非人类免疫缺陷病毒感染免疫抑制宿主耶氏肺孢子菌肺炎26例临床特征分析  

Clinical features of Pneumocystis jirovecii pneumonia in non-HIV infection immunosuppressed host: an analysis of 26 cases

作　　者：龚金如 杨家盛 屈满英 孙瑞琳 Gong Jinru;Yang Jiasheng;Qu Manying;Sun Ruilin(Department of Pulmonary and Critical Care Medicine,Guangdong Second Provincial General Hospital,Guangzhou 510317,China)

机构地区：[1]广东省第二人民医院呼吸与危重症医学科,广州510317

出　　处：《中华全科医师杂志》2023年第12期1295-1299,共5页Chinese Journal of General Practitioners

摘　　要：回顾性分析2017年1月1日至2022年2月28日在广东省第二人民医院确诊的非人类免疫缺陷病毒(HIV)感染免疫抑制宿主耶氏肺孢子菌肺炎患者的临床特征、辅助检查、治疗和转归。共纳入26例患者,男19例,女7例,年龄44(30,51)岁。26例患者均有免疫抑制基础疾病。临床表现以发热(18例,69.2%)、咳嗽(15例,57.7%)、气促(11例,42.3%)为主。95.7%患者(22/23)C反应蛋白水平、78.3%(18/23)降钙素原水平、17例(17/19)乳酸脱氢酶水平、70.0%(14/20)G试验水平均升高,14例(14/19)CD4^(+)T细胞计数水平下降。肺泡灌洗液检出耶氏肺孢子菌16例(61.5%),血液检出10例(38.5%);痰或肺泡灌洗液涂片镜检均未检出耶氏肺孢子菌。胸部CT表现以磨玻璃影为主(25例,96.1%)。所有患者均接受复方磺胺甲噁唑片剂治疗,联合其他真菌药物治疗21例(80.8%)。所有患者中,接受体外膜肺氧合治疗1例(3.9%),无创通气5例(19.2%),有创机械通气7例(27.0%),鼻导管氧疗13例(50.0%)。19例(73.1%)发展为重症肺炎,最终21例(80.8%)好转,5例(19.2%)死亡。本组非HIV耶氏肺孢子菌肺炎患者以存在免疫抑制基础疾病的中老年为主,临床症状以发热、咳嗽、气促为主;影像学表现以磨玻璃影为主;实验室检查部分指标水平升高。治疗方案以复方磺胺甲噁唑为主的综合治疗。患者发展为重症肺炎比例高,死亡风险高。The clinical features,laboratory tests,imaging findings,treatment and outcomes of 26 non-HIV infection patients with Pneumocystis jirovecii pneumonia(PJP)diagnosed in our hospital from January 2017 to February 2022 were retrospectively analyzed.There were 19 males and 7 females,with an average age of 44(30,51)years.All patients had underlying diseases of immunosuppression.The main symptoms included fever in 18 cases(69.2%),cough in 15 cases(57.7%),shortness of breath in 11 cases(42.3%).The laboratory test results showed elevated levels of CRP in 22 cases(95.7%),PCT in 18 cases(78.3%),lactate dehydrogenase in 17 cases(17/19),G test in 14 cases(14/20),and decreased CD4^(+)T cell count in 14 cases(14/19).Pneumocystis jirovecii pathogen was detected in bronchoalveolar lavage fluid in 16 cases(61.5%),in blood samples in 10 cases(38.5%).Pneumocystis jirovecii was not detected in sputum or bronchoalveolar lavage fluid using smear microscopy.Chest CT showed ground-glass opacity in 25 cases(96.1%).All patients received compound sulfamethoxazole tablet,21 patients(80.8%)were also treated with other anti-fungal drugs.Among the 26 patients,1 case(3.9%)received extra-corporeal membrane oxygenation(ECMO),5 cases(19.2%)received non-invasive ventilation,7 cases(27.0%)received invasive ventilation,and 13 cases(50.0%)received nasal cannula oxygen therapy.Of the 26 cases,19 cases(73.1%)developed severe pneumonia.Finally,21 patients(80.8%)improved and discharged,and 5 patients(19.2%)died.In conclusion,non-HIV infection patients with Pneumocystis jirovecii pneumonia were mainly middle-aged or elderly people with underlying diseases of immunosuppression.The clinical symptoms are mainly fever,cough,and shortness of breath.The imaging manifestations are mainly ground-glass opacity and consolidation opacity.Laboratory tests show elevated CRP,PCT,LDH,and G tests,and decreased CD4^(+)T cells.Compound sulfamethoxazole-based comprehensive treatment is effective for PJP.The disease is characterized by high proportion of severe pneumonia,fast

关 键 词：获得性免疫缺陷综合征 肺炎 肺孢子菌 宏基因组 

分 类 号：R563.1[医药卫生—呼吸系统]