艾滋病合并肺孢子菌肺炎在病毒性肺炎流行期的临床观察

Clinical observation of AIDS combined with pneumocystis pneumonia during the prevalence of viral pneumonia

目的艾滋病合并肺孢子菌肺炎与病毒性肺炎均可引起呼吸道症状及肺部病变,通过对艾滋病合并肺孢子菌肺炎的临床观察,提高医务工作者在病毒性肺炎流行期对艾滋病合并肺孢子菌肺炎的诊疗水平,最大限度地改善患者预后。方法回顾性分析病毒性肺炎流行期间艾滋病合并肺孢子菌肺炎患者38例的流行病学史、临床表现、实验室检查、肺部CT、治疗方法及效果。结果 38例患者中,艾滋病患者的感染途径均为性传播,其中男男同性性传播占86.84%;首发症状以发热、干咳、运动性呼吸困难为主;消瘦33例(86.84%);合并有其他感染的患者36例(94.74%),其中合并细菌性肺炎患者35例(92.11%);鹅口疮20例(52.63%);白细胞降低28例(73.68%),淋巴细胞绝对值数降低33例(86.84%);乳酸脱氢酶升高36例(94.74%);(1,3)-β-D-葡聚糖(G)试验阳性33例(86.84%);患者CD+4T淋巴细胞数计数均<200个/μl,其中<50个/μl的患者34例(89.47%);患者肺部CT主要表现为双肺云雾样、磨玻璃状、网状磨玻璃影、碎石路样、肺气囊或斑片状实变影等;给予复方磺胺甲■唑口服治疗肺抱孢子菌肺炎,及早开始HAART抗病毒治疗对于病情有所缓解。结论艾滋病合并肺孢子菌肺炎病情严重,在病毒性肺炎防控期间,做到早诊断,及时治疗,可改善患者生存质量,延长患者生命。

Objective To investigate the data about AIDS combined with pneumocystis pneumonia during the prevalence of viral pneumonia to improve the diagnosis and treatment levels of medical staff,so as to improve the prognosis of patients as much as possible.Methods The epidemiological history,clinical manifestations,laboratory examination results,lung CT,treatment methods and therapeutic effects about 38 patients with AIDS combined with pneumocystis pneumonia during the prevalence of viral pneumonia to improve were retrospectively analyzed.Results Of the 38 patients,the infection routes of patients with AIDS were sexually transmitted,of whom,male and male homosexual transmission accounted for 86.84%,and the first symptoms were mainly fever,dry cough and exercise-induced dyspnea,moreover,there were 33 cases(86.84%)of wasting,36 cases(94.74%)of other infections,including 35 patients(92.11%)with bacterial pneumonia,20 patients with thrush(52.63%);28 patients with leukopenia(73.68%),and 28 patients with decreaseof WBC count,33 cases(86.84%)of decrease of absolute number of lymphocytes,36 cases(94.74%)of increase of lactate dehydrogenase,and 33 patients(86.84%)with positive(1,3)-β-D-glucan(G)test.Among the patients with CD+4T lymphocyte counts being less than 200/μl,there were 34 patients(89.47%)with lymphocyte counts being less than 50/μl,and the main manifestations by lung CT examination were cloudiness of double lungs,ground glass,reticulated ground glass shadow,and lithotripsy road-like,pulmonary air sac or patchy solid changes.Moreover the patients were treated by oral co-trimoxazole for eumocystis pneumonia,and early pplication of HAART antiviral therapy could relieve the disease condition.Conclusion The disease condition in patients with AIDS combined with pneumocystis pneumonia is severe,therefor,early diagnosis and timely treatment can improve the life quality of patients and prolong patient’s life.During the prevention and control of viral pneumonia,early diagnosis and timely treatment can improve the quality of life of patients and prolong their lives.