艾滋病合并肺孢子菌肺炎22例临床分析

目的探讨AIDS合并肺孢子菌肺炎(PCP)的临床特点,以提高对PCP的认识。方法回顾性分析我院22例AIDS合并PCP的临床资料,并进行相关文献复习。结果(1)22例患者中,男性占72·7%,年龄(35·0±9·4)岁。感染HIV途径主要经输血(54·5%)和性传播(27·3%);(2)最常见的临床表现为发热(21例)、进行性加重的呼吸困难(20例)、咳嗽(16例)、咳痰(12例)及体重下降(18例)。68·2%(15例)患者肺呼吸音正常或稍粗。外周PaO2<60mm Hg(1mm Hg=0·133kPa)者占63·6%(14例);(3)均为AIDS晚期患者,外周血CD4 T淋巴细胞(3~148)×106/L,其中<100×106/L者占90%(18/20)。CD4 /CD8 <0·20者占95%(19/20);(4)常见的胸部影像学表现为双侧肺间质纹理改变(19/22)和斑片影(14/22);(5)治疗药物主要为复方磺胺甲唑(SMZco)(100%)和肾上腺糖皮质激素(86·4%)。治愈13例、自动放弃5例、死亡4例。死亡患者CD4 T淋巴细胞计数明显低于治愈组(P=0·07)。结论PCP主要发生于AIDS晚期患者;临床遇有发热、呼吸困难、低氧血症、体重下降来诊的青壮年患者,胸部影像学提示间质纹理改变或斑片影,应警惕AIDS合并PCP的可能;临床怀疑AIDS合并PCP时应尽早给予SMZco治疗。

A clinical analysis of 22 cases of Pneumocystis pneumonia in acquired immunodeficiency syndrome

OBJECTIVE: To investigate the clinical characteristics, therapeutical approaches and outcome of Pneumocystis pneumonia (PCP) in patients with AIDS. METHODS: The clinical data of 22 PCP patients with AIDS who were treated in Peking Union Medical College Hospital from January 1992 to October 2004 were analyzed, including the routes of HIV infection, clinical profiles, immunological status, chest radiological characteristics, therapeutic managements and outcome. RESULTS: (1) Of the 22 PCP patients, 16 were male and 6 female. The average age was (35.0 +/- 9.4) years old. The majority of patients got HIV infection through blood transfusion (54.5%) and sexual transmission (27.3%). (2) The common clinical presentations were fever (21/22), progressive exertional dyspnea (20/22), cough (16/22), sputum (12/22) and weight loss (18/22). 68.2% (15/22) of the patients had normal or mild coarse breath sounds on auscultation. 14 patients had an PaO(2) less than 60 mm Hg (1 mm Hg = 0.133 kPa). (3) All the 22 PCP cases were in their late stage of AIDS. For the 20 patients who had an immunological test, the peripheral CD(4)(+) T lymphocyte count was ranging from 3 x 10(6)/L to 148 x 10(6)/L and 90% of the cases had a CD(4)(+) T cell count less than 100 x 10(6)/L, 95% of the cases had a CD(4)(+)/CD(8)(+) ratio less than 0.20; (4) The most common abnormal chest radiological findings were bilateral diffuse interstitial infiltrations (19/22) and patchy shadows (14/22); (5) All patients were given trimethoprim-sulfamethoxazole (SMZco) and 86.4% of the patients were treated with corticosteroids concomitantly. Of the 22 PCP patients, 13 recovered, 5 gave up after knowing their definite diagnosis, 4 died. Comparing with the recovery patients, the 4 patients who died of PCP had much lesser CD(4)(+) T cell count (P = 0.07). CONCLUSIONS: Most PCP occurred in patients who were in their late stage of AIDS and with a CD(4)(+) T cell count below 100 x 10(6)/L. For these reasons, we suggest that whenever encountering a young patient presenting with fever, dyspnea, hypoxia, loss of weight, the possibility of PCP complicating AIDS should be considered, especially when chest radiological study revealed interstitial infiltration or patchy shadows. If HIV was confirmed to be positive, the combined therapy of SMZco and corticosteroids should be started immediately.