获得性免疫缺陷综合征并肺孢子菌肺炎54例误诊分析

目的 探讨获得性免疫缺陷综合征（艾滋病）并肺孢子菌肺炎（PCP）的误诊原因及防范措施.方法 对我院艾滋病并PCP误诊54例的临床资料进行回顾性分析.结果 本组因发热、咳嗽、呼吸困难就诊,误诊为细菌性肺炎28例,肺结核14例,心力衰竭5例,支气管炎3例,肺出血2例,支气管扩张症2例.经详细询问病史,结合血常规、胸部CT、CD4＋T淋巴细胞计数、艾滋病病毒抗体阳性、复方磺胺甲（口恶）唑治疗后效果确诊为艾滋病并PCP.予相应治疗后,治愈28例,好转6例,死亡20例.结论 PCP临床表现和体征缺乏特异性,影像学检查方法不当,基层医生缺乏PCP相关知识及诊断思维局限是该病误诊的主要原因.提高基层医生对PCP的认识,加强临床与影像科室的合作交流,对可疑艾滋病并PCP者及时行相关医技检查可避免或减少误诊.

Misdiagnosis Analysis of 54 Patients with Acquired Immunodeficiency Syndrome Accompanied with Pneumocystis Pneumonia

Objective To explore misdiagnosis causes and preventive measures for acquired immunodeficiency syndrome （AIDS） accompanied with pneumocystis pneumonia （PCP）.Methods Clinical data of 54 misdiagnosed patients with AIDS accompanied with PCP in our hospital was retrospectively analyzed.Results The patients visited doctors for fever,cough and dyspnea,etc.They were misdiagnosed as having bacterial pneumonia in 28 patients,tuberculosis in 14 patients,heart failure in 5 patients,bronchitis in 3 patients,pulmonary hemorrhage in 2 patients and bronchiectasis in 2 patients.AIDS accompanied with PCP was confirmed by results of detailed medical history,blood routine,chest CT,CD4 ＋ T lymphocyte count,HIV-positive,effect of Sulfame-thoxazole treatment.After corresponding treatment,28 patients were eured,6 patients＇symptoms were relieved,and 20 patients died.Conclusion The main misdiagnosis reasons of PCP are laeking the specific clinical symptoms and signs,inappropriate methods of imaging examination,poor related knowledge and limitations of diagnosis thinking in primary care physicians.The misdiagnosis can be avoided and the rate can be reduced by enhancing PCP awareness in primary physicians,increasing cooperation of clinicians and imaging operators,performing related medical examination in time for suspected patients.