非HIV感染患者肺孢子菌肺炎合并急性呼吸衰竭16例诊疗分析

目的 提高对非HIV感染患者肺孢子菌肺炎（PCP）合并急性呼吸衰竭的诊断和治疗的认识。方法 对2015年1月—2017年12月我院重症监护科收治的16例非人类免疫缺陷病毒（HIV）感染的肺孢子菌肺炎合并急性呼吸衰竭患者的临床表现、实验室检查、影像特点、治疗及转归等临床资料进行总结及讨论。结果 15例患者在发病前存在激素或免疫抑制剂使用史，均以发热和干咳、呼吸困难为首发症状后病情进展迅速。患者均存在呼吸衰竭［氧合指数（85.8±16.8）mmHg］，有创呼吸机辅助呼吸11例，高流量氧疗5例。胸部CT主要表现为弥漫性磨玻璃影。支气管肺泡灌洗液六胺银染色阳性2例，肺孢子菌PCR检测阳性16例。16例患者应用复方磺胺甲噁唑（SMZco）联合卡泊芬净与激素治疗，8例痊愈，7例死亡，1例放弃治疗后死亡。入住ICU时间为3~29 d，平均（13.0±7.1）d。结论PCP是应用免疫抑制剂患者易患的机会性感染，对于重症PCP患者SMZco联合卡泊芬净与激素治疗效果良好。

Analysis of diagnosis and treatment of pneumocystis pneumonia in the non-HIV-infected patients with acute respiratory failure

Objective To improve diagnostic and therapeutic levels of pneumocystis pneumonia (PCP) in non-HIVinfected patients. Methods The clinical data (including clinical manifestation，laboratory examination, imaging features,diagnosis, treatment and prognosis) of sixteen non-HIV-infected patients with acute respiratory failure caused by PCP who were diagnosed in our intensive care units (ICU) during January 2015 to December 2017, were summarized and discussed.Results Almost all patients were immunocompromised by hormone or immunosuppresant before PCP (15/16). Fever, dry cough, and dyspnea were the first symptoms in all patients. The development of PCP was rapid. All patients showed acute respiratory failure oxygen index: (85.8±16.8) mmHg]. Invasive ventilator support was required in 11 patients (68.8%), high flow oxygen therapy was used in 5 patients (31.2%). The chest CT characteristics indicated diffuse ground glass opacity. Two patients were found methenamine silver-stained positive in bronchoalveolar lavage fluid. Sixteen cases were positive for pneumocystis detected by PCR. Sixteen patients were treated with compound sulfonamide (SMZco)，caspofungin and corticosteroid. Eight patients were cured, 7 died and 1 case was given up and then died. The ICU length of stay was 3-29 days, average days (13.0±7.1). Conclusion PCP is a kind of opportunistic infection among patients who are treated with immunosuppressive agents. SMZco combined with caspofungin and corticosteroid is effective in the treatment of severe PCP patients.