摘要：目的：探讨血小板动态变化与新生儿重症肺炎之间的关系。方法：测定40例新生儿重症肺炎患儿急性期（3天）及恢复期（10天）的血小板计数（platelet count, PLT）计数、平均血小板溶剂（mean platelet volume, MPV）、血小板压积（platelet hematocrit, PCT）及血小板分布宽度（platelet distribution width, PDW），并进行比较。结果：40例重症肺炎患儿中，PLT随病情好转而上升，PCT、MPV、PDW水平随病情好转而下降。急性期PLT、PCT、MPV、PDW的水平与恢复期相比，差异有统计学意义（Plt;0.05）。结论：动态的观察血小板参数及其变化有助于新生儿重症肺炎的评估及疗效观察。Abstract : Objective: To assess the relationship between neonatal severe pneumonia and platelet. Methods: We test platelet count, mean platelet volume, platelet hematocrit and platelet distribution width in 40 patients whom diagonosed neonatal svere pneumonia; moreover, we compared the platelet change in acute phase and recovery phase. Results: Mean platelet volume, platelet count increased with recovery of pneumonia (Plt;0.05). Conclusion: Observing platelet change is helpful for the evaluation of neonatal pneumonia.
Objective To analyze the clinical outcome of one-stage repair of aortic coarctation combined with cardiac anomalies and pneumonia. Methods We retrospectively reviewed the clinical data of 26 patients with severe pneumonia undergoing repair of aortic coartation between January 2014 and August 2015, among whom 7 patients (26.9%) received tracheal intubation, 5 patients double incision, and 21 patients single incision. Long-term follow-up results were obtained from outpatient department. Results Two patients died from operations. The mean hospital stay was 18.5±4.5 d, bypass time 93.5±36.4 min, and mechanical ventilation time 89.5±41.3 min. Postoperative complication mainly was pneumonia. During 6-month follow-up at outpatient department, incidence of pneumonia decreased, and children’s growth and development remarkably improved. Conclusion In the case of uncontrollable pneumonia, one-stage repair of aortic coarctation associated with cardiac anomalies still can receive a good outcome.
Objective To investigate the clinical manifestations, diagnosis, treatment and prognosis of psittacosis patients. Methods The clinical features, treatment and prognosis of severe pneumonia caused by Chlamydia psittaci were analyzed and relevant literatures were reviewed. Results An 83-year-old male with a history of type 2 diabetes mellitus was admitted to the hospital for "fever, cough for 5 days and dyspnea for 3 days". Chest CT showed a large mass of increased density in the right lung; CD4+ T lymphocytes had an absolute value of 23 cells/μL; Blood gas analysis showed type Ⅰ respiratory failure; Chlamydia psittaci was detected by metagenomic next-generation sequencing. The patient was diagnosed of severe pneumonia (Chlamydia psittaci), type 2 diabetes mellitus, suspected central nervous system infection. This patient was treated with doxycycline and macrolides antibiotics and discharged from hospital after complete recovery. Literature review showed that patients got infected from contacting sick bird, manifested with multiple system involvement. Respiratory symptoms were common, while central nervous system infection seemed to be rare. The diagnosis of psittacosis depended on serology, nucleic acid detection, pathogen isolation and culture. Metagenomic next-generation sequencing had superiority in the diagnosis of psittacosis. Tetracyclines were the preferable treatment, such as doxycycline or tetracycline, with a duration of at least 10 to 14 days. The prognosis of psittacosis was well, and most of the severe and even life-threatening cases were caused by unclear diagnosis and delayed treatment, and the overall mortality rate was about 1%. Conclusions Psittacosis is one kind of zoonoses. History of poultry exposure is helpful in diagnosis, and metagenomic next-generation sequencing has advantages in diagnosing psittacosis. Tetracyclines are preferred with adequate course of treatment. The overall prognosis is good.
