自身免疫病并发卡氏肺孢子菌肺炎的临床分析

Pneumocystis carinii pneumonia in 12 patients with autoimmune diseases

目的了解自身免疫病并发卡氏肺孢子菌肺炎(PCP)的临床特点。方法回顾性分析北京协和医院12例自身免疫病并发PCP患者的临床特点和外周血T细胞亚群的改变。结果12例自身免疫病合并PCP患者的临床主要表现为发热12例、咳嗽9例、咳痰9例及明显呼吸困难12例,并呈进行性加重,血气分析均显示Ⅰ型呼吸衰竭;胸部X线片主要表现为双肺间质纹理改变和斑片影。外周血T细胞总数(0.44±0.31)×10~9//L、CD4^+T淋巴细胞(0.120±0.079)×10~9/L、CD8^+T淋巴细胞(0.248±0.252)×10~9/L,均明显下降,CD4/CD8比值倒置,与正常人比较差异均有统计学意义(P<0.05)。经复方磺胺甲嗯唑和糖皮质激素、给氧、辅助通气治疗后,3例好转,9例死亡。结论自身免疫病合并PCP病死率高,当患者出现进行性呼吸困难、Ⅰ型呼吸衰竭及胸部X线片示肺间质浸润,CD4^+淋巴细胞计数明显下降时,应警惕合并PCP的可能,早期诊断及治疗可改善预后。

Objective To investigate the clinical features of pneumocystis carinii pneumonia （PCP） in patients with autoimmune diseases. Methods The data from 12 patients with autoimmune diseases who were hospitalized in Peking Union Medical College Hospital because of developing PCP were retrospectively reviewed. Clinical characteristics and T cell subsets in the peripheral blood were analyzed. Results The main clinical manifestations of these 12 patients were fever（12/12）, cough（9/ 12）, expectoration（9/12）and obvious dyspnea（12/12）, which were progressive. Blood gas analysis presented with type Ⅰ respiratory failure. Bilateral interstitial and alveolar infiltrates were observed in chest X-ray film. The counts of peripheral blood lymphocytes（0. 44 ± 0. 31 ） × 10^9/L, CD4 ^＋ T-lymphocytes （0. 120 ± 0. 079） × 10^9/L and CD8^＋ T-lymphocytes were（0. 248 ± 0. 252） × 10^9/L decreased significantly and the CD4/CD8 ratio reversed, which were significantly different from those of healthy person（P 〈0.05 ）. After treated with trimethoprim-sulfamethoxazole and corticosteroids combining with oxygen inhalation, assisted ventilation, 3 patients survived and 9 died. Conclusions The mortality rate is high if patients with autoimmune diseases develop with PCP. When patients present with progressive dyspnea,type Ⅰ respiratory failure, lower CD4^＋ T-lymphocyte count and interstitial pulmonary infiltrates, PCP should be consid ered. Early diagnosis and treatments may improve the prognosis.