儿童肾病合并肺孢子菌肺炎3例临床分析  

Clinical analysis of Pneumocystis pneumonia in 3 children with nephropathy

作　　者：周楠[1] 孟繁英[1] 沈颖[1] 陈植[1] 袁林[1] 

机构地区：[1]首都医科大学附属北京儿童医院肾脏内科,北京100045

出　　处：《临床儿科杂志》2011年第8期732-734,共3页Journal of Clinical Pediatrics

摘　　要：目的提高对肺孢子菌肺炎(PCP)的认识。方法回顾分析3例肾病并发PCP患儿的临床资料。结果 3例患儿的共同特点是,PCP起病急,临床以发热、咳嗽起病,伴有低氧血症,症状与体征不平行;早期临床表现无特异性,易漏诊,并发PCP前患儿均长期或大量应用免疫抑制剂、足量泼尼松口服疗程达8周及以上;免疫功能检查均有不同程度的CD4细胞比例下降。结论提高对PCP的认识,做到早期诊断;适当控制免疫抑制剂应用、改善患儿生活环境、针对高危人群定期检测CD4细胞水平以及酌情应用复方磺胺甲基异噁唑预防均有利于降低肺孢子菌肺炎的发病率。Objective To further understand Pneumocystis pneumonia（PCP）.Methods Clinical symptoms and laboratory data of 3 pediatric primary or secondary nephropathy cases with PCP were retrospectively analyzed.Results When infected with PCP,the three patients had the common characters of fever and cough at beginning with progressive hypoxia.Clinical presentations in the early stage were not special and may lead to misdiagnosis.Before PCP developed,the three patients had received immunosuppressant and high dose of oral corticosteroids for at least 8 weeks for the treatment of nephropathy.Full dose of methylprednisolone and cyclophosphamide were used in two of them.The percent of CD4＋ T-lymphocyte decreased to different extent in all patients.Conclusions To monitor immunosuppressive therapy and improve the living environment of these high-risk patients should be addressed.To observe lymphocyte counts and administer TMP-SMZ when necessary is important for reducing the occurrence of PCP.

关 键 词：肺孢子菌肺炎 肾病 儿童 

分 类 号：R725.6[医药卫生—儿科] R726.9[医药卫生—临床医学]