摘要
目的:探讨艾滋病患者合并卡氏肺孢子虫肺炎(PCP)的诊断及治疗。方法:对我院感染科2009年6月至2010年5月432例艾滋病中确诊的107例PCP病例进行回顾性分析。结果:85例患者有发热、咳嗽、咳痰或呼吸困难;动脉氧压<70mmHg16例;乳酸脱氢酶(LDH)升高者91例;胸片肺纹理增多、增粗和(或)毛玻璃样改变67例、肺小结节或斑片状阴影36例、胸片正常3例,液气胸1例;CD4+T细胞<50cells/μL86例。107例中19例找到肺孢子虫。治疗药物为复方磺胺甲恶唑,93例治愈,12例死亡,2例转ICU。结论:PCP诊断标准是找到病原体,其检出率低,目前仍以临床诊断为主。艾滋病患者合并PCP发病率高,特别是CD4+T细胞<50cells/μL者,AIDS患者应尽早高效逆转录抗病毒治疗(HAART),提高患者免疫力减少机会性感染,一旦临床考虑合并PCP应尽早复方磺胺甲噁唑治疗,减少病死率。
Objective To approach the diagnosis and treatment on acquired immune deficiency syndrome （AIDS） complicated by pneumocystis carinii pnenmonia（PCP）. Methods 107 patients complicated by PCP in 432 cases of AIDS who were hospitalized in the infectious department of our hospital during June 2009 to May 2010 were retrospectively analyzed. Results 85 patients had fever, cough, sputum or dyspnea; There were 16 cases whose arterial oxygen pressure were under 70 mmHg; Lactic dehydrogenase （LDH） was higher than normal in 91 cases; Chest radiography revealed increasing,thickening and/or ground glass-like changes in 67 cases, pulmonary nodules or patchy shadows in 36 cases, normal chest in 3 cases, hydropneumothorax in 1 case; CD4＋ T cells was less than 50 cells/uL in 86 cases. 19 cases were found pneumocystis carinii, almost all were clinical diagnosed. The treatment with sulfamethoxazole（SMZ） had been for 21 days,93 cases were cured, 12 cases died, and 2 cases were converted to ICU. Conclusions The gold standard to diagnose PCP is finding the pathogen. Its detection rate is low, the current clinical diagnosis is still based. The incidence of AIDS cmnplicated by PCP is high, particularly in whose CD4＋ T cells was less than 50 cells/μL. The AIDS patients should be given highly active antiretroviral therapy （HAART） as early as possible, to improve patients＇s immunity and reduce opportunistic infections. Once considering of clinical PCP, we should treat the patients with SMZ as soon as possible to reduce mortality.
出处
《实用医学杂志》
CAS
北大核心
2011年第4期637-639,共3页
The Journal of Practical Medicine
