艾滋病合并卡氏肺孢子虫肺炎的临床特点及诊断方法

目的　探讨艾滋病合并卡氏肺孢子虫肺炎 (PCP)的临床特点和诊断方法。方法　对1 999～ 2 0 0 1年经痰聚合酶链反应 (PCR)确诊的 1 2例艾滋病合并PCP进行分析。结果　 (1 )合并结核病 4例 ,细菌性肺炎 1例。 (2 )痰PCR阳性 1 2例 ,其中血PCR阳性 9例 ,姬姆萨染色阳性 6例 ,六胺银染色阳性 5例。 (3) 1 2例CD+ 4(5～ 1 55)× 1 0 6 /L ,平均CD+ 4(51± 48)× 1 0 6 /L ;其中CD+ 4<(1 0 0× 1 0 6 ) /L1 0例 (83 % ) ,CD+ 4<(50× 1 0 6 ) /L 9例 (75 % ) ;CD+ 4/CD+ 8:0 .0 1～ 0 .2 9。结论　 (1 )PCP是艾滋病晚期常见的合并症 ,常常合并其它机会性感染如结核等。 (2 )痰PCR阳性 +典型的临床表现可以确诊PCP。

Clinical characteristics and diagnosis of Pneumocystis carinii pneumonia (PCP) in patients with the acquired immunodeficiency syndrome (AIDS)

OBJECTIVE: To explore the clinical characteristics and the diagnostic methods for PCP in patients with AIDS. METHODS: Twelve cases of AIDS associated PCP confirmed by sputum polymerase chain reaction (PCR) were analyzed. RESULTS: Tuberculosis was found in 4 cases and pneumonia in 1 case of PCP. Sputum PCR was positive in all the 12 cases, of them blood PCR was positive in 9, Gomori methenamine silver stain (GMS) positive in 5 and Giemsa stain positive in 6 cases. The CD(4)(+) lymphocyte count was (5 approximately 155) x 10(6)/L, with a mean of (51 +/- 48) x 10(6)/L; the number of CD(4)(+) cells less than 100 x 10(6)/L in 10 cases (83%) with 9 cases (75%) less than 50 x 10(6)/L. The CD(4)(+)/CD(8)(+) ratio was 0.01 approximately 0.29. CONCLUSIONS: PCP was common in patients with advanced AIDS and often co-infected with other opportunistic infections such as tuberculosis. A diagnosis of PCP should be considered if sputum PCR is positive and typical clinical manifestations are present in patients with AIDS.