艾滋病合并肺孢子菌肺炎101例临床分析

 

目的 探讨艾滋病（AIDS）合并肺孢子菌肺炎（PJP）患者的临床特征，以提高对PJP规范诊治的认识。方法 回顾性分析2016年6月-2019年6月凉山州布拖县人民医院收治的101例AIDS合并PJP患者的临床资料，包括病史、症状、体征、胸部影像学、实验室检查及治疗与转归等资料。结果 101例AIDS合并PJP患者中，78.2%（79例）为中青年男性，72.3%（73例）的人类免疫缺陷病毒（HIV）感染主要经性接触传播。常见的临床表现有进行性呼吸困难（69例）、发热（17例）、咳嗽（15例）等。动脉血气分析提示低氧血症（PaO₂<60 mmHg），外周血乳酸脱氢酶显著升高，为（527.4±85.7）U/L。合并其他肺部感染（细菌或结核）现象常见（34例）。CD4⁺T淋巴细胞计数下降明显（<200个/μL，90例），细胞免疫功能损伤严重。胸部CT主要表现为双肺多发磨玻璃样影，可见从肺门开始的弥漫性网状结节样间质浸润。结论 AIDS合并PJP患者临床表现多样，以呼吸系统损伤最常见，早期诊断和规范治疗是影响AIDS合并PJP预后的关键。

Clinical analysis on 101 cases of AIDS combined with Pneumocystis jiroveci pneumonia

Objective To explore clinical characteristics of patients with acquired immunodeficiency syndrome(AIDS) combined with Pneumocystis jiroveci pneumonia (PJP), so as to improve the understanding on standardized diagnosis and treatment of PJP. Methods Clinical data of 101 AIDS patients combined with PJP who were admitted to Butuo People''s Hospital of Liangshan Prefecture from June 2016 to June 2019 were analyzed retrospectively, including medical history, symptoms, signs, chest imaging, laboratory examination, treatment and outcome. Results Among 101 AIDS patients combined with PJP, 78.2% (n=79) were young and middle-aged men, 72.3% (n=73) of HIV infection was mainly transmitted by sexual contact. The common clinical manifestations were progressive dyspnea (n=69), fever (n=17), cough (n=15) and so on. Arterial blood gas analysis indicated that patients had hypoxemia (PaO₂<60 mmHg) and significant elevation of lactate dehydrogenase (LDH) in peripheral blood (527.4±85.7)U/L. Combination of other pulmonary infection (bacteria or tuberculosis) were common (n=34). CD4⁺T lymphocyte count decreased significantly (< 200/μL, n=90), and cellular immune function was seriously damaged. The main manifestations of chest CT were multiple ground-glass opacity in both lungs, and diffuse reticular nodular interstitial infiltration from the hilus of lung. Conclusion Clinical manifestations of AIDS patients combined with PJP are various, respiratory system damage is most common, early diagnosis and standardized treatment are the key to the influence of prognosis of AIDS patients combined with PJP.