耶氏肺孢子菌肺炎的临床特征分析

Analysis of clinical characteristics of Pneumocystis pneumonia

目的分析耶氏肺孢子菌肺炎患者的临床特点,以提高对此类疾病的认识,做到早诊早治。方法选择2017年3月1日至2022年3月1日,空军军医大学第二附属医院收治的耶氏肺孢子菌肺炎患者43例,按是否感染HIV分为非HIV感染组17例,HIV感染组26例。分析两组患者性别、年龄、吸烟史,基础疾病,既往用药,临床症状、实验室检查、胸部CT资料及治疗、疗效。结果非HIV感染组年龄(52.29±13.59)岁大于HIV感染组(39.42±12.55)岁;两组患者性别,临床症状,起病时间,白细胞总数、淋巴细胞总数及胸部CT表现差异无统计学意义(P>0.05),吸烟史、起病时间小于1周、既往用药基础疾病、合并症,静滴丙种球蛋白、使用机械通气及疗效差异有统计学意义(P<0.05)。非HIV感染组,胸部CT表现、起病时间、治疗中激素使用、丙种球蛋白使用无统计学意义(P>0.05),机械通气使用有统计学意义(P<0.05)。结论中年,有吸烟史,基础疾病,服用激素或免疫抑制剂患者,在小于1周内出现双肺弥漫性病变后应考虑耶氏肺孢子菌肺炎可能,静滴丙种球蛋白有可能疗效亦不佳,使用机械通气可改善预后,完善宏基因组二代测序,精准治疗,降低病死率。

Objective To analyze the clinical characteristics of Pneumocystis pneumonia(PCP)patients,in order to improve its early diagnosis and treatment.Methods All of 17 patients with non-HIV PCP and 26 patients with HIV PCP were admitted to the Second Affiliated Hospital of the Air Force Medical University during March 1,2017 to March 1,2022.Their gender,age,smoking history,basic diseases,medication history,clinical symptoms,laboratory examinations,chest CT imaging,treatment and curative effect were analyzed.Results The age of non-HIV infected PCP group[(52.29±13.59)years]was higher than that of HIV infected PCP group[(39.42±12.55)years],gender,the onset time(within 3 weeks,1 month,3 months,greater than 3 months),the total number of white blood cells,total number of lymphocyte and chest CT imaging were showed no significant difference(P>0.05)and there were significant differences in smoking history,onset time less than 1 week,basic diseases,complications,intravenous immunoglobulin,mechanical ventilation and curative effect(P<0.05).In the non-HIV infected PCP group,chest CT imaging,onset time,hormone and intravenous immunoglobulin during treatment were showed no significant difference(P>0.05),but the use of mechanical ventilation was significant difference(P<0.05).Conclusion When middle-aged patients with a history of smoking,underlying diseases,hormonal or immunoglobulin therapy should consider the possibility of PCP,Intravenous gamma globulin may have poor curative effect,but mechanical ventilation can be used to improve its prognosis,so we should actively improve the metagenomic next generation sequencing as soon as possible,to obtain etiological examination,accurate treatment and reduce mortality.