| 摘要: |
| ［摘要］ 目的 分析下呼吸道标本惠普尔养障体（TW）阳性患者的临床特征及诊疗方法。方法 回顾性分析2023年12月至2025年9月于北京航天总医院接受靶向二代测序（tNGS）检查的13例TW阳性肺炎患者的临床资料，均经tNGS在支气管肺泡灌洗液检出TW。对患者的临床特征、实验室检查资料、影像学检查资料、治疗方案及转归进行总结分析。结果 13例患者均有咳嗽、咳痰症状，其中8例出现发热，3例存在关节痛。电子支气管镜检查显示13例患者均有气道炎症，气管镜下见黄痰、痰多5例，少量白痰8例。13例患者中TW为唯一病原体者2例。13例患者中白细胞、中性粒细胞水平正常者8例，降钙素原水平正常者11例，淋巴细胞水平降低者7例，C反应蛋白水平升高者10例；肺实变7例，肺间质性病变4例，支气管充气征4例，单侧胸腔积液2例，双侧磨玻璃影1例，单侧肺结节1例。在确诊TW为病原体后，患者接受针对TW的抗生素治疗（单药治疗或联合用药治疗），所有患者均症状缓解后出院，住院时间4～17（8.46±3.33）d。结论 TW肺部感染患者临床症状、影像学表现无特异性，tNGS为该病的早期诊断和治疗提供依据。针对TW所致肺部感染，短程抗生素治疗能有效改善患者病情。 |
| 关键词: 惠普尔养障体 肺部感染 临床特征 靶向二代测序 |
| DOI：10.3969/j.issn.1674-3806.2026.08.13 |
| 分类号:R 563 |
| 基金项目: |
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| Analysis of clinical characteristics and the diagnosis and treatment of 13 patients with positive Tropheryma whipplei in lower respiratory tract specimens |
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Ma Liyun, Ren Xiyan, Yan Chunliang, Ren Guanjun
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Department of Respiratory Medicine, Beijing Aerospace General Hospital, Beijing 100076, China
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| Abstract: |
| ［Abstract］ Objective To analyze the clinical characteristics, diagnosis and treatment methods of patients with positive Tropheryma whipplei(TW) in lower respiratory tract specimens. Methods A retrospective analysis was conducted on the clinical data of 13 patients with TW-positive pneumonia who underwent targeted next-generation sequencing(tNGS) examination in Beijing Aerospace General Hospital from December 2023 to September 2025. TW was detected in the bronchoalveolar lavage fluid of all the patients by using tNGS. The clinical characteristics, laboratory testing data, imaging data, treatment regimens and clinical outcomes of the patients were summarized and analyzed. Results All the 13 patients had symptoms of cough and expectoration. Among them, 8 patients had fever and 3 patients had joint pain. Electronic bronchoscopy examination revealed endobronchial inflammation in all the 13 patients, with yellow purulent sputum and copious sputum observed in 5 cases and scant mucoid sputum in 8 cases. Among the 13 patients, TW was the sole pathogen in 2 patients. Among the 13 patients, laboratory data revealed normal white blood cell and neutrophil levels in 8 patients, normal procalcitonin levels in 11 patients, decreased lymphocyte levels in 7 patients, and elevated C-reactive protein levels in 10 patients; chest computed tomography(CT) findings showed pulmonary consolidation in 7 patients, pulmonary interstitial lesions in 4 patients, air bronchogram sign in 4 patients, unilateral pleural effusion in 2 patients, bilateral ground-glass opacities in 1 patient, and unilateral pulmonary nodules in 1 patient. After TW was identified as the pathogenic pathogen, the patients received antibiotic treatment targeting TW(monotherapy or combination drug therapy). All the patients were discharged after achieving symptom relief, and the length of hospital stay ranged from 4 to 17(8.46±3.33)days. Conclusion The clinical symptoms and imaging manifestations of patients with TW-associated pulmonary infections are not specific, and tNGS provides a basis for the early diagnosis and treatment of the diseases. For the TW-associated pulmonary infections, short-course antibiotic treatment can effectively improve the patients′ condition. |
| Key words: Tropheryma whipplei(TW) pulmonary infection clinical characteristics targeted next-generation sequencing(tNGS) |
