HIV感染者及非感染者中肺孢子菌肺炎的诊疗进展  

Advances in the diagnosis and management of pneumocystis pneumonia in patients with or without HIV infection

作　　者：张德发[1] ZHANG Defa(Tianjin Second People Hospital,Tianjin 300192,China)

机构地区：[1]天津市第二人民医院感染二科,天津300192

出　　处：《中国艾滋病性病》2022年第7期868-871,共4页Chinese Journal of Aids & STD

基　　金：“十三五”艾滋病和病毒性肝炎等重大传染病防治(2018ZX10302104)。

摘　　要：在HIV感染者中,耶氏肺孢子菌肺炎(PCP)是一种严重的机会性感染,很多指南已经明确了PCP在HIV感染者中的治疗方案,但是对于艾滋病晚期患者中重症PCP仍然是致死率很高的机会性感染。与此同时,PCP逐渐成为非HIV感染免疫低下人群的新威胁,特别是接受免疫抑制疗法的患者如恶性肿瘤、器官移植、结缔组织病等。非HIV感染者患PCP时的表现与HIV感染者完全不同。在未感染HIV的PCP患者中,病情进展更加迅速,诊断更加困难,同时伴随严重呼吸衰竭,预后也更差。HIV感染者与非HIV感染者PCP的CT表现也不同。这些临床和放射学特征的差异是由于严重失调的炎症反应引起的,非HIV感染者中只需要较少的肺孢子菌感染就可以引发严重的免疫反应。近年来,聚合酶链反应和血清β-D-葡聚糖检测在PCP快速、无创性诊断中已开始应用。此外,皮质类固醇等辅助抗炎药物已被证明对某些人群有益,其最佳剂量和持续应用的时间仍有待确定。本文就PCP在HIV感染者及非HIV感染者中的临床特点、诊断及治疗等方面做一综述。In HIVinfected patients,Pneumocystis jirovecii pneumonia(PCP) is a well-known opportunistic infection with well-established management programs.However,PCP is an emerging threat to immunocompromised patients without HIV infection,such as those receiving novel immunosuppressive therapeutics for malignancy,organ transplantation,or connective tissue diseases.Clinical manifestations of PCP are different between patients with and without HIV infections.In patients without HIV infection,PCP rapidly progresses,is challenging to diagnose correctly and causes severe respiratory failure with a poor prognosis.In addition,high-resolution computed tomography findings are different between PCP patients with or without HIV infection.These differences in clinical and radiological features are due to severe or dysregulated inflammatory responses evoked by a relatively small number of Pneumocystis organisms in patients without HIV infection.In recent years,the usefulness of polymerase chain reaction and serum β-D-glucan assay for rapid and non-invasive diagnosis of PCP has been revealed.Although corticosteroid adjunctive to anti-Pneumocystis agents is beneficial in some populations,the optimal dose and duration remain determined.Because a variety of novel immunosuppressive therapeutics has been emerging in medical practice,further innovations in diagnosing and treating PCP are needed.

关 键 词：肺孢子菌肺炎 免疫低下宿主 化学药物预防 感染控制 

分 类 号：R373.9[医药卫生—病原生物学]