血液病并发肺孢子菌肺炎10例并文献复习

Hematologic diseases with Pneumocystis carinii pneumonia:report of 10 cases and review of literature

目的探讨血液病并发肺孢子菌肺炎(PCP)患者的临床特征、诊治和转归,提高对该病的认识。方法回顾性病例系列研究。回顾性分析2016年1月至2020年6月于航天中心医院就诊的10例血液病并发PCP患者的临床资料,分析患者临床特征、治疗过程和转归,并复习相关文献。结果10例患者中,男性、女性各5例,年龄[M(Q_(1),Q_(3))]39岁(25岁,51岁);急性髓系白血病(AML)7例,急性淋巴细胞白血病(ALL)2例,外周T细胞淋巴瘤1例;8例并发PCP时已行造血干细胞移植。8例患者通过肺泡灌洗液、2例患者通过痰液查找病原菌而确诊PCP。治疗药物包括联磺甲氧苄啶片、甲泼尼龙、卡泊芬净。治愈7例,死亡3例。结论血液病并发PCP患者临床表现及影像学表现具有潜伏性及非特异性,早期诊断困难,确诊主要依赖于查找病原学病因。早期诊断和治疗是改善血液病并发PCP患者预后、降低病死率的关键。

Objective To explore the clinical characteristics,diagnosis,treatment and outcome of hematologic diseases complicated with Pneumocystis carinii pneumonia(PCP),and to improve the understanding of the disease.Methods A retrospective case series study was conducted.The clinical data of 10 patients with hematologic diseases complicated with PCP in Aerospace Central Hospital from January 2016 to June 2020 were retrospectively analyzed,and their clinical characteristics,treatment process and outcome were also analyzed.The literature was reviewed.Results Among the 10 patients,5 cases were male and 5 cases were female;the age[M(Q_(1),Q_(3))]was 39 years old(25 years old,51 years old);7 cases were acute myeloid leukemia(AML),2 cases were acute lymphoblastic leukemia(ALL),and 1 case was peripheral T-cell lymphoma;8 cases had received hematopoietic stem cell transplantation when complicated with PCP.Eight patients were diagnosed by pulmonary alveolar lavage fluid,and 2 patients were diagnosed by seeking pathogenic bacteria in sputum.The therapeutic agents included trimethoprim tablets,methylprednisolone and caspofungin.Seven cases were cured and 3 died.Conclusions The clinical and imaging manifestations of patients with hematologic diseases complicated with PCP are latent and non-specific,so the early diagnosis is difficult.The diagnosis mainly depends on etiology.Therefore,early diagnosis and treatment is the key to improve prognosis and reduce mortality in patients with hematologic diseases complicated with PCP.