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目的探讨无明显肝炎临床症状但反复发生社区获得性肺炎(CAP)的慢性HBV携带者患者的临床特点,指导今后的临床诊治工作。方法回顾性分析本院近3年来6例无明显肝炎临床症状的慢性HBV携带者在1年内反复合并CAP(≥2次)的临床资料。结果 6例患者中,临床表现以发热(100%)、肺部啰音(83.3%)、咳嗽(100%),咳黄痰(83.3%)、胸部CT改变(100%)为主,66.6%的患者外周血白细胞及中性粒细胞百分比增高,83.3%的患者CRP、降钙素原升高。对6例肺部感染者进行痰培养,发现1例阳性,为细菌感染,多数对常用抗生素敏感。结论慢性乙型肝炎患者不一定是在重症肝炎及肝炎后肝硬化时期才易反复发生肺部感染,在稍早期无明显的肝炎临床症状如乏力、畏食、恶心、腹胀、肝区疼痛等症状出现时,即已容易反复发生肺部感染,其临床表现可以不典型,对常用抗生素较敏感,且肺部感染较重症肝炎及肝炎后肝硬化时合并的肺部感染易控制,但肺部影像学资料显示:病灶较不伴乙肝的患者吸收缓慢,部分残留未完全吸收的实变影。
Objective To investigate the clinical features of patients with chronic HBV carriers who have no clinical symptoms of hepatitis but recurrent community acquired pneumonia (CAP), and to guide future clinical diagnosis and treatment. Methods A retrospective analysis of 6 cases of chronic HBV carriers who had no obvious clinical symptoms of hepatitis in our hospital in the recent 3 years was retrospectively analyzed. Results The clinical manifestations included fever (100%), pulmonary rales (83.3%), cough (100%), cough yellow sputum (83.3%) and chest CT changes (100%) with 66.6% Of patients with peripheral white blood cells and neutrophils increased the percentage of 83.3% of patients with CRP, procalcitonin increased. Six cases of pulmonary infection were sputum culture and found that one case was positive for bacterial infection, the majority of commonly used antibiotics. Conclusions Patients with chronic hepatitis B are not always prone to recurrent pulmonary infections in patients with severe hepatitis and post-hepatitis cirrhosis. Clinical symptoms such as fatigue, vomiting, nausea, bloating and pain in the liver are not obvious in the early stage Appeared, that has been prone to recurrent pulmonary infections, the clinical manifestations may be atypical, common antibiotics are more susceptible, and severe pulmonary infection and hepatitis cirrhosis combined with pulmonary infection easily controlled, but the lung image School data show: lesion is not associated with the slow absorption of hepatitis B patients, some residual incomplete absorption of real change shadow.