肾移植受者卡氏肺囊虫肺炎影像学研究

Radiographic imaging study of pneumocystis carinii pneumonia in renal transplantation recipient

目的提高对肾移植受者并发卡氏肺囊虫肺炎(PCP)影像学特点的认识.方法总结24例肾移植受者并发PCP的影像学表现,分析其治疗前后的动态变化.结果男19例,女5例;平均年龄39.2岁.发病距肾移植时间平均5.6个月,起病至就诊时间平均5.5 d,发热24例,呼吸困难24例.病理表现为肺泡内蛋白样物质渗出,肺泡上皮细胞变性,肺泡间隔增宽,局部可见纤维化样改变.就诊时胸部X线10例呈弥漫性改变,其中3例磨玻璃样改变,2例磨玻璃样改变中见网格样改变,4例伴有片状渗出或融合实变.就诊时24例胸部CT均可见磨玻璃样改变,其中9例可见细网格状改变,12例可见边缘模糊的片状渗出影及肺内实变影.随着病情加重,胸部X片、CT出现肺内渗出和实变增多,明显时可见支气管空气影.约1～2周内发展到高峰.治疗有效后约1周,胸部X片及CT出现病变吸收好转的改变,1个月内基本吸收.结论肾移植患者卡氏肺囊虫肺炎影像学表现为两肺弥漫性改变包括间质改变或肺泡渗出、实变,进展快,治疗有效后约1周胸部X片及CT才出现吸收好转的改变,1个月内基本吸收.胸部CT检查比X片更敏感.

Objective To improve the understanding of the imaging features of pneumocystis carinii pneumonia (PCP) in renal transplantation recipient. Methods Twenty-four renal transplantation recipients suffered from PCP. There were 19 males and 5 females, the age ranged from 23 to 62 years (mean 39.2 years). The mean time duration from renal transplantation to onset of illness was 5.6 months, and the mean time from onset of illness to consultation was 5.5 days. All patients had fever and dyspnea. The chest radiographic imaging was reviewed and the dynamic imaging changes were followed up. Results Pathology showed alveolar exudation, inflammation in the interstitium and alveolar lumen, fibrosis in lung interstitium, and erosion of alveolar epithelium. Initial chest X-ray demonstrated diffuse changes in only 10 patients. Of the 10 patients, 3 showed ground-glass changes, 2 showed ground-glass and reticular changes, and 4 showed consolidation. But all patients had abnormal ill-defined ground-glass findings on thoracic CT images, 9 of them showed reticulum among ground-glass changes, and 12 of them showed consolidation among ground-glass changes. Among patients with clinical deterioration, chest radiographs and CT showed progression of pulmonary infiltrations, and it reached the top level within 1 to 2 weeks. With successful response to therapy, chest radiographs and CT showed resolution of the lung opacities, but the resolution was retarded for about 1 week, complete resolution would need 4 weeks. Conclusion The radiographic imaging features of PCP in renal transplantation recipient were diffuse interstitial alterations and consolidations, and with fast progression. With successful response to therapy, it showed resolution of the lung opacities, but the resolution was retarded for about 1 week, and complete resolution would need 4 weeks. Chest CT was more sensitive than radiographs.