异基因造血干细胞移植后耶氏肺孢子菌肺炎20例临床特征

Clinical features of 20 cases with Pneumocystis jirovecii pneumonia after allogeneic hematopoietic stem cell transplantation

2014年4月至2022年10月,20例血液病患者在北京大学人民医院接受异基因造血干细胞移植(allo-HSCT)后发生耶氏肺孢子菌肺炎(pneumocystisjiroveciipneumonia,PJP)。男13例(65.0%),女7例(35.0%),中位年龄34(19~60)岁。急性髓系白血病11例(55.0%),急性淋巴细胞白血病4例(20.0%),骨髓增生异常综合征2例(10.0%),慢性粒-单核细胞白血病1例(5.0%),非霍奇金淋巴瘤1例(5.0%),再生障碍性贫血1例(5.0%)。同胞全相合移植3例(15.0%),无关供者移植3例(15.0%),单倍体移植14例(70.0%)。PJP中位发病时间为移植后353(74~1121)d。主要临床症状为发热、咳嗽、咯痰、呼吸困难。所有患者CT检查均有双肺弥漫磨玻璃影、斑片影、实性结节等感染征象。9例(45.0%)患者需鼻导管吸氧支持,7例(35.0%)患者需呼吸机辅助呼吸。重症感染7例(35.0%),轻、中度感染13例(65.0%)。8例(40.0%)患者发生巨细胞病毒感染,2例患者发生EB病毒感染。所有20例患者均接受复方磺胺甲唑治疗(标准剂量11例,低剂量9例)。19例患者存活,1例患者死亡。

This study included 20 patients with hematological diseases who developed Pneumocystis jirovecii pneumonia (PJP) after receiving allogeneic hematopoietic stem cell transplantation (allo-HSCT) from April 2014 to October 2022 at Peking University People’s Hospital. The 20 patients comprised 13 males (65.0% ) and seven females (35.0% ), with a median age of 34 (19-60) years. Eleven cases (55.0% ) of acute myeloid leukemia, four cases (20.0% ) of acute lymphocytic leukemia, two cases (10.0% ) of myelodysplastic syndrome, one case (5.0% ) of chronic myelomonocytic leukemia, one case (5.0% ) of non-Hodgkin lymphoma, and one case (5.0% ) of aplastic anemia were analyzed. Three cases (15.0% ) of HLA-identical sibling hematopoietic stem cell transplantation, three cases (15.0% ) of matched unrelated donor hematopoietic stem cell transplantation, and 14 cases (70.0% ) of haploid hematopoietic stem cell transplantation were identified. The median onset time of PJP was 353 (74-1121) days after transplantation. The clinical symptoms mainly included fever, cough, expectoration, and dyspnea. All patients presented signs of infection based on the CT scan, including bilateral diffuse ground-glass opacities, patchy shadows, and solid nodules. Nine patients (45.0% ) required respiratory support via nasal catheter oxygen inhalation, while seven patients (35.0% ) required ventilator-assisted breathing. Seven (35.0% ) severe infections and 13 (65.0% ) mild to moderate infections were recorded. Moreover, eight patients (40.0% ) were complicated with human cytomegalovirus infection, whereas two patients were complicated with EB virus infection. Furthermore, all 20 patients received treatment with compound sulfamethoxazole (standard dose, 11 cases;low dose, 9 cases). Furthermore, 19 patients survived and one patient died.