艾滋病合并卡氏肺孢子菌肺炎15例临床分析

Clinical analysis on acquired immune deficiency syndrome combined with pneumocystis carinii pneumonia in 15 cases

摘要:

目的：分析、总结艾滋病（Acquired immune deficiency syndrome，AIDS）合并卡氏肺孢子菌肺炎（Pneumocystis carinii pneumonia，PCP）的临床特点、胸部影像学特点，以提高临床医师对PCP的认识和诊治水平。方法：前瞻性研究我院呼吸科2010年3月-2011年9月诊治的15例AIDS合并PCP患者的临床资料，包括病史、体征、实验室检查、胸部影像学检查、治疗及预后等资料，并进行分析、总结。结果：AIDS合并PCP临床特点为发热、咳嗽、呼吸困难，肺部常无阳性体征，部分患者肺部可闻及湿啰音（13.3%）或爆裂音（20%）。典型的胸部影像学特征为双肺磨玻璃影， 有由肺门向外周肺野发展的趋势，可伴网状影或“碎石路征”。15例患者中仅3例行支气管肺泡灌洗（Bronchoalveolar lavage，BALF），灌洗液作银染找到肺孢子菌包囊，确诊为PCP，其余患者均为临床诊断。主要治疗药物为复方磺胺甲噁唑（Sulfamethoxazole，SMZco）（100%）及肾上腺糖皮质激素（86.7%）。结论：临床凡遇发热、咳嗽、呼吸困难者，特别是胸部影像学表现为双肺磨玻璃影时，应高度警惕AIDS合并PCP可能，尽早给予SMZco诊断性试疗，减少误诊率及病死率。

Abstract:

Objective：To study and summarize the clinical feature and chest radiograph feature of acquired immune deficiency syn－drome（AIDS）combined with Pneumocystis carinii pneumonia（PCP），so as to improve the clinicians’ understanding of the PCP and the level of diagnosis and treatment. Methods：The clinical data of 15 AIDS patients combined with PCP in respiratory department of our hospital from Mar. 2010 to Sep. 2011 were studied prospectively， including history， signs， chest imageolgy，laboratory tests，lung biopsy pathological examination，treatment，prognosietc，et al. Results：The clinical features of AIDS patients combined with PCP are fever，cough，dyspnea. Patients often have no positive signs in the lungs，some patients could have moist rales（13.3%） or crackles （20%）. The typical chest radiograph feature is ground-glass shadows in both lungs. There is a development tendency from hilar to peripheral lung field，and may be associated with reticular shadows or “gravel sign”. Of 15 patients，only 3 patients were given bron－choalveolar lavage （BALF） and diagnosed with PCP as pneumocystis cysts were found through silver staining of the fluid. The other patients were clinically diagnosed. All the patients were treated with sulfamethoxazole （SMZco，100%） and corticosteroids （86.7%）. Conclusion：Whenever a patient got fever，cough，dyspnea，especially ground glass were found in the lungs by the chest radiograph，AIDS combined with PCP should be highly considered，and diagnostic treatment with SMZco should be performed as soon as possi－ble，so as to reduce misdiagnosis rate and mortality.