非HIV感染免疫抑制肺孢子菌肺炎临床特点分析

Analysis of clinical characteristics of 11 cases of non-HIV infection immunosuppressive pneumocystis pneumonia

目的分析非HIV感染免疫抑制肺孢子菌肺炎(PCP)的临床特征。方法收集2016年1月—2018年10月河北医科大学第二医院呼吸与危重症医学二科收治的11例非HIV感染免疫抑制患者发生PCP的临床资料,分析临床特点。结果11例患者中,男8例,女3例,年龄19~70岁,中位数40岁。基础疾病中肾脏疾病6例,血液系统疾病3例,自身免疫性疾病2例,所有患者入院前均接受糖皮质激素治疗,4例患者联合免疫抑制剂。患者均有发热,呼吸困难6例,咳嗽咯痰3例。体征以呼吸音增粗为主(6例),部分患者闻及细湿啰音、捻发音或者Velcro音(4例)。11例患者均伴有呼吸衰竭,氧合指数降低。CT影像学表现以弥漫的双肺磨玻璃影为主(9例),其次为片状高密度阴影(2例)。11例患者均合并巨细胞病毒感染,3例患者同时合并EB病毒感染。入院后所有患者使用联磺甲氧苄啶,7例患者联合应用卡泊芬净。9例患者初期给予无创通气,7例患者无创通气失败转为有创通气。最终存活5例,死亡6例。结论非HIV感染免疫抑制患者罹患PCP的基础疾病多样,PCP发病与接受糖皮质激素及免疫抑制剂有关,病情较重,混合机会性感染常见,病死率较高。

Objective To analyze the clinical features of Pneumocystis pneumonia(PCP)in immunosuppressed patients with non-human immunodeficiency virus(HIV)infection.Methods From January 2016 to October 2018,the clinical data of 11 cases of non-HIV infection immunosuppressive patients admitted to the Intensive Care Unit(ICU)of the Second Department of Respiratory and Critical Care Medicine of Hebei Medical University were collected,and the clinical characteristics were analyzed.Results Among the 11 patients,8 were males and 3 were females,aged 19 to 70 years old,with a median of 40 years old.Among the basic diseases,there were 6 cases of kidney disease,3 cases of blood system disease,and 2 cases of autoimmune disease.All patients received glucocorticoid treatment before admission,and 4 patients were combined with immunosuppressive agents.All patients had fever,dyspnea was common(6 cases),and cough and expectoration were rare(3 cases).The physical signs were mainly thickened breath sounds(6 cases),and some patients could hear fine wet rales,crepitus or Velcro sounds(4 cases).All 11 patients had respiratory failure and decreased oxygenation index.The imaging findings were mainly diffuse ground glass shadows in both lungs(9 cases),followed by sheet-like high-density shadows(2 cases).All 11 patients had cytomegalovirus infection,and 3 patients had EB virus infection at the same time.After admission,all patients were treated with trimethoprim,and 7 patients were treated with caspofungin.Nine patients were given non-invasive ventilation at the initial stage,and 7 patients failed non-invasive ventilation and switched to invasive ventilation.In the end,5 patients survived and 6 died.Conclusion Non-HIV infection immunosuppressive patients suffer from various basic diseases of PCP.The onset of PCP is related to receiving glucocorticoids and immunosuppressive agents.The condition is severe,mixed opportunistic infections are common,and the mortality rate is high.