非HIV感染肺孢子菌肺炎患者临床特点及诊治分析

Analysis of Clinical Features,Diagnosis and Treatment of Pneumocystis Pneumonia in the Non-HIV-infected Patients

目的提高对非HIV感染肺孢子菌肺炎(PCP)患者的诊断和认识。方法对2011—2013年我院确诊的24例非HIV感染PCP患者的临床表现、实验室检查、CT影像特点、治疗及转归等临床资料进行总结及讨论。结果发热和呼吸困难为首发症状。病情进展迅速,所有患者存在Ⅰ型呼吸衰竭。胸部CT主要表现为弥漫性磨玻璃影。痰或支气管肺泡灌洗液姬姆萨染色肺孢子菌或肺孢子菌PCR阳性确诊。21例患者应用复方磺胺甲口恶唑(SMZco)治疗,3例患者因SMZco严重过敏或初用SMZco发生不良反应而应用卡泊芬净治疗,所有患者治愈。结论 PCP是应用免疫抑制剂患者易患的机会性感染,通过痰或支气管肺泡灌洗液PCR检测阳性或涂片姬姆萨染色查到肺孢子菌而确诊,临床应注意与其他肺炎鉴别。PCP治疗首选SMZco,当对SMZco过敏或发生不良反应时可改用卡泊芬净治疗。

Objective To improve diagnostic level and awareness of pneumocystis pneumonia（ PCP） in the non-HIV- infected patients. Methods The clinical data（ including manifestation,laboratory examination,CT imaging features,treatment and prognosis） of twenty- four non- HIV- infected patients with PCP who were diagnosed in our hospital from 2011 to2013,was summarized and discussed. Results Fever and dyspnea were the first symptoms,the development of PCP was rapid. All the patients had type Ⅰrespiratory failure. The chest CT characteristics indicated diffuse ground- glass appearance. The phlegm or bronchoalveolar lavage fluid was stained by Giemsa stain method,if pneumocystis could be found,or PCR result of phlegm or bronchoalveolar lavage fluid was positive for pneumocystis,PCP could be diagnosed. Twenty- one cases were treated with SMZco,the others were highly allergic to SMZco,or adverse reactions occurred,so they were treated with caspofungin,all the patients were cured. Conclusion PCP is a kind of common opportunistic infection among patients who are treated with immunosuppressive agents,if PCR result of phlegm or bronchoalveolar lavage fluid is positive for pneumocystis,or pneumocystis can be found in phlegm or bronchoalveolar lavage fluid smear,PCP can be diagnosed,differential diagnosis should be done between PCP and other kinds of pneumonia. SMZco is the first choice in the treatment of PCP,but caspofungin can be used when SMZco adverse reactions occur.