一例肺部感染诱发噬血细胞综合征导致死亡的病例报告  

A case report of death due to pulmonary infection-induced hemophagocytic syndrome

作　　者：李彦华[1] 田淬[1] 韦妍妍 郭新红[1] LI Yan-hua;TIAN Cui;WEI Yan-yan;GUO Xin-hong(Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院第六医学中心心血管病医学部,北京100853

出　　处：《中华医院感染学杂志》2024年第10期1487-1491,共5页Chinese Journal of Nosocomiology

摘　　要：目的通过分析总结一例肺部感染合并心包积液患者临床特点、诊断及治疗转归,提高对噬血细胞综合征危重症的认识。方法对象为近期在解放军总医院就诊的一例肺部感染合并心包积液的患者,通过对患者的病史、疾病演变过程、化验检查及治疗反应进行总结,探讨在疾病诊治过程中出现不能解释的病情变化时的处置策略,为救治赢得时间。结果患者以肺部感染合并心包积液起病,病程中出现心脏压塞症状,抗感染及心包穿刺引流一度有效,后病情反复,炎症指标升高、血清铁蛋白升高、贫血、血小板减低、肝功能异常、甘油三酯升高,自然杀伤(NK)细胞活性下降(12.34%),sCD25升高(32843 pg/ml),骨髓涂片见噬血细胞,符合2004年噬血细胞综合征的诊断标准。结论感染可诱发炎症的过度表达,尤其存在基础风湿免疫系统疾病或血液系统疾病的患者,诊治过程中出现检查结果与临床病情分离的现象,及时完善NK细胞计数、CD4^(+)/CD8^(+)、sCD25、甘油三酯和纤维蛋白原等相对特异性指标,必要时尽快行骨髓穿刺及涂片,查找噬血细胞,有利于明确诊断,及时调整治疗方向,尽最大努力改善患者预后。OBJECTIVE To analyze the clinical characteristics,diagnosis and treatment outcome of 1 case of pulmonary infection patient complicated with pericardial effusion so as to raise awareness of the critical disease hemophagocytic syndrome.METHODS A case of pulmonary infection complicated with pericardial effusion who were treated in the Chinese PLA General Hospital was chosen as the research subject.The medical history,disease evolution process,clinical laboratory tests and treatment reactions were summarized,the treatment strategies for unexplained change of illness condition during the treatment process was explored so as to save time for the treatment.RESULTS The patient suffered from pulmonary infection complicated with pericardial effusion in the early onset and presented cardiac tamponade during the course of disease.Anti-infection therapy and pericardial puncture drainage were once effective,then the patient showed recurrent illness condition,rise of inflammatory indexes,rise of serum ferritin,anemia,decline of blood platelets,abnormal liver function,rise of triglyceride,decline of natural killer(NK)activity(12.34%)and rise of sCD25(32843 pg/ml).Hemophagocytes were displayed on bone marrow smear,which conformed to 2004 criteria for diagnosis as hemophagocytic syndrome.CONCLUSION The infection may induce the overexpression of inflammation,especially in the patient with underlying rheumatic immune system diseases or blood system diseases.There is a phenomenon of separation of test result from clinical illness condition.It is necessary to detect the relatively specific indexes such as NK counts,CD_(4)^(+)/CD_(8)^(+),sCD25,triglyceride and fibrinogen and carry out the bone marrow puncture and smear to find out the hemophagocytes in a timely manner if necessary so as to clarify the diagnosis,adjust the treatment direction and improve the prognosis of the patient.

关 键 词：肺部感染 心包积液 噬血细胞综合征 自身免疫性疾病 诊断 

分 类 号：R563.1[医药卫生—呼吸系统]