Objective To investigate the clinical features of interstitial lung disease (ILD) complicated with severe Pneumocystis pneumonia (PCP). Methods The patients with interstitial lung disease complicated with severe Pneumocystis pneumonia who were admitted to the Respiratory Intensive Care Unit (RICU) of the Department of Respiratory and Critical Care Medicine, Nanjing Drum Tower Hospital from September 2017 to June 2022 were retrospectively analyzed. Laboratory examinations, imaging features, complications and mortality data were used to analyze the clinical characteristics and prognosis of these patients. Results A total of 17 patients admitted to the RICU were finally enrolled in this study. 16 of the 17 patients had a history of corticoids therapy, and none of the 17 patients had received prophylaxis before the onset of PCP; 58.8% (10/17) of them were ILD secondary to connective tissue disease, and 41.2% (7/17) were idiopathic ILD; all patients were tested positive for P. jirovecii with polymerase chain reaction and/or next-generation metagenomic sequencing in sputum, bronchoalveolar lavage fluid or serum; all patients developed respiratory failure (oxygenation index: 146.8±66.4 mm Hg) after onset; within 24 hours of admission, the pneumonia severity index score was 91.9±20.1 and the Acute Physiology and Chronic Health Evaluation Ⅱ score was 16.1±3.0; imaging findings showed diffuse ground-glass opacity in both lungs on the basis of the original ILD; all patients were treated with trimethoprim-sulfamethoxazole (TMP-SMX) and corticoids, 52.9% (9/17) patients were treated with TMP-SMX + caspofungin + clindamycin; 70.6% (12/17) patients were treated with mechanical ventilation; 76.5% (13/17) patients during hospitalization complicated bacterial infection, 9 cases (52.9%) had viral infection. The 28-day mortality was 64.7% (11/17), and the 90-day mortality was 82.4% (14/17), as of telephone follow-up (July 2022) the overall mortality was 88.2% (15/17). Conclusions ILD patients with severe PCP are progressing rapidly. The clinical manifestations are severe which are the same as acute exacerbation of ILD, with poor prognosis.
Objective To verify the association between admission serum phosphate level and short-term (<30 days) mortality of severe pneumonia patients admitted to intensive care unit (ICU) / respiratory intensive care unit (RICU). Methods Severe pneumonia patients admitted to the ICU/RICU of Quanzhou First Hospital Affiliated to Fujian Medical University from November 2019 to September 2021 were included in the study. Serum phosphate was demonstrated as an independent risk factor for short-term mortality of severe pneumonia patients admitted to ICU/RICU by logical analysis and receiver operator characteristic (ROC) curve. The patients were further categorized by serum phosphate concentration to explore the relationship between serum phosphate level and short-term mortality. Results Comparison of baseline indicators at admission between the survival group (n=54) and the non survival group (n=46) revealed that there was significant difference in serum phosphate level [0.9 (0.8, 1.2) mmol/L vs. 1.2 (0.9, 1.5) mmol/L, P<0.05]. Logical analysis showed serum phosphate was an independent risk factor for short-term mortality. ROC curve showed that the prediction ability of serum phosphate was close to pneumonia severity index (PSI). After combining serum phosphate with PSI score, CURB65 score, and sequential organ failure score, the predictive ability of these scores for short-term mortality was improved. Compared with the normophosphatemia group, hyperphosphatemia was found be with significantly higher short-term mortality (85.7% vs. 47.3%, P<0.05), which is absent in hypophosphatemia (25.8%). Conclusions Serum phosphate at admission has a good predictive value on short-term mortality in severe pneumonia patients admitted to the ICU/RICU. Hyperphosphatemia at admission is associated with a higher risk of short-term death.
Objective To explore the clinical characteristics of Chlamydia psittaci pneumonia. Methods From January 2020 to March 2023, 21 cases of Psittacosis from the First Affiliated Hospital of Nanjing Medical University were diagnosed via metagenomic next-generation sequencing (mNGS). They were divided into a severe group (n=10) and a non-severe group (n=11) based on diagnostic criteria for severe pneumonia, and the clinical presentation, secondary examination, treatment, and prognosis of the two groups were analyzed retrospectively. Results Among the 21 patients, there were 11 males and 10 females, with a mean age of (51.7±11.6) years. All patients had an acute onset and 12 had a confirmed history of exposure to poultry. The onset of the disease occurred in the autumn and winter seasons in 18 patients. All the patients were suffering from high fevers. Other symptoms included coughing, phlegm, tightness in the chest and fatigue. Laboratory examinations showed that the levels of leukocytes, neutrophil counts, C-reactive protein, procalcitonin, aminotransferase, creatine kinase, lactic dehydrogenase, brain natriuretic peptide precursors and D-dimer were significantly higher in the severe group than those in the non-severe group. Chest CT scans revealed varying levels of consolidation and spot shadowing with peripheral exudate in all patients. The patients in the severe group were more likely to have bilateral lung involvement, bilateral pleural effusion, cavity and mediastinal lymph node enlargement. Eleven patients received tetracycline alone, three received laudanum alone, two received respiratory quinolones alone, and five received a combination of two drugs including tetracycline. Chest CT at clinical follow-up showed absorption of lung lesions. Conclusions Chlamydia psittaci pneumonia usually occurs in the fall and winter, and most patients have a history of contact with poultry. Clinical presentation and imaging are not specified. The technology of mNGS enables early diagnosis of the disease, and neutrophil lymphocyte ratio, neutrophil-lymphocyte ratio and lactic dehydrogenase levels help assess the risk of severe disease.
