获得性免疫缺陷综合征合并耶氏肺孢子菌肺炎5例分析

Analysis of 5 cases of acquired immunodeficiency syndrome complicated with pneumocystis carinii pneumonia.

目的探讨获得性免疫缺陷综合征合并耶氏肺孢子菌肺炎(PCP)的临床表现、实验室检查、影像学特征鉴别要点。方法回顾性分析2019年12月至2020年3月某综合医院收治的影像学不除外新冠肺炎,经诊治确诊为获得性免疫缺陷综合征合并PCP的5例患者的临床特点、实验室检查和胸部CT表现。结果5例患者均有发热(4例体温>38.5℃),伴有咳嗽、咳痰及呼吸困难。实验室检查:5例患者外周白细胞总数均正常;3例淋巴细胞绝对值降低;4例淋巴细胞亚群CD4+/CD8+比例显著降低;5例患者C反应蛋白均增高。胸部CT:双肺弥漫性对称分布磨玻璃密度结节影,伴小叶间隔增厚,气道陷闭,呈“马赛克征”。1例出现囊性病变。经治疗,4例患者好转出院,1例患者死亡。结论在流行病学史不明确时,患者临床表现为发热、咳嗽、咳痰、呼吸困难,白细胞总数正常,淋巴细胞绝对值偏低,胸部CT以磨玻璃样病变为主,除了需要警惕新冠肺炎外,还应认真鉴别其影像学特征,早期明确诊断。

Objective To explore the clinical manifestations,laboratory tests,and imaging characteristics of acquired immunodeficiency syndrome complicated with pneumocystis carinii pneumonia(PCP).Methods Retrospective analysis of clinical features,laboratory examinations and chest CT of 5 patients diagnosed with acquired immunodeficiency syndrome and PCP does not exclude the diagnosis of COVID-19 in a general hospital from December 2019 to March 2020.Results All the 5 patients developed fever(4 of them>38.5℃),accompanied by cough,sputum,and dyspnea.Laboratory tests:the total number of peripheral leukocytes was normal,the absolute value of lymphocytes decreased in 3 cases,and the CD4+/CD8+ratio was significantly reduced in 4 cases.The C-reactive protein increased in all 5 patients.Chest CT:the diffuse symmetrical distribution of ground glass density nodules in the lungs was accompanied by thickened lobular septum and airway occlusion,showing a mosaic sign.One case had pulmonary cystic lesions.Four patients improved and were discharged after treatment,and 1 patient died.Conclusions When the epidemiological history is not clear,patients with fever and cough,dyspnea as the main clinical manifestations,normal total number of white blood cells,low absolute value of lymphocytes,and chest CT is mainly composed of ground-glass opacity.In addition to the need to exclude COVID-19.The imaging characteristics should be carefully identified to make a definite early diagnosis.