儿童淋巴瘤合并耶氏肺孢子菌肺炎5例临床分析  

Clinical analysis of 5 children with lymphoma complicated with Pneumocystis jirovecii pneumonia

作　　者：张楠[1] 段彦龙[1] 金玲[1] 杨菁[1] 黄爽[1] 张梦[1] 张永红[1] Zhang Nan;Duan Yanlong;Jin Ling;Yang Jing;Huang Shuang;Zhang Meng;Zhang Yonghong(Department of Medical Oncology,Pediatric Oncology Center,Beijing Children's Hospital,Capital Medical University,National Center for Children's Health,Beijing Key Laboratory of Pediatric Hematology Oncology,Key Laboratory of Major Diseases in Children,Ministry of Education,Beijing 100045,China)

机构地区：[1]国家儿童医学中心,首都医科大学附属北京儿童医院,儿童肿瘤中心肿瘤内科,儿童血液病与肿瘤分子分型北京市重点实验室,儿科重大疾病研究教育部重点实验室,北京100045

出　　处：《白血病．淋巴瘤》2023年第2期109-113,共5页Journal of Leukemia & Lymphoma

摘　　要：目的 探讨儿童淋巴瘤合并耶氏肺孢子菌肺炎(PJP)的临床特点。 方法 回顾性分析2013年1月至2022年4月北京儿童医院收治的5例淋巴瘤合并PJP患儿的临床资料及诊断治疗经过。 结果 5例患儿中,男性3例,女性2例;中位发病年龄7岁;非霍奇金淋巴瘤4例,霍奇金淋巴瘤1例;于化疗后5~18个月出现发热,咳嗽;2例可见典型的"马赛克"征,未合并气胸及胸腔积液,未合并其他病原学感染;5例均有低氧血症;以二代测序(NGS)确诊4例。全部患者均CD4/CD8减低,中位CD4 + T细胞200个/μl。未规律预防应用甲氧苄啶-磺胺甲基恶唑(TMP-SMZ)3例,治疗过程中全部机械辅助通气,均予TMP-SMZ静脉滴注,联合应用卡泊芬净、糖皮质激素、丙种球蛋白。5例PJP均治愈,无感染反复。 结论 淋巴瘤患儿因化疗可导致免疫功能低下,为PJP的易感人群,且病情进展迅速。当遇到发热、气促、肺部症状重而体征轻的患儿时,需警惕PJP;NGS可协助诊断,应积极予以TMP-SMZ治疗及预防,早期诊断及积极治疗可取得良好的预后。Objective To explore the clinical features of childhood lymphoma complicated with Pneumocystis jirovecii pneumonia(PJP).Methods The clinical data,diagnosis and treatment of 5 children with lymphoma complicated with PJP admitted to Beijing Children's Hospital from January 2013 to April 2022 were retrospectively analyzed.Results Among 5 patients,there were 3 males and 2 females,the median onset age was 7 years old;4 cases were non-Hodgkin lymphoma and 1 case was Hodgkin lymphoma.Fever and cough occurred 5-18 months after chemotherapy;typical mosaic sign could be seen in 2 cases without pneumothorax and pleural effusion as well as other pathogenic infection;all 5 cases had hypoxemia;4 cases were diagnosed by next-generation sequencing(NGS).The CD4/CD8 ratio decreased in all cases,and the median CD4 positive T-cell was 200/μl.Trimethoprim-sulfamethoxazole(TMP-SMZ)was irregularly used in 3 cases.During the treatment,all cases received mechanical ventilation,TMP-SMZ intravenously dripping combined with caspofungin,glucocorticoid and gamma globulin.All 5 cases of PJP were cured and there was no recurrent infection.Conclusions Lymphoma children are susceptible to PJP due to immunocompromise caused by chemotherapy,and their condition progresses rapidly.When encountering fever,shortness of breath,severe lung symptoms and mild signs of children,it is necessary to improve the vigilance of PJP.NGS can help diagnosis,and TMP-SMZ should be actively treated and prevented.Early diagnosis and active treatment can achieve a good prognosis.

关 键 词：淋巴瘤 儿童 耶氏肺孢子菌肺炎 治疗 

分 类 号：R733.1[医药卫生—肿瘤] R725.6[医药卫生—临床医学]