系统性红斑狼疮并发卡氏肺孢子虫肺炎二例并文献复习

目的：研究系统性红斑狼疮（SLE）合并卡氏肺孢子虫肺炎（PCP）的临床表现，方法：回顾分析2例SLE合并PCP患者的临床资料，并复习相关文献，结果：2例患者均为31岁，SLE并狼疮肾炎病程分别为4年及7年，并曾使用大剂量泼尼松及环磷酰胺治疗，在诊断PCR时已分别停用激素或免疫抑制剂6个月及12个月。2例患者均表现为干咳，静息时气促，急性发热及进行性低氧血症，胸部X线表现为弥漫性网状阴影。支气管肺泡灌洗液（BAE）均发现卡氏肺孢子虫。使用复方磺胺甲基异恶唑片（SMZ）治疗后，1例患者临床症状及X线表现好转，另1例死亡。结论：必须警惕SLE患者出现快速进行低氧血症及Ⅰ型呼吸衰竭时PCR发生的可能性；SLE并发PCP病死率很高，早期诊断和治疗是改善预后的关键。PCP易复发，必须给以足够疗程的治疗。

Systemic lupus erythematosus complicated with Pneumocystis carinii pneumonia

Objective To explore the clinical manifestation of systemic lupus erythematosus (SLE) complicated with Pneumocystis carinii pneumonia (PCP).Methods Retrospective analysis of the clinical data of two cases of SLE complicated with PCP.Results The two patients were both aged 31 years and have had SLE disease for 4 and 7 years respectively.Both had lupus nephritis and were previously treated with high dose corticosteroid and cyclophosphadmide.Both patients had ceased immunosuppressive drug treatment for 6 and 12 months respectively at the time of diagnosis of PCP infection.Both patients presented with acute fever with dry cough,shortness of breath at rest,progressive hypoxia and diffuse reticular shadows on chest X ray. Pneumocystis carinii were identified in the bronchoalveolar lavage fluid (BAF) in both cases.SMZ was used to treat the PCP infection.The first patient recovered with improvement in her clinical well being and chest X ray appearance,while the second failed to respond and eventually succumbed.Conclusion One should be alert to the occurrence of PCP when patients with SLE present with rapidly progressive hypoxemia and type I respiratory failure.The mortality rate is high in SLE patients complicated with PCP and early diagnosis and treatment are the key to improving survial in these patients.Recurrence of PCP is common and adequate duration of treatment is essential.