摘要
目的探讨艾滋病(AIDS)合并卡氏肺孢子菌肺炎(PCP)的临床表现、诊断和治疗。方法采用回顾性分析的方法收集宁夏医科大学总医院感染疾病科自2014年10月~2015年1月间收治的艾滋病合并卡氏肺孢子菌肺炎患者的临床特点、实验室检查和64排螺旋CT表现。结果咳嗽、持续低热、进行性呼吸困难、紫绀是PCP最常见的临床症状,CD^(4+)T淋巴细胞数为(1~400)个/μL;典型影像学表现为双肺弥漫性磨玻璃样渗出影;PCP患者均采用复方磺胺甲基异恶唑(SMZco)治疗,如动脉血氧分压<70 mmHg联合强的松治疗,如合并其他机会性感染予以相应的治疗;其中3例患者好转,1例患者死亡,1例患者放弃治疗自动出院。大多数患者因合并其他病原菌感染而死亡,且其CD^(4+)T淋巴细胞计数明显低于病情好转的患者。结论 PCP主要发生在AIDS晚期,如AIDS患者有低热、呼吸困难、低氧血症、体重下降等临床表现,且胸部CT表现为间质纹理增粗、模糊或呈磨玻璃状阴影,需留心AIDS合并PCP的可能,应早期给予SMZco治疗,严重患者可联合糖皮质激素冲击治疗。
Objective To investigate AIDS patients complicated with pneumocystis carinii pneumonia（PCP）. Methods Using a retrospective analysis method,collected AIDS patients complicated with PCP hospitalized in the department of infectious disease in General Hospital Ningxia Medical University from October 2014 to January 2015,included datas of clinical features,laboratory tests,MSCT data. Results The most common clinical symptoms were cough,continuous fever, progressive dyspnea and cyanosis.The number of CD^（4＋）T lymphocyte was（1-400）/μL; pulmonary groundglass changes was the typical CT imaging; all the PCP patients were treated by sulfamethoxazole（SMZco）. If PCP patients ＇ arterial oxygen pressure 〈70 mmHg, they would be treated by SMZco combined with prednisone. If having other opportunistic infections,they would be treated accordingly. Among them,3 cases improved, and 1 case dead,1 case was discharged to give up treatment and dead in home. However,death patients were mostly and simultaneously combined with other pathogens infection and CD^（4＋）T lymphocyte counts were significantly lower than the patients got better.Conclusion PCP occurs mainly in late stage of AIDS, clinical symptoms are continuous fever, dyspnea, hypoxemia,weight loss,etal. If typical CT showed interstitial changes or frosted glass-like texture change should alert the possibility of PCP in AIDS patients,which should be given treatment of SMZco as soon as possible.In severe cases should be combined with corticosteroid therapy.
出处
《中国现代医生》
2016年第10期73-76,共4页
China Modern Doctor
