艾滋病合并肺孢子菌肺炎10例诊治分析

A diagnostic and therapeutic analysis of 10 cases of Pneumocystis pneumonia in acquired immunodeficiency syndrome

目的探讨艾滋病合并肺孢子菌肺炎(PCP)的临床诊治。方法对10例艾滋病合并PCP的临床资料进行回顾性分析。结果首发症状均有发热,8例伴咳嗽,7例伴气促,2例可闻及双肺湿罗音。外周血CD4+T淋巴细胞(41.57±37.35)×106/L,PO2(86.0±33.3)mmHg,LDH(412.1±166.9)U/L,血清白蛋白(29.57±3.74)g/L。胸部螺旋CT表现为不同程度两肺磨玻璃样改变,并可同时合并其他多种特征性影像学改变。3例找到肺孢子菌包囊。4例使用SMZco单药治疗,6例为SMZco+卡泊芬净联合治疗,严重氧合障碍4例,加用糖皮质激素,最后7例好转,2例死亡,1例自动出院。结论艾滋病合并PCP常有典型的临床、实验室指标与胸部影像学表现,部分能找到肺孢子菌包囊,尽早明确诊断并予SMZco或SMZco+卡泊芬净联合治疗,严重氧合障碍者予糖皮质激素治疗,大部分可临床缓解。

Objective To investigate the diagnostic and therapeutic approaches and outcome of Pneumocystis pneumonia（PCP） in patients with acquired immunodeficiency syndrome. Methods The clinical data of 10 cases with acquired immunodeficiency syndrome complicating PCP were retrospectively analyzed. Results All of the cases showed first symptom as fever （10/10）, cough（8/10）, progressive dyspnea（7/10）, moist rales in double lungs （2/10）, the peripheral CD4~T lymphocyte count （41.57±37.35）×10^6/L, PO2 （86.0±33.3）mmHg, LDH （412.1±166.9）U/L, Serium Albium （29.57±3.74）g/L. All patients showed ground glass shadows on chest CT in varying degrees. In these, simple ground glass appeared in 2 patients, with grid-like or cord-like shadows appeared in 2 cases, macadam in 1 case, local nodular shadows in 2 cases, pulmonary balloon in 2 case, mediastinal emphysema and pneumothorax in 1 case, mediastinal lymphadenectasis in 1 case and diffused miliary nodules in double lungs in 1 case. Cysts of Pneumocystis were found by toluidine blue stain of sputum or bronchoalveolar lavage fluid in 3 cases. SMZco were used for therapy in 4 cases, SMZco combining caspofungin in 6 cases, and corticosteroids were used in 4 patients with serious obstacle oxygenation. Of the 10 PCP patients, 7 recovered, 2 died and 1 gave up due to economic reasons. Conclusion When acquired immunodeficiency syndrome complicating PCP, it has classic symptom, laboratory parameters and chest imaging, and cysts of Pneumocystis can be found in sputum or bronchoalveolar tavage fluid or by lung biopsy in partial cases. SMZco or SMZco combining caspofungin therapy should be used immediately and corticosteroids should be added in patients with serious obstacle oxygenation, finally most of acquired immunodeficiency syndrome complicating PCP patients can acquire clinical remission.