不同免疫状态下卡氏肺孢子菌肺炎临床特征的差异性分析  

Difference Analysis of the Clinical Features of Pneumocystis carinii Pneumonia under Different Immune Status

作　　者：孟静 李光才 肖建生[3] 李剑 宫念樵[5] Meng Jing;Li Guangcai;Xiao Jiansheng(Department of Radiology,The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture,Enshi 445000,China;Department of Respiratory and Critical Care Medicine,The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture,Enshi 445000,China;Department of Organ Transplantation,First Affiliated Hospital of Nanchang University,Nanchang 330006,China)

机构地区：[1]湖北省恩施土家族苗族自治州中心医院中医部放射科,恩施445000 [2]湖北省恩施土家族苗族自治州中心医院呼吸与危重症医学科,恩施445000 [3]南昌大学第一附属医院器官移植科,南昌330006 [4]华中科技大学同济医学院附属同济医院肝脏外科,武汉430030 [5]华中科技大学同济医学院附属同济医院器官移植研究所,器官移植教育部重点实验室,国家卫生健康委员会器官移植重点实验室,中国医学科学院器官移植重点实验室,武汉430030

出　　处：《华中科技大学学报（医学版）》2021年第2期225-229,共5页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

基　　金：国家自然科学基金资助项目(No.81873623);华中科技大学同济医学院研究型临床医师资助计划项目(No.201704)。

摘　　要：目的比较免疫功能正常的卡氏肺孢子菌肺炎(Pneumocystis carinii pneumonia,PCP)与免疫功能受损PCP的临床特征,以提高对该病的诊疗水平。方法按照免疫功能正常和受损两种状态,以病原学诊断为基础,将患者分为无基础疾病感染组(PCP without basic disease,NBD-PCP)和肾移植术后组(PCP after kidney transplantation,KT-PCP),两组均7例。采集两组患者的临床表现、实验室检查及肺部CT检查资料,对各指标进行单因素方差分析。结果NBD-PCP组与KT-PCP组的临床表现和肺部CT影像学特征比较,并无轻症化趋势。发热和干咳、弥散分布于双侧肺部的磨玻璃样改变、最大病变范围>10 cm、少数伴肺门和纵隔淋巴结肿大和胸腔积液等指标的差异均无统计学意义(均P>0.05);C反应蛋白升高在两组间的差异具有统计学意义(P<0.05)。结论免疫功能正常和受损两种状态下,PCP患者均具有严重的间质性肺炎临床表现和肺部损伤影像学特征,免疫功能正常患者没有出现轻症化趋势;C反应蛋白升高在免疫功能正常组更为明显,可以作为鉴别诊断的指标。Objective Pneumocystis carinii pneumonia(PCP)under normal immune status is a clinical rare disease,and its clinical features need to be compared with those of PCP under immunocompromised status to improve the clinical diagnostic and therapeutic level.Methods Based on the different immune status(normal or immunocompromised),with the confirmation of etiological diagnosis,the enrolled patients were divided into NBD-PCP group(undergoing PCP without basic disease,n=7)and KT-PCP group(PCP after kidney transplantation,n=7).The clinical data,including general characteristics,medical history,laboratory test and chest CT examination results,were collected for One-way ANOVA analysis.Results The clinical manifestation and lung CT images showed no significant difference between NBD-PCP and KT-PCP(P>0.05),including:fever and dry cough;most of the lesions diffused in bilateral lungs,most lesions with ground-glass changes,the maximum lesion length more than 10 cm,and few hilus pulmonis and mediastinal lymph nodes enlargement and pleural effusion.C-reactive protein increased more significantly in NBD-PCP group than in KT-PCP group(P<0.05).Conclusion The clinical manifestation and chest CT imaging characteristics are the common features for PCP patients with normal immune status and with immunocompromised status,while no slighter trend occurs in the patients with normal immune status.C-reactive protein increased more significantly in the PCP patients with normal immune status,which provides unique value for further diagnosis and treatment.

关 键 词：卡氏肺孢子菌肺炎 免疫功能 临床表现 实验室检查 影像学特征 

分 类 号：R563.1[医药卫生—呼吸系统]