肺癌放疗、化疗中合并伊氏肺孢子菌肺炎的临床特点分析  

Clinical characteristics of Pneumocystis pneumonia during chemotherapy and radiotherapy in lung cancer patients

作　　者：章巍[1] 王广发[1] 聂立功[1] 李海潮[1] 金哲[1] 曹菊[1] 赵燕妮[1] 李楠[1] 马靖[1] 栗少飞[1] 朱广迎 余荣 

机构地区：[1]北京大学第一医院呼吸内科,北京100034 [2]北京肿瘤医院暨北京市肿瘤防治研究所放射治疗科,恶性肿瘤发病机制及转化研究教育部重点实验室,北京100142

出　　处：《实用肿瘤杂志》2012年第2期175-179,共5页Journal of Practical Oncology

摘　　要：目的分析肺癌放疗、化疗期间合并伊氏肺孢子菌肺炎患者的临床特点,以期达到早期诊断、早期治疗。方法回顾性分析4例确诊肺癌合并伊氏肺孢子菌肺炎患者的临床表现、治疗、影像学以及检验资料,分析患者的临床特点和诊治中的经验和教训。结果 4例患者均为男性,年龄53～65岁,均为ⅢA期至Ⅳ期鳞状细胞肺癌并接受了一线化疗和放疗,在放疗过程中出现发热、咳嗽、进行性呼吸困难并迅速进展为Ⅰ型呼吸衰竭,2例出现气胸及皮下气肿。肺部影像学均表现为双肺磨玻璃影及实变阴影,其中3例死亡者为双肺弥漫分布;3例伴有不规则气囊影,2例伴有间质增厚,1例伴有牵拉性支扩。血清1-3-β-D-葡聚糖试验均阳性。4例患者均采用机械通气,复方磺胺甲基异肟唑、糖皮质激素或合并卡泊芬净、克林霉素及伯氨喹等治疗,其中1例治愈,3例治疗无效死亡。结论肺癌治疗期间合并伊氏肺孢子菌肺炎病情危重、预后差,临床和影像学表现有显著特点,血清1-3-β-D-葡聚糖水平升高。从事肺癌放、化疗工作的医务工作者应保持对伊氏肺孢子菌肺炎的高度警惕。Objective To review the clinical features of Pneumocystis pneumonia（PCP） during chemotherapy and radiation therapy in lung cancer patients.Methods Four lung cancer patients admitted during June to August 2010 were complicated with PCP during chemotherapy and radiotherapy.The case records,laboratory and radiological data were retrospectively reviewed.Results All 4 patients were male,aged 53~65 years and had pathological confirmed stage ⅢA~Ⅳ squamous cell lung carcinoma.All of them received first line chemotherapy and radiotherapy.Fever,cough and progressive dyspnea developed during the radiotherapy and rapidly progressed to type I respiratory failure.Two patients developed pneumothorax or subcutaneous emphysema.Radiological studies showed bilateral ground glass opacity or consolidation,diffusely distributed in 3 patients who did not survive.Pneumatoceles were observed in 3 cases,interstitial thickness in 2 cases and traction bronchiectasis in one.Serum（1-3）-β-D-glucan level was elevated in all patients.All the 4 patients were treated with trimethoprim-sulfamethoxazole and corticosteroids or combined with caspofungin,clindamycin or primaquine,and mechanical ventilation was used.One patient survived and the rest died.Conclusions Lung cancer combined with PCP during treatment is a severe condition with poor outcomes.Elevated serum（1-3）-β-D-glucan is a reliable indicator of PCP in lung cancer patients.

关 键 词：肺肿瘤/并发症 肺炎/病因学 肺炎/诊断 β葡聚糖类/血液 抗菌药/投药和剂量 综合疗法 回顾性研究 

分 类 号：R734.2[医药卫生—肿瘤]