间质性肺疾病患者合并重症肺孢子菌肺炎的临床特征分析  

Analysis of clinical features of patients with interstitial lung disease complicated by severe pneumocystis pneumonia

作　　者：赵婷婷[1] 邱晓华 高玉娟[1] 演欣 石沈云 肖永龙[1] ZHAO Tingting;QIU Xiaohua;GAO Yujuan;YAN Xin;SHI Shenyun;XIAO Yonglong(Department of Respiratory and Critical Care Medicine,Nanjing Drum Tower Hospital,The Affiliated Hospital of Nanjing University Medical School,Nanjing,Jiangsu 210008,P.R.China)

机构地区：[1]南京大学医学院附属鼓楼医院呼吸与危重症医学科,江苏南京210008

出　　处：《中国呼吸与危重监护杂志》2022年第8期581-586,共6页Chinese Journal of Respiratory and Critical Care Medicine

摘　　要：目的 探讨间质性肺疾病(interstitial lung disease,ILD)合并重症肺孢子菌肺炎(Pneumocystis pneumonia,PCP)的临床特征。方法 回顾性分析2017年9月-2022年6月南京鼓楼医院呼吸与危重症医学科重症监护室(Respiratory Intensive Care Unit,RICU)收治的间质性肺疾病合并重症肺孢子菌肺炎的患者,收集其临床表现、实验室检查、影像学特点、并发症、病死率等资料,分析此类患者的临床特征及预后。结果 共17例患者纳入研究,其中有16例有糖皮质激素使用史,17例患者发病前均未进行化学预防;其中58.8%(10/17)为结缔组织病继发ILD,41.2%(7/17)为特发性ILD;经痰液、肺泡灌洗液或外周血肺孢子菌PCR检测阳性,以及宏基因组二代测序阳性;发病后均合并呼吸衰竭,氧合指数为(146.8±66.4)mm Hg,入院24小时内肺炎严重程度指数评分(91.9±20.1)分,急性生理学和慢性健康状况评价Ⅱ评分(16.1±3.0)分;影像学均表现为在原有ILD基础新增两肺弥漫性磨玻璃影;所有患者均使用了复方磺胺甲噁唑及糖皮质激素治疗,52.9%(9/17)患者应用了复方磺胺甲噁唑+卡泊芬净+克林霉素三联治疗;70.6%(12/17)患者进行了机械通气治疗;在住院期间76.5%(13/17)患者合并细菌感染,9例(52.9%)合并病毒感染;28天病死率为64.7%(11/17),90天病死率为82.4%(14/17),截止电话随访时总病死率为88.2%(15/17)。结论 ILD患者合并重症PCP起病急,病情重,临床表现为ILD的急性加重,病死率极高。Objective To investigate the clinical features of interstitial lung disease(ILD) complicated with severe Pneumocystis pneumonia(PCP). Methods The patients with interstitial lung disease complicated with severe Pneumocystis pneumonia who were admitted to the Respiratory Intensive Care Unit(RICU) of the Department of Respiratory and Critical Care Medicine, Nanjing Drum Tower Hospital from September 2017 to June 2022 were retrospectively analyzed. Laboratory examinations, imaging features, complications and mortality data were used to analyze the clinical characteristics and prognosis of these patients. Results A total of 17 patients admitted to the RICU were finally enrolled in this study. 16 of the 17 patients had a history of corticoids therapy, and none of the 17 patients had received prophylaxis before the onset of PCP;58.8%(10/17) of them were ILD secondary to connective tissue disease, and41.2%(7/17) were idiopathic ILD;all patients were tested positive for P. jirovecii with polymerase chain reaction and/or next-generation metagenomic sequencing in sputum, bronchoalveolar lavage fluid or serum;all patients developed respiratory failure(oxygenation index: 146.8±66.4 mm Hg) after onset;within 24 hours of admission, the pneumonia severity index score was 91.9±20.1 and the Acute Physiology and Chronic Health Evaluation Ⅱ score was 16.1±3.0;imaging findings showed diffuse ground-glass opacity in both lungs on the basis of the original ILD;all patients were treated with trimethoprim-sulfamethoxazole(TMP-SMX) and corticoids, 52.9%(9/17) patients were treated with TMP-SMX + caspofungin + clindamycin;70.6%(12/17) patients were treated with mechanical ventilation;76.5%(13/17)patients during hospitalization complicated bacterial infection, 9 cases(52.9%) had viral infection. The 28-day mortality was 64.7%(11/17), and the 90-day mortality was 82.4%(14/17), as of telephone follow-up(July 2022) the overall mortality was 88.2%(15/17). Conclusions ILD patients with severe PCP are progressing rapidly. The clinical manife

关 键 词：间质性肺疾病 肺囊虫性 重症肺炎 化学预防 

分 类 号：R563[医药卫生—呼吸系统]