肺孢子菌肺炎31例临床分析

Clinical analysis of 31 patients with pneumocystis pneumonia

目的探讨研究肺孢子菌肺炎患者的临床特点、影像学表现及治疗方法。方法分析在我院诊断的肺孢子菌肺炎的31例患者的临床资料。结果 31例患者中HIV/AIDS患者28例,非AIDS患者3例,其中男性22例,女9例,年龄23～75岁。主要临床表现为咳嗽,气促者28例（90.3%）,发热25例（80.6%）,咳痰17例（54.8%）,乏力,纳差15例（48.3%）,胸痛8例（25.8%）,腹泻4例（12.9%）,反复皮疹3例（9.6%）。3例患者行无创通气,1例因严重肺部感染,低氧血症,行有创机械通气。31例患者胸部CT均表现为典型的双肺弥漫性磨玻璃影,所有患者均选用复方磺胺甲基异噁唑治疗,对吸空气时血氧分压PaO2低于70 mmHg患者给予激素治疗。结论当AIDS患者或免疫抑制患者出现发热,咳嗽,呼吸困难,低氧血症,其胸部CT提示典型的双肺弥漫性磨玻璃影,需考虑PCP的可能,但其病原学检查困难,治疗以复方磺胺甲基异噁唑及激素治疗为主。

Objective To study the clinical characteristics,CT imaging feature and treatment of pneumocystis pneumonia（ PCP）. Methods The clinical data of 31 inpatients,who were diagnosed with PCP in the Central Hospital of Dazhou,were retrospectively analyzed. Results There were 28 cases co-infected with HIV and 3 cases without HIV infection. The main clinical manifestations included cough and shortness of breath（ 90. 3%）,fever（ 80.6%）,expectoration（ 54.8%）,fatigue and poor appetite（ 48.3%）,chest pain（ 25.8%）,diarrhea（ 12.9%）,and recurrent skin rash（ 9.6%）. Besides,3 patients suffered from NPPV,and 1 patient suffered from IPPV because of serious lung infection and hypoxaemia. The chest CT scans of 31 patients were characterized with typical bilateral lung diffuse ground-glass opacity. Conclusion When patients with AIDS or immunosuppression have fever,cough,dyspnea and hypoxemia,and their chest CT scans show the typical bilateral lung diffuse groundglass opacity,the possibility of PCP needs to be considered,but its etiological examination is difficult,so the treatment is given priority to SMZ and hormone therapy.