摘要
目的研究非HIV感染者发生人肺孢子菌肺炎(PCP)的临床特点,感染的危险因素,治疗和预后。方法回顾性病例分析。结果在15个月内共诊断非HIV感染的PCP16例。患者的平均年龄为(51.9±23)岁。16例患者中,13例有免疫缺陷的基础疾病,其中结缔组织病者11例、非何杰金淋巴瘤者(NHL)1例、Good综合征者1例。在合并结缔组织病的患者中,所有PCP都发生在接受糖皮质激素治疗的过程中。16例PCP在诊断时都存在呼吸衰竭,其中11例需要气管插管,其余5例接受了无创机械通气治疗。平均急性生理和慢性病评分(APACHE II)为16±5。外周血淋巴细胞计数平均(955±635)/μl。9例患者有CD4+淋巴细胞计数结果,其中6例在诊断时CD4+淋巴细胞<250/μl。LDH平均(551.9±292.6)U/L。16例患者中14例在诊断后接受了TMP-SMZ治疗,除了2例患者外,其他患者同时还接受了糖皮质激素(相当于强的松≥60mg/d)辅助治疗。单因素分析显示有4种因素(高APACHEII评分、合并ALI/ARDS、延迟诊断、合并院内感染)是预后不良的危险因素。结论在免疫缺陷患者中,PCP是一种不太常见,但往往是致命的疾病。临床上的及时诊断和治疗对改善预后是非常重要的。
Objectives To discuss the clinical parameters,risk factors,treatment and clinical outcomes of Pneumocystis jiroveci pneumonia (PCP) in HIV negative patients.Methods Patients diagnosed as PCP were retrospectively reviewed.Results We describe 16 patients who presented with PCP without HIV infection during 15 months in a teaching hospital.The mean age was 51.9±23ys.Thirteen of the 16 patients had predisposing disease,of which 11 had connective tissue diseases(CTD),Non-Hodgkins lymphoma (NHL),Good syndrome.Among the patients with CTD,P.jiroveci pneumonia all occurred during the treatment with daily glucocorticoid therapy.All patients developed respiratory failure.The mean APACHE II was 16±5.The mean lymphocyte count was 955±635 cells/μl.The CD_ 4 ~ + lymphocyte counts were available in nine patients,and six of them had CD_ 4 ~ + lymphocyte less than 250 cells/μl at the time of diagnosis.The mean LDH level was 551.9±292.6U/L.Fourteen of the 16 patients received TMP-SMZ as initial therapy,all but two patients were also given increased high-dose steroid(≥60mg prednisone daily equivalent).The mortality rate was 68.8%(11/16).Univariate analysis revealed that four factors were associated with adverse outcome.Conclusion PCP is an uncommon,but often fatal,occurrence in patients with immunocompromised conditions.Diagnostic suspicion is an important factor in the correct identification of affected patients.
出处
《中国真菌学杂志》
2006年第1期31-35,共5页
Chinese Journal of Mycology
