6例耶氏肺孢子菌肺炎的临床特征和实验室检测分析  

Clinical features and laboratory tests of 6 Pneumocystis pneumonia cases

作　　者：黄汉莲 代小燕 周林涛 马雯 黄婷婷 周义文 袁燕飞 申红卫 HUANG Han-lian;DAI Xiao-yan;ZHOU Lin-tao;MA Wen;HUANG Ting-ting;ZHOU Yi-wei;YUAN Yan-fei;SHEN Hong-wei(Shenzhen Hospital,Southern Medical University,Shenzhen,Guangdong 518000;The University of Hong Kong-Shenzhen Hospital,Shenzhen,Guangdong 5180001 China)

机构地区：[1]南方医科大学深圳医院,广东深圳518000 [2]香港大学深圳医院,广东深圳518000

出　　处：《热带医学杂志》2021年第2期181-183,200,共4页Journal of Tropical Medicine

基　　金：广东省自然科学基金(2018A0303130119);深圳市卫计委临床技术研究及转化项目(201601040);南方医科大学深圳医院国自然培育计划(PY202002YM);2020年南方医科大学深圳医院重点学科建设基金科研提升计划(ZDXKKYTS007);深圳市宝安区医疗卫生基础研究项目(2020JD459)。

摘　　要：目的分析耶氏肺孢子菌肺炎的临床特征和实验室检测结果,为临床早期诊断和治疗提供依据。方法回顾性分析2017年1月至2020年5月深圳某综合医院耶氏肺孢子菌的检出和临床分布情况、影像学特征、生化指标,以及六铵银染色检查的注意事项。结果共检出6例耶氏肺孢子菌感染,患者年龄14~59岁,来源于ICU、血液内科、儿科等科室,主要临床诊断为白血病或肾炎。血清(1-3)-β-D-葡聚糖和乳酸脱氢酶均升高。染色温度和时间对六铵银染色的结果影响较大。影像学表现以胸部CT均发现磨玻璃密度影为主,患者经过复方新诺明和糖皮质激素联合治疗,症状有不同程度改善。结论患有不明原因肺炎的白血病或肾炎患者,常规治疗无效的,应考虑耶氏肺孢子菌感染;六铵银染色法是一种检测耶氏肺孢子菌快速、简便的方法,应注意控制染色温度和时间。Objective To investigate the clinical features and laboratory tests of Pneumocystis jirovecii infection,and provide basis for early diagnosis and treatment.Methods The medical data during January,2017 and May,2020 was reviewed retrospectively.The detection results,radiological features,levels of biochemical markers,and the clinical distribution of Pneumocystis pneumonia(PcP),as well as the instructions for methenamine silver stain were analyzed.Results A total of 6 PcP cases aged between 14 and 59 years old were identified.The departments where they stayed included intensive care unit(ICU),hematology,and pediatrics department.The main diagnosis for these cases was leukemia or nephritis.The elevated serum(1-3)-β-D-glucan and lactic dehydrogenase levels were observed.The microscopic examination was affected by the temperature and duration of staining.The ground-glass opacity was seen in the lungs on computed tomography scan.Symptom improvements were observed in most cases after treatment of sulfamethoxazole and glucocorticoid.Conclusions The examination of P.jirovecii should be considered in leukemia or nephritis patients with unknown pneumonia and those in whom regular treatments were not effective.The methenamine silver staining was a rapid and simple method for detection of P.jirovecii and the temperature and duration of staining should be well controlled.

关 键 词：耶氏肺孢子菌 肺炎 六铵银染色 

分 类 号：R563.19[医药卫生—呼吸系统]