结缔组织病并发重症肺炎19例临床分析

Connective tissue diseases accompanying severe pneumonia: A clinical analysis of 19 patients

目的探讨结缔组织病并发重症肺炎患者临床特点,为临床诊治提供参考。方法回顾性分析我院呼吸科重症监护病房2010年6月-2013年5月收治的结缔组织病并发重症肺炎患者的临床资料。结果共纳入19例患者,其中系统性红斑狼疮7例(36.8%)、类风湿关节炎5例(26.3%)、多发性肌炎/皮肌炎3例(15.8%)。本次起病前应用糖皮质激素或免疫抑制剂治疗15例(78.9%)。本组患者主要临床表现为发热(16例)、呼吸困难(17例)、咳嗽(12例)。病原体包括细菌、真菌和巨细胞病毒,部分病例为混合感染。经治疗,好转9例(均未接受有创机械通气),恶化或死亡10例(无创机械通气失败或接受有创机械通气)。结论结缔组织病并发重症肺炎患者病原体包括细菌和机会感染,无创机械通气失败或需要接受有创机械通气者预后差,早期进行全面综合诊治很重要。

Objective To investigate the clinical features of patients with connective tissue diseases（CTD） complicated with severe pneumonia. Methods Clinical data of severe pneumonia patients with CTD admitted to respiratory intensive care unit from June 2010 to May 2013 were retrospectively analyzed. Results This study included 19 patients, systemic lupus erythematosus 7 cases （36.8%）, rheumatoid arthritis 5 cases （26.3%）, polymyositis/dermatomyositis 3 cases（15.8%）. 15 （78.9%） out of the 19 patients were treated with corticosteroids or immunosuppressants before the onset of pneumonia. The main clinical manifestations included fever （16 cases）, dyspnea （17 cases）, cough（12 cases）. The pathogens detected in the patients included bacteria, fungi and Cytomegalovirus. Mixed infection occurred in some of the patients. After treatment, 9 patients who did not receive invasive mechanical ventilation were improved, 10 patients （noninvasive mechanical ventilation failure or receiving invasive mechanical ventilation） deteriorated or died. Conclusion Pathogens of severe pneumonia in patients with CTD include bacteria and opportunistic pathogens. Noninvasive mechanical ventilation failure and requiring invasive mechanical ventilation are poor prognostic indicators. Comprehensive diagnosis and treatment in early stage is important.