慢性肾小球疾病合并肺孢子虫肺炎的诊治及护理

目的探讨慢性。肾小球疾病合并肺孢子虫肺炎（PCP）的诊治和护理，以提高对慢性肾小球疾病合并PCP的认识。方法回顾性分析4例慢性肾小球疾病合并PCP患者的临床症状、影像学及实验室资料，分析其诊断、治疗转归及护理情况。结果4例临床均表现为发热、咳嗽、胸闷等，3例出现I型呼吸衰竭，1例顽固性低氧血症。其中3例支气管肺泡灌洗液痰姬姆萨染色找到伊氏肺孢子菌，1例支气管肺泡灌洗液痰PCR检测伊氏肺孢子菌虫体DNA（＋）。4例中IgA。肾病2例，肾淀粉样变性1例，膜性肾病1例。4例均应用激素治疗，有2例同时应用环磷酰胺（CTX），激素及CTX均为常规用法、用量。4例均予卡泊芬净及复方磺胺甲嗯唑治疗，均好转出院，无不良反应。结论PCP是接受激素和（或）CTX治疗的慢性肾小球疾病患者肺部机会感染之一，护理上早期发现患者的症状对患者的早期诊断具有重要意义。典型的胸部X线尤其是CT征像对PCP的诊断具有重要意义，但早期胸部X线和CT征像多不典型。对接受激素和（或）CTX治疗的慢性肾小球疾病患者，如出现发热、进行性呼吸困难，应尽早行痰或支气管肺泡灌洗液姬姆萨染色涂片找伊氏肺孢子菌或PCR检测伊氏肺孢子菌虫体DNA。呼吸道的护理对患者预后起决定性作用。

Diagnosis and nursing of pneumocystis carinii pneumonia patients with chronic glomerular diseases

Objective To explore the diagnosis and nursing of pneumocystis carinii pneumonia patients with chronic glomerular diseases. Methods Four patients with chronic glomerular disease and pneumocystis carinii (PC) pneumonia were retrospectively analyzed. Results The clinical manifestations were fever, cough,chest tightness and antibiotics ineffective. 3 patients were type Ⅰ respiratory failure and 1 patient was hypoxemia. 3 patients were detected pneumocystis carinii in bronchoalveolar lavage fluid. 1 patient was pneumocystis carinii DNA + in bronchoalveolar lavage fluid. 2 cases were IgA nephropathy, renal amyloidosis and membranous nephropathy in other two cases. All patients had hormone therapy and there are also two cases combined with of cyclophosphamide (CTX). Four patients were therapied with Caspofungin + cotrimoxazole (SMZco) + hormone, and they all improved and discharged with no side effects. Conclusions PC pneumonia is one of pulmonary opportunistic infections in patients with chronic glomerullar disease receiving hormone and (or) CTX therapy. Typical chest X-ray or CT sign were important for diagnosis, but the initial sign was non-typical.If patients receiving hormone and (or) immunosuppressive therapy for glomerular diseases were fever and antibiotics ineffective, they should be alert to PC pneumonia. Bronchoalveolar lavage fluid giemsa stain and sputum PCR should be done as soon as possible to find PC. Treatment of PC pneumonia with caspofungin and cotrimoxazole (SMZco) was preferred.