logistic regression analysis identified the following independent risk factors for severe Chlamydia psittaci pneumonia: duration of fever after admission (OR=1.460, 95%CI: 1.151~1.852, P<0.05), chills as an initial symptom (OR=5.473, 95%CI: 1.401~21.109, P<0.05), neutrophil count ≥9.5×109/L (OR=10.500, 95%CI: 2.555~43.143, P<0.05), white blood cell count ≤1.1×109/L (OR=4.952, 95%CI: 1.489~16.466, P<0.05), direct bilirubin ≥19 μmol/L (OR=4.667, 95%CI: 1.410~15.448, P<0.05), lactate dehydrogenase ≥100 U/L (OR=7.286, 95%CI: 1.775~29.907, P<0.05), procalcitonin ≥13 ng/ml (OR=4.062, 95%CI: 1.115~6.131, P<0.05), prothrombin time ≥4 s (OR=4.250, 95%CI: 1.169~15.454, P<0.05), air bronchogram on CT imaging (OR=6.538, 95%CI: 1.793~23.843, P<0.05), and pleural effusion (OR=2.854, 95%CI: 1.329~21.109, P<0.05).

Conclusion

The clinical manifestations of Chlamydia psittaci pneumonia are atypical. Early bronchoscopy with mNGS of bronchoalveolar lavage fluid can aid in early diagnosis. Specific clinical indicators, laboratory parameters, and CT imaging features serve as independent risk factors for severe Chlamydia psittaci pneumonia.

Key words: Severe Chlamydia psittaci pneumonia, Clinical features, Metagenomic next-generation sequencing, Iconography
表1 重症与非重症鹦鹉热衣原体肺炎患者间实验室指标比较[n(%)]
实验室指标 重症肺炎组(n＝21) 对照组(n＝31) 统计量 P值
WBC(109/L) 9.99(7.69，13.29) 6.78(5.43，9.15) －3.061 0.002
NEU(109/L) 9.64(6.56，12.05) 5.58(3.77，7.74) －3.567 0.001
LYM(109/L) 0.71(0.48，0.93) 0.85(0.64，1.10) －1.988 0.047
NEU/LYM(%) 13.99(10.43，22.99) 6.27(3.96，8.64) －4.125 0.001
PaO2(mmHg) 56.20(49.10，71.10) 65.00(61.45，86.75) －2.233 0.026
AST(U/L) 134.00(75.50，272.50) 73.00(40.50，143.00) －2.493 0.013
直接胆红素(μmol/L) 6.50(3.51，10.88) 3.10(2.39，4.56) －2.900 0.004
间接胆红素(μmol/L) 8.67(6.79，14.39) 5.90(5.05，8.46) －3.675 0.001
乳酸脱氢酶(U/L) 574.00(290.50，1 091.00) 242.00(218.00，307.00) －3.310 0.001
脑钠肽(Pg/ml) 142.41(61.92，253.33) 47.14(23.13，83.82) －2.293 0.022
降钙素原(ng/ml) 2.43(0.36，7.87) 0.24(0.07，1.68) －2.531 0.011
凝血酶原时间(s) 14.10(13.40，14.95) 13.00(12.20，14.05) －2.493 0.013
纤维蛋白降解产物 12.49(6.53，19.12) 4.50(2.98，5.94) －4.122 0.001
D-二聚体(μg/ml) 3.28(2.23，5.29) 1.22(0.79，2.49) －3.828 0.001
单核细胞(109/L) 0.30±0.14 0.53±0.24 4.396 0.001
白蛋白(g/L) 30.21±3.57 33.33±5.41 2.334 0.024
血小板(109/L) 165.43±71.38 220.61±92.98 2.317 0.024
CRP恢复天数 20.83±9.35 8.58±1.88 －3.178 0.023
表2 不同程度病情鹦鹉热衣原体肺炎患者间mNGS检查结果比较[n(%)]
病原体序列数 重症肺炎组(n＝21) 对照组(n＝33) 统计量 P值
鹦鹉热衣原体 585.50(190.25，1 957.00) 62.00(10.25，177.00) －3.866 0.001
人类疱疹病毒 6(28.57) 5(15.15) 1.425 0.233
流产衣原体 5(23.81) 0(0.0) － 0.006
念珠菌 6(28.57) 5(15.15) 1.425 0.233
肺炎克雷伯杆菌 3(14.28) 0(0.0) － 0.054
曲霉 3(14.28) 4(12.12) － 1.000
图1 1例重症鹦鹉热衣原体肺炎的男性胸部CT。CT显示大片实变伴支气管充气征
表3 不同程度病情鹦鹉热衣原体肺炎患者CT影像学改变比较[n(%)]
影像学特征 重症肺炎组(n＝21) 对照组(n＝33) 统计量 P值
累及肺叶数 4(2，5) 1(1，2) －3.954 0.001
双侧 14(66.67) 4(12.12) 14.815 0.001
左肺上叶 15(71.43) 10(30.30) 8.730 0.003
左肺下叶 15(71.43) 10(30.30) 8.730 0.003
右肺上叶 13(61.90) 11(33.30) 4.243 0.039
右肺中叶 11(52.38) 7(21.21) 5.610 0.018
右肺下叶 16(76.19) 14(42.42) 5.926 0.015
实变影 20(95.24) 16(48.48) 10.607 0.001
渗出 10(47.62) 22(66.67) 1.929 0.165
结节/肿块 7(33.33) 6(18.18) 1.612 0.204
间质改变 1(4.76) 1(3.03) － 1.000
支气管充气征 17(80.95) 13(39.39) 7.372 0.007
纵隔淋巴结肿大 4(19.05) 4(12.12) － 0.697
胸腔积液     12.051 0.003
无 6(28.57) 16(48.48)    
单侧 4(19.05) 14(42.42)    
双侧 11(52.38) 3(9.09)    
表4 重症鹦鹉热衣原体肺炎患者的多因素Logistic回归分析
临床资料 β 标准误 Wald P值 OR 95%置信区间
入院后发热天数 0.379 0.121 9.715 0.002 1.460 1.151~1.852
首发症状畏寒 1.693 0.692 5.987 0.014 5.437 1.401~21.109
中性粒细胞计数 2.351 0.721 10.636 0.001 10.500 2.555~43.143
白细胞计数 1.600 0.613 6.812 0.009 4.952 1.489~16.466
直接胆红素 1.540 0.611 6.362 0.012 4.667 1.410~15.448
乳酸脱氢酶 1.986 0.721 7.597 0.006 7.286 1.775~29.907
降钙素原 1.402 0.660 4.515 0.034 4.062 1.115~14.804
凝血酶原时间 1.447 0.659 4.826 0.028 4.250 1.169~15.454
支气管充气征 1.878 0.660 8.091 0.004 6.538 1.793~23.843
胸腔积液 1.049 0.390 7.231 0.007 2.854 1.329~6.131
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