慢性肾脏病合并肺孢子虫肺炎诊治分析  

Analysis on Diagnosis and Treatment of Pneumocystis Carinii Pneumonia in Patients with Chronic Kidney Disease

作　　者：宋岩[1] 李冀军[1] 姚凤华[1] 张壹言[1] 陈凤锟[1] 纪殿忠[1] 赵长征[1] 

机构地区：[1]解放军总医院第一附属医院肾内科,北京100048

出　　处：《中国中西医结合肾病杂志》2010年第10期895-898,共4页Chinese Journal of Integrated Traditional and Western Nephrology

摘　　要：目的:提高对慢性肾脏病(CKD)患者合并肺孢子虫肺炎(PCP)的认识。方法:回顾性分析4例CKD合并PCP患者的临床症状、影像学及实验室资料,分析诊断及治疗转归情况。结果:4例临床均表现为发热、咳嗽、胸闷等,3例出现Ⅰ型呼吸衰竭,1例顽固性低氧血症。其中3例支气管肺泡灌洗液痰姬姆萨染色找到伊氏肺孢子菌,1例支气管肺泡灌洗液痰PCR检测伊氏肺孢子菌虫体DNA(+)。4例中IgA肾病2例,肾淀粉样变性1例,膜性肾病1例。4例均应用激素治疗,有2例同时应用环磷酰胺(CTX),激素及CTX均为常规用法、用量。4例均予卡泊芬净及复方磺胺甲唑治疗,均好转出院,无副反应。结论:PCP是接受激素和(或)CTX治疗的CKD患者肺部机会感染之一。典型的胸部X线尤其是CT征像对PCP的诊断具有重要意义,但早期胸部X线和CT征像多不典型。对接受激素和(或)CTX治疗的CKD患者,如出现发热、进行性呼吸困难,应尽早行痰或支气管肺泡灌洗液姬姆萨染色涂片找伊氏肺孢子菌或PCR检测伊氏肺孢子菌虫体DNA。卡泊芬净及复方磺胺甲唑治疗PCP效果均明确,无明显副作用,卡泊芬净可以作为治疗PCP的首选药物。Objective：To improve our understanding toward pneumocystis carinii（PC） pneumonia in patients with chronic kidney disease.Methods：Four patients with chronic kidney disease and pneumocystis carinii （PC） pneumonia were retrospectively analyzed.Results：The clinical manifestations were fever,cough,chest tightness and no resonse to antibiotics.Three patients were confirmed type Ⅰ respiratory failure and 1 hypoxemia.Three patients were detected pneumocystis carinii in bronchoalveolar lavage fluid.One patient was found positive of pneumocystis carinii DNA in bronchoalveolar lavage fluid.Two cases were complicated with IgA nephropathy,one with renal amyloidosis and the other with membranous nephropathy.All patients received hormone therapy and 2 cases combined with cyclophosphamide （CTX）.Four patients were treated with Caspofungin＋cotrimoxazole （SMZco）＋ hormone,and they were all improved and discharged with no occurrence of side effects.Conclusion：PC pneumonia was one of pulmonary opportunistic infections in patients with chronic kidney disease receiving hormone and （or） CTX therapy.Typical chest X-ray or CT sign was important for diagnosis,but the initial sign was non-typical.If patients receiving hormone and （or） immunosuppressive therapy for kidney diseases were having fever and no response to antibiotics,they should be alert to PC pneumonia.Bronchoalveolar lavage fluid giemsa stain and sputum PCR should be done as soon as possible to confirm PC.Treatment of PC pneumonia with Caspofungin and cotrimoxazole （SMZco） was preferred.

关 键 词：慢性肾脏病 肺孢子虫肺炎 伊氏肺孢子菌 

分 类 号：R692[医药卫生—泌尿科学] R563.1[医药卫生—外科学]