疫情流行期间卡氏肺孢子虫肺炎与新型冠状病毒肺炎的鉴别诊断  

Differential diagnosis of Pneumocystis carinii Pneumonia and New Coronary Pneumonia During the Epidemic

作　　者：于恪 徐学敏[1] 武莉莉[1] 黄河[1] 张敏[1] 邓海燕[1] YU Ke;XU Xue-Min;WU Li-Li;HUANG He;ZHANG Min;DENG Hai-Yan(Shenzhen Second People’s Hospital,the First Affiliated Hospital of Shenzhen University,Guangdong Shenzhen 518035)

机构地区：[1]深圳市第二人民医院深圳大学第一附属医院,广东深圳518035

出　　处：《深圳中西医结合杂志》2020年第21期20-22,F0003,共4页Shenzhen Journal of Integrated Traditional Chinese and Western Medicine

摘　　要：目的:探讨疫情期间卡氏肺孢子虫肺炎(PCP)与双肺多发磨玻璃病变为特征的新型冠状病毒肺炎(COVID–19)的鉴别诊断要点。方法:回顾性分析深圳市第二人民医院2020年1月至2020年4月确诊的表现为双肺多发磨玻璃病变的5例COVID–19患者的临床特征(流行病学史、症状、实验室检查及影像学表现),并通过1例因疑似COVID–19但最终确诊为获得性免疫缺陷综合征(AIDS)继发PCP的患者,探讨两种疾病的鉴别诊断要点。结果:(1)流行病学特点:多数COVID–19患者有武汉旅游史,人群普遍易感;而AIDS继发PCP患者一般有冶游史,一般感染者为免疫缺陷患者。(2)临床表现:两者均可以发热、干咳为主要临床表现。COVID–19急性起病,普通型及轻型患者一般无呼吸困难。而PCP一般表现为亚急性起病,进行性加重的呼吸困难及严重的低氧血症。(3)实验室检查:两者常表现为白细胞正常、淋巴细胞减低,炎症指标增高。(4)影像学特点:两者胸部CT均可表现为双肺多发磨玻璃病变,COVID–19病变分布一般在外带胸膜下为主,而PCP表现为肺门为中心的分布的磨玻璃影,胸膜很少受累。(5)治疗转归情况:COVID–19尚无特效药物治疗,以对症支持治疗为主,而PCP对治疗效果较好。结论:PCP与COVID–19具有相似的临床症状及影像学表现,但流行病学特点、免疫力状态、起病过程、胸部病变分布及治疗的转归情况仍存在着一定差异性。Objective To explore the key points of differential diagnosis of Pneumocystis carinii pneumonia(PCP)and 2019 novel coronavirus pneumonia(COVID–19)characterized by multiple ground glass lesions in both lungs.Methods Retrospective analysis of the clinical characteristics(epidemiological history,symptoms,laboratory examinations and imaging performance)of five COVID–19 patients with multiple ground glass lesions diagnosed in our hospital from January 2020 to April 2020,and through a case of suspected COVID–19 but eventually diagnosed as acquired immunodeficiency syndrome(AIDS)secondary PCP cases,to explore the points of the differential diagnosis of the twodesease.Results(1)Epidemiological characteristics:Most patients with COVID–19 have a history of traveling in Wuhan,and the population is generally susceptible;While patients with secondary AIDS secondary to PCP generally have a history of stagnation,and the general infection is immunodeficiency.(2)Clinical manifestations:Fever and dry cough are the main clinical manifestations.COVID–19 has an acute onset.Ordinary and mild patients generally have no difficulty in breathing.While PCP generally has a subacute onset,progressively increased dyspnea,and severe hypoxemia.(3)Laboratory examination:the two desease often show normal white blood cells,decreased lymphocytes,and increased inflammation indicators.(4)Imaging features:both chest CT can show multiple ground glass lesions of the lungs,and the distribution of COVID–19 lesions is generally under the external pleura.While PCP is a ground glass shadow with the hilum as the center,and the pleura is rarely involved.(5)The outcome of treatment:COVID–19 has no special drug treatment,mainly symptomatic support treatment,and PCP has a better treatment effect.Conclusion PCP and COVID–19 have similar clinical symptoms and imaging findings,but there are still some differences in epidemiological characteristics,immune status,the onset process,chest disease distribution,and treatment outcomes.

关 键 词：新型冠状病毒肺炎 卡氏肺孢子虫肺炎 胸部CT 获得性免疫缺陷综合征 

分 类 号：R563.1[医药卫生—呼吸系统] R531.5[医药卫生—内科学]