获得性免疫缺陷综合征患者并临床诊断肺孢子菌肺炎10例回顾性分析

A retrospective study on 10 cases of acquired immunodeficiency syndrome patients with clinically Pneumocystis carini pneumonia

目的探讨获得性免疫缺陷综合征（AIDS）合并临床诊断肺孢子菌肺炎（PCP）的临床特点，以提高对PCP的认识，协助临床诊断治疗。方法回顾性分析我院及海南省农垦总医院10例获得性免疫缺乏综合征（AIDS）合并临床诊断PCP的临床资料。结果（1）男性9例，年龄22～51岁，平均38岁；有冶游史6例；（2）常见的临床表现为咳嗽10例，咳痰9例，呼吸困难8例，发热7例，精神疲倦6例、体重减轻6例；呼吸音增粗9例；（3）85．7％患者血清乳酸脱氢酶（LDH）升高；8例患者中4例动脉血pH〉7．45，7例外周PaO2降低，7例PaCO2降低者；所有患者血沉（ESR）均增快；88．9％的患者血清ALB降低；近半数转氨酶轻-中度升高；6例行T淋巴细胞亚群检测者CD4＋T淋巴细胞低于200×10^6／L；（4）胸部HRCT的主要特点：双肺磨玻璃样影5例；双侧不均匀斑片影3例；双肺不均匀网状条索影2例；（5）经复方磺胺甲噁唑（SMZco）片治疗，好转7例，死亡1例，放弃治疗2例。结论临床遇咳嗽、咳痰、呼吸困难、发热青壮年男性患者，有冶游史，胸部cT示肺门为中心对称性磨玻璃影、网状条索影，伴呼吸性碱中毒、低氧血症、ESR增快、LDH升高等，应考虑艾滋病合并PCP可能；如HIV初筛试验阳性应尽早给予SMZco治疗。

Objective To investigate the clinical characteristics of Pneumocystis pneumonia（PCP） in patients with acquired immunodeficiency syndrome（AIDS） , so that the overall recognising level to this disease would be improved, the diagnostic ability and therapeutic effects be increased. Methods The clinical data of 10 clinically PCP patients with AIDS who were treated in Affiliated Hospital of Hainan Medical College and Hainan General Agricultural Hospital from January 2011 to April 2015 and were analyzed, including the routes of human immunodeficiency virus （HIV） infection, clinical profiles, immunological status, chest radiological characteristics, therapeutic managements and outcome. Results （ 1 ） Of the 10 patients with clinically PCP, 9 were male. Age ranged from 22 to 51 years old. Average age was 38 years. The majority of patients got HIV infection through sexual transmission; （2）The common clinical presentations were cough （10 cases）, sputum （9 cases）, dyspnea （8 cases）, fever （7 cases）, fatigue （6 cases） and weight loss （6 cases）. 9 patients had coarse breath sounds on auscultation; （3）The proportion of patients with elevated lactate dehyrogenase（LDH） were about 85.7%. 8 cases underwent arterial blood gas analysis, among them, 7 patients had a PaO2 less than 60 mmHg, 7 patients had a PaCO2 below normal range, 4 patients had a pH over 7.45. The ESR altered fast in all of the patients. The proportion of patients with reduetive ALB in serum were about 85.7%. Nearly half of patients had mild or moderate rise-transaminase. All the 6 patients who had an immunological test, theperipheral C D4＋ T lymphocyte count less than 200×10^6/L; （4）Main characteristics in chest radiologial scan： （1）bilateral symmetrical ground-glass opcities （5 cases） ; （2）bilateral inhomogeneous patchy infiltrates （3 cases ） ; （3）bilateral inhomogeneous reticular fibrotic scarring（ 2 cases） ; （5）All patients were treated with trimethoprim- sulfamethoxazole （SMZco） . among them, 7 recovered, 2 gave up, and 1 died. Conclusions whenever encountering a young adult and male patient presenting with cough, sputum, dyspnea, fever, and with feculent sexual intercourse, the possibility of PCP associated with AIDS should be considered, especially when chest radiological reveal bilateral, perihilar, diffuse infiltrates （GGO） or fibrotic scarring, accompanying with hypoxia, respiratory alkalosis, acceleration in ESR, promotion in lactate dehydrogenase. If HIV infection is confirmed, the therapy of SMZco should be started immediately.