肾移植受者合并肺孢子菌肺炎的CT和肺功能观察

Study on changes of CT performance and pulmonary function in renal transplant recipients with pneumocystis pneumonia

目的探讨肾移植受者合并肺孢子菌肺炎（PCP）的CT和肺功能的动态变化。方法对2002至2006年期间确诊的肾移植术后合并肺孢子菌肺炎的16例患者，进行胸部CT、血气分析和肺功能动态变化的回顾性研究。结果16例患者确诊为PCP病例，年龄（36±11）岁，肾移植术后时间（4．3±2．1）个月，院外病程（4．5±1．9）d。入院后胸部CT均表现为两肺渗出、实变为主，比病程刚起时明显进展。部分还表现为渗出性病灶内多发的局灶性肺气肿样改变。治疗后肺部阴影开始吸收，病程2个月CT上遗留少许纤维灶。肺功能异常急性期表现为限制性通气功能障碍和弥散功能降低，第3周时通气功能异常即逐渐恢复正常，第4周弥散功能明显好转，病程第3个月内肺功能完全恢复。结论肾移植合并PCP患者胸部CT以肺泡病变（渗出和实变为主）为特点，可有局部肺气肿样改变。肺功能异常急性期以限制性通气功能障碍和弥散功能下降为主；治疗若有效，病程第3个月内肺功能异常可完全恢复。

Objective To investigate dynamic changes of CT performance and pulmonary function in renal transplant recipients with pneumocystis pneumonia. Methods A retrospective analysis was made upon the clinic data of chest CT, arterial blood gas and pulmonary function in renal transplant recipients with pneumocystis pneumonia from 2002 to 2006 in the first affiliated hospital of Wenzhou Medical College. Results 16 cases were enrolled, followed by average age （36 ± 11 ） years, mean duration after transplantation （4. 3 ± 2. 1 ） months, mean course of disease （ 4. 5 ± 1.8 ） days. CT performance after admission revealed diffuse alveolar exudates and consolidation in all patients, and others still showed focal emphysema. With effective treatment, CT performance showed resolution of lung opacities completely until the second month, just little fiber remained. The pulmonary dysfunction showed apparent restrictive ventilatory abnormal and decreased DLco. Pulmonary dysfunction improved in the coming 3-4 weeks, and all dysfunction became complete resolution by the third month. Conclusions The characteristic CT performance was focused on the alveolar, with exudates, consolidation and focal emphysema. The main pulmonary dysfunction showed restrictive ventilatory abnormality and decreased DLco. Under effective therapy, these abnormalities would improve significantly by the third month.