Objective To investigated the early risk factors of AIDS severe pneumonia complicated with acute respiratory distress syndrome in order to carry out early recognition and intervention of ARDS and improve the prognosis of patients. Methods The clinical data of 232 patients with severe AIDS pneumonia admitted to Chengdu Public Health Clinical Medical Center from January 2017 to December 2020 were retrospectively analyzed, including general data, vital signs, laboratory examination indexes, basic diseases, etc. Firstly influential indexes for complicated with ARDS were screened by single factor logistic regression analysis, then the multicollinearity assessment indicators were filtered out in multi-factor logistic stepwise regression analysis, finally the receiver operating characteristic (ROC) curves were drawn and the predictive value of the indicators were assessed. Results Thirty-three of 232 AIDS patients with severe pneumonia were complicated with ARDS. The mortality rate in ARDS group was 81.8%. The intra-group mortality of non-ARDS group was 33.7%. Single factor logistic regression analysis showed that pH, acute physiology and chronic health evaluation Ⅱ grade, sequential organ failure assessment grade, white blood cell count, lactate dehydrogenase, α-hydroxybutyric acid dehydrogenase (α-HBDH), alanine aminotransferase (ALT), aspartic acid aminotransferase (AST), calcium, fibrinogen degradation produc (FDP) and D-dimer, total 11 indicators were associated with the incidence of ARDS. The multicollinearity analysis of the 11 indicators showed that there was no multicollinearity problem among the other 9 indicators except the variance inflation factor of ALT and AST which was greater than 10. Multivariate logistic stepwise regression analysis showed α-HBDH (OR=1.001, 95% confidence interval 1.000 - 1.002, P=0.045) and D-dimer (OR=1.044, 95% confidence interval 1.006 - 1.083, P=0.024) were independent factors. ROC curve indicated the following: alpha hydroxy butyric acid dehydrogenase (the area under ROC curve=0.667, P=0.002, the optimal threshold was 391 U/L, the corresponding sensitivity and specificity was 78.8% and 61.8%, respectively), D-dimer (the area under ROC curve=0.602, P=0.062, the optimal threshold was 4.855 µg/mL, the corresponding sensitivity and specificity was 42.4% and 82.9%, respectively). Conclusion AIDS severe pneumonia complicated with ARDS is associated with many factors, among whichα-HBDH (≥391 U/L) and D-dimer (≥ 4.855 µg/mL) on admission are independent risk factors, which have great early predictive value and can provide reference for early clinical identification of ARDS high-risk patients.
Objective To investigate the effect of picroside Ⅱ (PIC Ⅱ) on the pyroptosis and thioredoxin-interacting protein (TXNIP)/nucleotide-binding oligomerization domain-like receptor protein 3 (NLRP3) signaling pathway in alveolar epithelial cells of severe pneumonia rats. Methods A severe pneumonia rat model was constructed and all experimental rats were divided into a control group, a severe pneumonia group, low, medium, and high dose PIC Ⅱ groups (PIC Ⅱ-L, PIC Ⅱ-M, PIC Ⅱ-H groups), and a high-dose PIC Ⅱ+TXNIP/NLRP3 pathway activator trimethylamine oxide group (PIC Ⅱ-H+TMAO group). The levels of tumor necrosis factor α (TNF-α), interleukin-1β (IL-1β) and interleukin-6 (IL-6) were detected by ELISA; Wright’s staining was applied to detect eosinophil count (EOS), lymphocyte count (LYM), and neutrophil count (NEU) in the sediment of alveolar lavage fluid. Hematoxylin-eosin staining was used to observe the pathological changes of lung tissue. The expressions of cysteine aspartate protease 1 (Caspase-1) and dermatin D (GSDMD) were detected by immunohistochemistry. The expressions of TXNIP, NLRP3 and apoptosis-associated microprotein (ASC) were detected by Western blot. Results Compared with the control group, the severe pneumonia group had severe lung tissue injury, obvious inflammatory cell infiltration, and increased expressions of TNF-α, IL-1β, IL-6, EOS, LYM, NEU, Caspase-1, GSDMD, TXNIP, NLRP3 and ASC (all P<0.05). Compared with the severe pneumonia group, lung tissue injury in PIC Ⅱ-L, PIC Ⅱ-M and PIC Ⅱ-H groups was reduced successively, and inflammatory cell infiltration was gradually reduced. The expressions of TNF-α, IL-1β, IL-6, EOS, LYM, NEU, Caspase-1, GSDMD, TXNIP, NLRP3 and ASC were decreased successively (all P<0.05). Compared with the PIC Ⅱ-H group, the PIC Ⅱ-H+TMAO group showed increased lung tissue damage and obviously increased inflammatory cell infiltration, the expression of TNF-α, IL-1β, IL-6, EOS, LYM, NEU, Caspase-1, GSDMD, TXNIP, NLRP3, and ASC were obviously increased (all P<0.05). Conclusion PIC Ⅱ inhibits pyroptosis of alveolar epithelial cells in severe pneumonia rats by inhibiting the TXNIP/NLRP3 pathway.