摘要
目的回顾性分析首都医科大学附属北京朝阳医院住院肺孢子菌肺炎(pneumocystis pneumon ia,PCP)患者的临床表现,探讨导致PCP的高危因素与诊断治疗和预防措施。方法回顾分析2004年4月至2008年9月19例PCP患者的临床资料。结果26.3%(5/19)的PCP患者有获得性免疫缺陷综合征;73.4%(14/19)的病例患有基础疾病。19例患者中男性12例、女性7例,平均年龄41.53±9.22岁。起病急骤7例,起病缓慢12例。11例患者肺呼吸音正常或稍粗,6例患者肺底闻及局限湿啰音,2例患者肺底闻及爆裂音(考虑与肺纤维化有关)。胸部影像学主要表现为弥漫性网状阴影、片絮影、斑片影。7例患者痰或支气管肺泡灌洗液六胺银染色找到包囊,1例支气管镜肺活检(TBLB)六胺银染色找到包囊,7例患者痰或支气管肺泡灌洗液聚合酶链反应(PCR)阳性检出PC病原体的特异性基因片段和结合临床特征而诊断,其余4例为临床诊断。100%患者服用复方磺胺甲基异恶唑片(TMP-SMZco)和84.2%(16/19)患者合并肾上腺糖皮质激素治疗,14例存活,5例死亡,其中3例死于多脏器功能衰竭,2例死于急性呼吸窘迫综合征。结论随着HIV感染越来越多,现代医学技术的发展,如器官移植肿瘤放化疗及免疫抑制剂的应用等,PCP在临床上已不属于少见病。因其临床表现无明显特异性,病死率较高,应引起临床高度重视,尤其对高危人群应考虑使用预防性治疗。
Objective To study the clinical characteristics,diagnosis and treatment of Pneumocystis carini pneumonia（PCP）.Methods The retrospective analyses of 19 inpatients who were diagnosed with PCP in Beijing Chaoyang Hospital from 2004 to 2008 were performed,and the literature was reviewed with regard to clinical profiles.Results Of the19 PCP patients,12 were male and 7 female.The average age was（41.53±9.22） years.Five patients（26.3%） were co-infected with human immunodeficiency virus（HIV）.The remaining 14 non-HIV-infected patients had underlying diseases.Seven patients had a sudden onset;others had a gradual onset.Twelve of 19 patients had normal or mildly coarse breath sounds on auscultation;5/19 patients had rales at the bottom of lung.2/17 of the patients had inspiratory crackles which is considered to be related with fibrosis of lung.The most common abnormal chest radiological findings were bilateral diffuse interstitial infiltrations,patchy shadows or ground-glass.Seven patients were found positive for PC in their sputum or bronchoalveolar lavage fluid（BALF） by Gomori methenamine silver stain（GMS）,7 patients were proved positive for PC in their sputum or bronchoalveolar lavage fluid by polymerase chain reaction（PCR）,and one patient was also proved positive for PC in transbronchial lung biopsy（TBLB）.All patients were treated with trimethoprim-sulfamethoxazole and 84.2%（16/19） of the patients were treated with corticosteroids concomitantly.Five patients died;3 of 5 patients succumbed to MODS,2 succumbed to ARDS.Overall crude mortality was 26.3%.Conclusion Being infected with HIV much frequently and increasing immuno-suppressive therapy（such as organ transplantations and tumor therapy）,PCP does not belong to rare diseases.The mortality of PCP was high despite appropriate treatment,because of lack of specific clinical characteristics.Chemoprophylaxis should be considered in populations at high risks.
出处
《首都医科大学学报》
CAS
北大核心
2010年第5期552-557,共6页
Journal of Capital Medical University
