摘要目的 探讨尿抗原检测法诊断军团菌肺炎的临床价值.方法 连续入选沈阳3家医院呼吸科病房2011年5月至2013年11月收治的疑似军团菌肺炎患者56例,均进行尿抗原检测,尿抗原阳性病例进行军团菌体外培养、聚合酶链式反应(PCR)及双份血清军团菌抗体检测.结果 尿抗原阳性诊断军团菌肺炎的患者13例,其中1例从下呼吸道分泌物中分离出了军团菌;8例行PCR检测军团菌核酸,4例阳性;12例行双份血清军团菌抗体检测,7例阳性.13例中有环境接触史9例,下呼吸道分泌物呈橘黄色4例,伴消化道症状6例,伴精神神经症状8例,低钠血症10例.氧合指数＜ 300 mmHg(1 mmHg=0.133 kPa) 11例,肺炎严重程度指数(PSI)评分风险分级为Ⅴ级(＞130分)者8例.胸部CT 6例为双侧病变,11例表现为实变合并磨玻璃影,11例合并少量胸腔积液,各有1例患者表现为空洞形成及反晕轮征.13例均应用喹诺酮类药物治疗,11例好转出院,2例因多脏器功能障碍死亡,其中1例死亡患者病程中出现二重感染.结论 尿抗原检测法对军团菌肺炎具有重要的诊断价值;对疑诊病例应关注患者的环境接触史、多脏器受累情况,橘黄色痰可能提供诊断线索;对危重病例应关注二重感染及高浓度吸氧可能造成的肺损伤加重.

abstractsObjective To investigate the clinical value of urinary antigen detection of Legionella,and to describe the clinical characteristics of Legionella pneumonia.Methods Patients with suspected Legionella pneumonia were enrolled from the Respiratory departments of 3 tertiary hospitals in Shenyang during May 2011 to November 2013.Urinary Legionella antigen was detected for all the enrolled patients.Bacterial culture,polymerase chain reaction (PCR) for Legionella,and double Legionella antibody detection in sera were performed for each patient whose urinary antigen was positive.Patients confirmed to have Legionella pneumonia were pooled and analyzed.Results Totally 13 cases presenting with pneumonia were positive for Legionella by the urinary antigen method,and in one of them Legionella strain was isolated from the secretion of lower respiratory tract.PCR detection was performed in 8 patients,and 4 of them were positive.Legionella antibody detection was performed in 12 patients,and 7 of them were positive.Nine patients had a history of exposure to Legionella high-risk environments.The characteristics of the cases with Legionella pneumonia were as follows:characteristic orange sputum in 4 patients,digestive symptoms in 6,neurologic disorders in 8,hyponatremia in 10,hypoxia with oxygenation index ＜ 300 mmHg (1 mmHg =0.133 kPa)in 11,and severe pneumonia with PSI of grade Ⅴ (PSI score ＞ 130) in 8 patients.Chest CT scan showed bilateral involvement in 6,ground-glass opacity combined with consolidation in 11,and moderate pleural effusion in 11 patients.Cavity and reversed halo sign were found in one case,respectively.All of the patients received fluoroquinolone treatment,and 11 patients recovered completely while 2 died of multiple organ dysfunction syndrome,one of them was complicated with secondary infection.Conclusion Detection of urinary antigen of Legionella is very useful in the diagnosis of Legionella pneumonia.Attention should be paid to exposure history to the high-risk environments and multiple organ impairment when Legionella infection is suspected.Orange sputum may be characteristic for Legionella pneumonia and therefore a clue for diagnosis.In critical cases,secondary infection and additional lung injuries induced by high concentration oxygen therapy may occur.