激素与免疫抑制剂治疗慢性肾病并发重症肺炎临床与CT特点

Clinical and CT Charactristics of Concurrent Severe Pneumonia During Glucocorticoid and Immunosuppressive Drugs Treat Chronic Nephropathia

目的分析糖皮质激素(以下简称激素)与免疫抑制剂治疗慢性肾病并发重症肺炎的临床与CT特点,并总结治疗中的体会。方法回顾性分析2009年9月至2014年1月我院肾内科收治的19例接受激素与免疫抑制剂治疗的慢性肾病并发重症肺炎患者完整的临床与影像学资料,分析其致病因素、对其临床与CT特点进行总结。结果临床特点:以发热起病,多伴有寒战、乏力、胸闷、气短、轻咳、少量白痰,并迅速出现低氧血症。CT特征:早期:双肺间质性磨玻璃影为主且内见支气管血管束,少部分为散在小斑片状密度增高影;后期:双肺弥漫性磨玻璃影或大片实变影。所有患者胸腔积液无或少见,无纵膈淋巴结肿大。结论激素与免疫抑制剂治疗慢性肾病并发重症肺炎临床与CT有典型表现,CT表现结合临床可以对本病做出准确诊断。广谱抗菌药及丙种球蛋白在治疗中起了至关重要作用。

Objective To analyze clinical and CT characteristics of concurrent severe pneumonia during glucocorticoid and immunosuppressive drugs to be used for chronic nephropathy,and summarize treatment experience.Methods From September 2009 to January 2014 in nephrology department of our hospital,the clinical and imaging data of 19 patients with concurrent severe pneumonia were analyzed retrospectively during glucocorticoid and immunosuppressive drugs to be used for chronic nephropathy,analyzing its pathogenic factors,and summarizing its clinical and CT characteristics.Results Clinical characteristics：begin with fever,mostly with shiver,weak,chest congestion,breatheless,cough a little white sputum,and hyoxemia appears quickly.parts shows respiratory failure and respiatory alkalosis in the therapeutic process;blood tests prompt infection and immunity-low.Characteristic of CT manifestations：Early stage：interstitial ground-glass opacities of double-lung are main,and bronchovascular bronchus are in them,sporadic small patchy clouding opacities are a small number;Later stage：Diffuse ground-glass opacities of double-lung or large patchy consolidation,all patients don＇t have pleural effusion or scarce,and don＇t have mediastinal lymph nodes tumour.Conclusion：Concurrent severe pneumonia has typical clinical and CT characteristics during glucocorticoid and immunosuppressive drugs treat chronic nephropathia,CT mainfestation combining clinical symptoms can make an accurate diagnosis to this disease.Broad-spectrum antibiotic and gamma globulin perform an important function during the therapy.