异基因造血干细胞移植后并发肺孢子菌肺炎的临床观察

Diagnosis and treatment of pneumocystotis pneumonia after allogeneic hematopoietic stem cell transplantation

目的:探讨异基因造血干细胞移植后合并肺孢子菌肺炎(PCP)的临床诊断、治疗和预防措施。方法:回顾分析9例造血干细胞移植后临床诊断为PCP的表现、肺部CT影像、血气分析、G试验、支气管镜检查等相关资料,进行总结。结果:9例患者临床诊断PCP的时间在移植+80～+316d,早期表现为发热、咳嗽、进行性呼吸困难等非特异性症状,血气分析严重低氧血症,肺部CT影像以磨玻璃样改变为主的间质病变,血G试验升高,均接受复方磺胺甲基唑(即磺胺甲基唑SMZ/甲氧卞胺嘧啶TMP,复方新诺明,SMZCO)治疗,6例低氧血症严重者同时口服激素,治疗时间3周,9例均治愈。结论:PCP多发生在异基因造血干细胞移植后3～12个月,对于以发热、呼吸困难、低氧血症、血G试验阳性、肺CT影像磨玻璃样改变且抗生素治疗无效的异基因造血干细胞移植患者应考虑PCP临床诊断,尽早SMZCO治疗有助改善预后。

Objective：To investigate the early diagnosis,treatment and prevention of pneumocystotis pneumonia （PCP） after allogeneic hematopoietic stem cell transplantation （allo-HSCT）.Method：The clinical data of 9 cases who developed PCP after allo-HSCT were discussed including clinical symptoms,signs,the β-D-glucan levels,blood gase,CT scan imaging,and results of bronchoscopy and alveolar douche examination.Result：The data showed that the time of onset of symptoms ranged from 80 to 316 d after allo-HSCT. The common clinical presentations were fever,cough,progressive exertional dyspnea and hypoxia. The β-D-glucan levels were higher than in normal controls. The most common abnormal chest CT findings included bilateral diffuse interstitial infiltrations,patchy shadows and frosted glass like change. All of the 9 cases were given trimethoprim-sulfamethoxazole （SMZ/TMP,SMZCO） for 3 weeks. Of them,6 cases with severe hypoxia were treated with corticosteroids concomitantly. All of them recovered.Conclusion：Most PCP occurred at 3 to 12 months after allo-HSCT. Diagnosis of PCP should be considered whenever the patients have fever,dyspnea,hypoxia and high level β-D-glucan,especially when the chest CT findings revealed interstitial infiltration and frosted glass like change. The therapy with SMZCO should start immediatedly,which is effective in the prevention and treatment of PCP.