毛细胞白血病合并肺孢子菌肺炎和Sweet综合征临床治疗分析

Analysis of Clinical Treatment of Hairy Cell Leukemia and Pneumocystis Pneumonia and Sweet Syndrome

目的探究毛细胞白血病合并肺孢子菌肺炎和Sweet综合征临床特点、诊断治疗方法。方法选择2013年2月—2017年2月该院收治的5例毛细胞白血病合并肺孢子细菌肺炎和Sweet患者作为研究对象,并对其实施相应的治疗,探究其治疗效果。结果患者住院初始疾病为毛细胞白血病,住院期间表现为呼吸困难、持续发热、咳嗽等现象,在CT诊断中肺部多呈现出结节状实变影、片状,边缘较为模糊,胸腔内存在积液,在接受抗真菌、光谱抗生素治疗之后未产生显著效果,使用磺胺类药物与治疗之后,其咳嗽、发热、皮疹症状得到改善,所有患者治疗效果都较为显著,出院随诊期间皮疹、发热消失,主CD11c、HLA—DR、CD20、CD19、CD25等得到缓解,骨髓系增受抑现象也得到缓解。患者的白细胞计数从治疗之前的0.7×10~9/L到1.6×10~9/L上升到标准范围之内;并且中性粒细胞计数从0.14~0.44×10~9/L上升到标准范围。结论毛细胞白血病出现原因不明的感染征象,当选择抗真菌药物、光谱抗生素药物治疗效果不明显时,可以诊断患者是否存在肺孢子菌肺炎;当患者毛细胞白血病出现皮肤散在斑疹时,特别是合并肺孢子菌肺炎时,则需要考虑其是否为Sweet综合征现象。

Objective To study the clinical features and diagnosis and treatment method of hairy cell leukemia and pneumocystis pneumonia and Sweet syndrome. Methods 5 cases of patients with hairy cell leukemia and pneumocystis pneumonia and Sweet syndrome admitted and treated in our hospital from February 2013 to February 2017 were selected and were given the corresponding treatment and the treatment effect was studied. Results The initial disease of patients was hairy cell leukemia, and the manifestations during the hospitalization period were dyspnea, persistent fever and cough, and the CT diagnosis showed the nodositas consolidation images and blurring edges and pleural effusion, and the cough, fever and rash symptoms were improved after the sulfa-drugs treatment, and the treatment effect of all patients was obvious, and the rash and fever disappeared during the follow-up period and the CD11 c,HLA-DR,CD20,CD19,CD25 were relieved and the myelosuppression was also relieved, and the leucocyte count of patients increased from 0.7×10^9/L to 1.6×10^9/L in the critical field, and the neutrophil count increased from 0.14×10^9/L to 0.44×10^9/L in the critical field. Conclusion The patients can be diagnosed with pneumocystis carinii pneumonia when the hairy cell leukemia is with unknown infection signs and the treatment effect of antifungal drug and spectrum antibiotic drugs is not obvious, and the patients can be diagnosed with Sweet syndrome when the hairy cell leukemia is with skin rash especially with pneumocystis pneumonia.