卡氏肺囊虫肺炎的临床诊治分析

Analysis of diagnosis and treatment on pneumocystis carinii pneumonia

目的:探讨卡氏肺囊虫肺炎(PCP)的临床诊断、治疗方法。方法:分析和总结2001～2008年本院诊治的9例卡氏肺囊虫肺炎患者的临床表现、实验室检查、影像学检查、支气管镜检查等诊断方法和治疗措施。结果:肺泡灌洗检出22.2%,纤支镜肺组织活检检出55.6%,PCR法确诊2例,占22.2%。早期胸片呈间质性肺炎表现66.7%,CT肺部多发毛玻璃样表现55.6%,肺泡实变影表现33.3%。治疗和预防首选复方磺胺甲噁唑(TMP/SMZ)。其中2例因合并严重呼吸道感染导致呼吸哀竭而死亡,其余7例均治愈,呼吸功能正常。结论:卡氏肺囊虫病的患者早期临床表现不特异,实验室检查亦无明显特异性,X线胸片可以提示PCP的出现,CT可对PCP的诊断提供进一步的帮助。诊断主要依靠支气管镜行肺组织活检查见卡氏肺囊虫孢子,PCR诊断法快速准确,推荐使用。治疗和预防采用复方磺胺甲噁唑为主的综合预防治疗措施。

Objective ：To investigate the diagnosis and prevention of pneumocystosis. Methods：9 cases of pneumocystosis were analyzed with clinical manifestation,laboratory examination,imaging,bronchoscopy and biopsy,preventive measure and therapy. Results：Ratio of diagnose was 22.2% for douche from respiratory,55.6% for bronchoscopy and biopsy ,22.2%for PCR selectively. Plain chest film showing cirrhosis of lung was 66.7%. CT showing frosted glass of lung was 55.6% and consolidation of lung 33.3%.We applied TMP / SMZ for the prevention and therapy primarily and firstly. All patients were cured expect 2 died. Conclusion：Pneumocystosis showed with insignificant fever,hacking cough and laboratory examination in early stage. Plain chest film and CT can clue on pneumocystosis. The final diagnosis of pneumocystosis depended on bronchoscopy and biopsy. PCR is a precise and promising diagnosis method. Prevention and therapy were used TMP/SMZ primarily.