非人类免疫缺陷病毒感染的肺孢子菌肺炎患者的临床特征

Clinical Characteristics of Pneumocystis Pneumonia Patients with Non-human Immunodeficiency Virus Infection

【目的】探讨非人类免疫缺陷病毒(HIV)感染的肺孢子菌肺炎(PCP)患者的临床特征。【方法】收集2018年10月至2019年9月在本院呼吸与危重症医学科诊治的非HIV感染的PCP患者的临床资料,分析其临床特征。【结果】研究纳入45例患者,19例(42.2%)死亡。基础疾病中最常见的为自身免疫性疾病,其次为恶性肿瘤、实体器官移植术后及肾脏疾病;PCP患者主要表现为非特异性的发热、咳嗽、呼吸困难,典型的胸部CT影像为双肺多发或散在磨玻璃影。和住院期间存活的患者相比,死亡患者入院时白蛋白更低(33.9±5.0vs27.7±4.3),乳酸脱氢酶更高(390.7±189.1vs524.1±246.9),血浆尿素氮水平更高[6.1(5.2~8.0)vs9.4(5.0~15.5)],氧合指数更差[371.4(316.2~423.8)vs300.0(257.1~354.8)],其差异均有统计学意义(均P<0.05)。入院后44例均使用复方磺胺甲噁唑抗PCP治疗,其中31例联合使用卡泊芬净;41例(91.1%)患者在抗感染基础上接受糖皮质激素治疗。【结论】非HIV感染的PCP患者病死率较高,入院时低白蛋白、血浆乳酸脱氢酶和尿素氮升高及氧合指数差的患者预后不良。

【Objective】To investigate clinical characteristics of pneumocystis pneumonia(PCP)in non-HIV-infected patients.【Methods】The clinical data of non HIV infected PCP patients diagnosed and treated in respiratory and critical care medicine department of our hospital from October 2018 to September 2019 were collected,and their clinical characteristics were analyzed.【Results】Forty five patients were included in the study,and 19(42.2%)died.The most common underlying diseases are autoimmune diseases,followed by malignant tumors,solid organ transplantation and kidney diseases;the main manifestations of PCP patients are nonspecific fever,cough and dyspnea,and the typical chest CT images are multiple or scattered ground glass shadows in both lungs.Compared with the patients who survived in hospital,the dead patients had lower albumin(33.9±5.0 vs 27.7±4.3),higher lactate dehydrogenase(390.7±189.1 vs 524.1±246.9),higher plasma urea nitrogen level[6.1(5.2-8.0)vs 9.4(5.0-15.5)]and worse oxygenation index[371.4(316.2-423.8)vs 300.0(257.1-354.8)],the differences were statistically significant(all P<0.05).After admission,44 cases were treated with compound sulfamethoxazole anti PCP,31 cases were treated with caspofungin;41 cases(91.1%)were treated with glucocorticoid on the basis of anti infection.【Conclusion】The mortality of PCP patients without HIV infection is higher,and the prognosis of patients with low albumin,increased plasma lactate dehydrogenase and urea nitrogen and poor oxygenation index on admission is poor.