2025 年第 1 期 第 20 卷

肺部惠普尔养障体感染患者临床及影像特征分析

Analysis of the clinical and imaging features of patients with pulmonary Tropheryma whipplei infection

作者：曾宪琴1 黄艺林2 赵兰兰1 钱效森1 刘毅1

英文作者：Zeng Xianqin1 Huang Yilin2 Zhao Lanlan1 Qian Xiaosen1 Liu Yi1

单位：1民航总医院呼吸内科，北京100123；2北京大学第一医院呼吸与危重症医学科，北京100034

英文单位：1Department of Respiratory Medicine Civil Aviation General Hospital Beijing 100123 China; 2Department of Respiratory and Critical Care Medicine Peking University First Hospital Beijing 100034 China

关键词：肺炎；  惠普尔养障体；  二代测序；  支气管肺泡灌洗液

英文关键词：Pneumonia;  Tropherymawhipplei;  Next-generationsequencing;  Bronchoalveolarlavagefluid

• 摘要：

• 目的  分析和总结肺部惠普尔养障体（TW）感染患者的临床资料，进一步提高对肺部TW感染的认识。方法  收集2021年9月1日至2023年1月31日民航总医院呼吸内科收治的7例肺部TW感染患者的临床资料（包括基础信息、检验结果、胸部CT、治疗及转归情况）行回顾性分析。结果  7例肺部TW感染患者中男3例、女4例，年龄67（45，73）岁。所有患者既往病史中均存在至少1种可能导致免疫功能异常的基础疾病，最常见的为冠心病（冠状动脉粥样硬化性心脏病）。所有患者外周血白细胞计数均在正常范围，但2例混合感染的患者中性粒细胞百分比明显升高，分别达86.9%和95.9%。胸部CT多表现为磨玻璃密度影、弥漫小结节影或斑片影。7例患者均经支气管肺泡灌洗液病原体靶向二代测序明确诊断，其中2例患者TW为唯一病原体。7例患者均接受抗微生物治疗，其中6例患者治疗后临床症状和影像学均明显改善，1例患者失访。结论  肺部TW感染的患者常伴有免疫功能异常的疾病，且常规实验室检查难以确诊，多通过二代测序诊断，胸部CT可呈多种非特异性改变。抗微生物治疗可明显改善病情。

• Objective  To analyze and summarize the clinical data of patients with pulmonary Tropheryma whipplei (TW) infection, and further improve the understanding of pulmonary TW infection. Methods   The clinical data (including basic information, test results, chest CT, treatment and outcome) of 7 patients with pulmonary TW infection admitted to the Department of Respiratory Medicine, Civil Aviation General Hospital from September 1, 2021 to January 31, 2023 were collected and retrospectively analyzed. Results   Among the 7 patients with pulmonary TW infection, there were 3 males and 4 females, with age of 67(45, 73) years. All patients had at least one underlying disease in their past medical history that may lead to abnormal immune function, the most common being coronary atherosclerotic heart disease. The white blood cell counts of all patients were in the normal range, but the percentage of neutrophils in 2 patients with mixed infection was significantly increased, which reached 86.9% and 95.9%, respectively. Chest CT showed ground glass density shadow, diffuse small nodular shadow or patchy shadow. All the 7 patients were diagnosed by pathogen targeted next-generation sequencing of bronchoalveolar lavage fluid, and TW was the only pathogen in 2 patients.All the 7 patients received antimicrobial therapy, of which 6 patients had significant improvement in clinical symptoms and imaging after treatment, and 1 patient was lost to follow-up. Conclusion   Patients with pulmonary TW infection are often accompanied by diseases with abnormal immune function, and it is difficult to be diagnosed by routine laboratory tests, and most of them are diagnosed by next-generation sequencing. Chest CT can show a variety of non-specific changes. Antimicrobial therapy can significantly improve the condition.