摘要
目的探讨非HIV免疫功能抑制患者肺孢子菌肺炎(PCP)的临床特点。方法回顾性分析9例非HIV免疫功能抑制患者肺孢子菌肺炎患者的临床资料。结果所有患者发生PCP前均接受了长期激素或免疫抑制剂治疗,其中8例(88.9%)应用糖皮质激素,3例(33.3%)接受免疫抑制剂治疗。所有患者均存在进行性呼吸困难,7例(77.8%)出现典型三联征——发热、干咳和进行性呼吸困难。影像学特征为双肺弥漫磨玻璃浸润影8例(88.9%)和实变影1例(11.1%)。7例患者应用磺胺甲恶唑/甲氧苄啶联合卡泊芬净治疗,死亡2例;2例患者应用磺胺甲恶唑/甲氧苄啶治疗,死亡1例;总病死率33.3%。结论非HIV免疫功能抑制患者感染PCP病死率较高,对有出现发热、干咳和进行性呼吸困难及双肺弥漫磨玻璃浸润影等临床表现的患者,尤其是免疫功能受损时应考虑PCP的可能,及早进行痰或支气管肺泡灌洗液病原学检查,以早期诊断、早期治疗。
Objective To investigate the clinical characteristics of pneumocystis pneumonia patients with non-human immunodeficiency virus（non-HIV）. Methods 9 patients with confirmed non-HIV PCP were retrospectively analyzed.Results All the patients received corticosteroid therapy and immunosuppressive therapies before they had the PCP, in which 8 patients（88.9%） used corticosteroid therapy and three patients（33.3%） accepted immunosuppressive therapy.All the patients had the symptom of progressive dyspnea, in which seven patients（77.8%） appeared typical triad：fever,dry cough and progressive dyspnea. Eight patients＇（88.9%） CT showed diffuse ground-glass opacity and one patient（11.1%） showed consolidation in double lungs. Seven patients were treated with trimethoprim-sulfamethoxazol combining with caspofungin in which two patients died. Two patients were treated with trimethoprim-sulfamethoxazol in which one patient died. The total mortality rate was 33.3%. Conclusion The mortality of non-HIV immunosuppressed patients with PCP is high. Patients who have symptoms of fever, dry cough and progressive dyspnea together with diffuse ground-glass opacity in double lungs should be suspected with of PCP, especially in immunosuppressive patients.The pathogenic examination of sputum or bronchoalveolar lavage fluids should be taken as soon as possible in order to early diagnosis and early treatment.
出处
《中国现代医生》
2016年第21期33-35,38,共4页
China Modern Doctor
基金
浙江省自然科学基金资助项目(LY12H01002)
