9例确诊非HIV患者肺孢子菌肺炎临床分析

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1、9例确诊非HIV患者肺胞子菌肺炎临床分析［摘要］目的探讨非HIV免疫功能抑制患者肺胞子菌肺炎(PCP)的临床特点。方法回顾性分析9例非HIV免疫功能抑制患者肺砲子菌肺炎患者的临床资料。结果所有患者发生PCP前均接受了长期激素或免疫抑制剂治疗，其中8例(88.9%)应用糖皮质激素，3例(33.3%)接受免疫抑制剂治疗。所有患者均存在进行性呼吸困难，7例(77.8%)出现典型三联征”“发热、干咳和进行性呼吸困难。影像学特征为双肺弥漫磨玻璃浸润影8例(88.9%)和实变影1例(11.1%)O7例患者应用磺胺甲恶吐/甲氧节噪联合卡泊芬净治疗，死亡2例；2例患者应用磺胺甲恶哇/

2、甲氧节唳治疗，死亡1例；总病死率33.3%o结论非HIV免疫功能抑制患者感染PCP病死率较高，对有出现发热、干咳和进行性呼吸困难及双肺弥漫磨玻璃浸润影等临床表现的患者，尤其是免疫功能受损时应考虑PCP的可能，及早进行痰或支气管肺泡灌洗液病原学检查，以早期诊断、早期治疗。［关键词］肺胞子菌肺炎；非获得性免疫缺陷综合征；临床特点；G试验［中图分类号］R563.1［文献标识码］B［文章编号］1673-9701(2016)21-0033-03［Abstract］ObjectiveToinvestigatetheclinicalcharacteristicsofPneumocy

3、stispneumoniapatientswithnon-humanimmunodeficiencyvirus(non~HIV).Methods9patientswithconfirmednon-HIVPCPwereretrospectivelyanalyzed.ResultsAllthepatientsreceivedcorticosteroidtherapyandimmunosuppressivetherapiesbeforetheyhadthePCP,inwhich8patients(88.9%)usedcorticosteroidtherapyandthree

4、patients(33・3%)acceptedimmunosuppressivetherapy.Allthepatientshadthesymptomofprogressivedyspnea,inwhichsevenpatients(77.8%)appearedtypicaltriad：fever,drycoughandprogressivedyspnea.Eightpatients(88.9%)CTshoweddiffuseground-glassopacityandonepatient(11.1%)showedconsolidationindoublelungs・

5、Sevenpatientsweretreatedwithtrimethoprim-sulfamethoxozolcombiningwithcaspofungininwhichtwopatientsdied.Twopatientsweretreatedwithtrimethoprim-sulfamethoxazolinwhichonepatientdied.Thetotalmortalityratewas33.3%.ConclusionThemortalityofnon-HIVimmunosuppressedpatientswithPCPishigh.Patientsw

6、hohavesymptomsoffever,drycoughandprogressivedyspneatogetherwithdiffuseground-glassopacityindoublelungsshouldbesuspectedwithofPCP,especiallyinimmunosuppressivepatients.Thepathogenicexaminationofsputumorbronchoalveolarlavagefluidsshouldbetakenassoonaspossibleinordertoearlydiagnosisandearl

7、ytreatment.[Keywords]Pneumocystispneumonia；Non-humanimmunodeficiencyvirus；Clinicalfeature；Gtest肺鞄子菌肺炎(pneumocystispneumonia,PCP)是由卡氏肺砲子菌感染引起的肺部非化脓性间质性炎症，为一种呼吸系统严重的机会感染性疾病，是艾滋病(AIDS)患者常见的机会感染和主要的致死原因之一。近些年，PCP在其他免疫功能抑制患者，如移植、恶性肿瘤放化疗、结缔组织病及长期应用激素及免疫抑制剂患者中发病率逐渐增加[1-4]o本病在非AIDS免疫抑制