摘要
目的总结非人类免疫缺陷病毒(HIV)感染的耶氏肺孢子菌肺炎(PJP)患儿的临床和影像学特征。方法纳入2014年8月1日至2019年7月31日在安徽省儿童医院PICU确诊PJP且HIV阴性并接受治疗的连续病例。比较入PICU 90 d后存活和死亡患儿的临床资料。结果 13例进入本文分析,男7例、女6例,发病年龄(80.8±23.8)月,12例有基础疾病,以原发性肾病综合征、先天性免疫缺陷病和血液肿瘤多见。10例发病前使用免疫抑制剂,13例均曾使用抗生素治疗无效。临床症状主要包括发热、气促、咳嗽(多为干咳)、纳差/体重减轻和进行性呼吸困难,小婴儿常表现为呻吟,2例肺底可闻及固定湿啰音。13例LDH均升高[(646±122) U·L-1],8例BDG升高[(184±119) pg·m L-1]。胸部影像学检查:13例双肺均呈磨玻璃样改变,3例气胸、皮下气肿和纵隔气肿。与存活患儿相比,死亡患儿淋巴细胞计数(P=0.012)和氧合指数较低(P=0.027),发病至给予SMZ治疗的时间较长(P<0.038)。结论当免疫功能低下的患儿出现发热、气促、干咳、进行性加重的呼吸困难,肺部CT检查提示双肺磨玻璃样改变时,需考虑PJP可能。
Objective To summarize the clinical and imaging characteristics of children with pneumocystis jirovecii pneumonia(PJP)infected by non⁃human immunodeficiency virus(HIV).Methods The consecutive cases of PJP with HIV negative confirmed and treated in PICU of Anhui Children's Hospital between August 1st,2014 and July 31st,2019 were included.Clinical data of survival and died children after 90 days of admission to PICU were compared.Results Thirteen cases were analyzed in this study,including 7 males and 6 females,with the onset age of(80.8±23.8)months.Twelve cases had underlying diseases,most of which were primary nephrotic syndrome,congenital immunodeficiency disease and hematologic tumor.Ten cases were treated with immunosuppressive agents before the onset of the disease,and all of 13 cases failed to respond to antibiotics.Clinical symptoms included fever,shortness of breath,cough(mostly dry cough),anorexia/weight loss,and progressive dyspnea.Moans were common in small infants,and moist rales could be heard and fixed in 2 cases.LDH was increased in 13 cases[(646±122)U·L-1],and BDG was increased in 8 cases[(184±119)pg·mL-1].Chest imaging examination showed that 13 cases had ground⁃glass opacity in both lungs,and 3 cases had pneumothorax,subcutaneous emphysema and mediastinal emphysema.Compared with the survival group,the lymphocyte count(P=0.012)and oxygenation index(PaO2/FIO2)were lower in the death group(P=0.027),and the time from onset to SMZ treatment was longer(P<0.038).Conclusion When immunocompromised children have symptoms such as fever,shortness of breath,dry cough,progressive dyspnea,and ground⁃glass opacity in both lungs by CT,PJP should be considered.
作者
段袁园
金丹群
许愿愿
童文佳
DUAN Yuanyuan;JIN Danqun;XU Yuanyuan;TONG Wenjia(Department of Pediatric Intensive Care Unit,Anhui Children's Hospital,Hefei 230051,China)
出处
《中国循证儿科杂志》
CSCD
北大核心
2020年第5期351-355,共5页
Chinese Journal of Evidence Based Pediatrics
基金
安徽医科大学校科研基金项目:2019xkj186。
关键词
儿童
耶氏肺孢子菌肺炎
非人类免疫缺陷病毒
Children
Pneumocystis jirovecii pneumonia
Non⁃human immunodeficiency virus
