CAJ | 학술논문

目的了解AIDS合并肺孢子菌肺炎(PCP)的临床特点、诊断方法及治疗效果.方法参照1993年美国国家疾病预防控制中心修订的诊断标准选择69例AIDS合并PCP患者,观察临床症状与体征,检测外周血T淋巴细胞计数、血气分析,同时行支气管肺泡灌洗液(BALF)检查和经支气管镜肺组织活检.结果 69例患者均属AIDS晚期.发热69例,占100.0%,咳嗽67例.占97.1%,呼吸困难64例,占92.8%,42例可闻及肺部哕音,占60.9%.外周血CD4+T淋巴细胞计数1×106～88×106/L,低氧血症(动脉血氧分压≤10.7 kPa,1 kPa=7.5 mm Hg)52例,占75.4%,血清乳酸脱氢酶(LDH)增高61例,占88.4%.胸部影像学以双肺弥漫性间质性改变与弥漫磨砂玻璃样改变最常见,各占46.4%与29.0%.2例支气管肺泡灌洗液和35例经支气管镜肺活组织检查(TBB)找到肺孢子菌.全部患者均接受复方磺胺甲噁唑(SMZ-TMP)治疗,重症患者中33例辅以糖皮质激素,27例接受机械辅助通气.治愈、好转50例,死亡11例,自动出院8例.结论当AIDS患者出现发热、咳嗽、呼吸困难、低氧血症、LDH增高及CD4+T淋巴细胞＜100×106/L时,结合胸部影像间质性肺炎或磨砂玻璃样改变,临床需考虑PCP;病原学诊断困难,但TBB肺孢子菌检出率高;治疗首选SMZ-TMP,重症病例辅以糖皮质激素和机械辅助通气可改善预后.
목적 료해AIDS합병폐포자균폐염(PCP)적림상특점、진단방법급치료효과.방법 삼조1993년미국국가질병예방공제중심수정적진단표준선택69례AIDS합병PCP환자,관찰림상증상여체정,검측외주혈T림파세포계수、혈기분석,동시행지기관폐포관세액(BALF)검사화경지기관경폐조직활검.결과 69례환자균속AIDS만기.발열69례,점100.0%,해수67례.점97.1%,호흡곤난64례,점92.8%,42례가문급폐부홰음,점60.9%.외주혈CD4+T림파세포계수1×106～88×106/L,저양혈증(동맥혈양분압≤10.7 kPa,1 kPa=7.5 mm Hg)52례,점75.4%,혈청유산탈경매(LDH)증고61례,점88.4%.흉부영상학이쌍폐미만성간질성개변여미만마사파리양개변최상견,각점46.4%여29.0%.2례지기관폐포관세액화35례경지기관경폐활조직검사(TBB)조도폐포자균.전부환자균접수복방광알갑오서(SMZ-TMP)치료,중증환자중33례보이당피질격소,27례접수궤계보조통기.치유、호전50례,사망11례,자동출원8례.결론 당AIDS환자출현발열、해수、호흡곤난、저양혈증、LDH증고급CD4+T림파세포＜100×106/L시,결합흉부영상간질성폐염혹마사파리양개변,림상수고필PCP;병원학진단곤난,단TBB폐포자균검출솔고;치료수선SMZ-TMP,중증병례보이당피질격소화궤계보조통기가개선예후.
Objective To study the clinical characteristics, diagnostic methods and therapeutic efficacy of pneumocystis pneumonia (PCP) in patients with acquired immunodeficiency syndrome (AIDS). Methods Sixty-nine AIDS cases of PCP were diagnosed according to the criteria of USA Centers for Disease Control and Prevention revised in 1993. The clinical symptoms and signs of the patients were observed. The peripheral blood lymphocyte counts, blood gas analysis and bronchoalveolar lavage fluid (BALF) were checked and transbronchoscopic lung biopsy was performed. Results All studied patients were in the late stage of AIDS. The main clinical manifestations included fever (100.0%), cough (97.1%), and dyspnea (92.80%). Pulmonary rales could be heard in 42 cases (60.9% ). Peripheral CD4+ T lymphocyte counts ranged from 1 × 106 -88 × 106/L. Fifty-two cases (75.4% ) had low arterial partial pressure of oxygen value of less than 10.7 kPa (1 kPa = 7.5 mm Hg). Sixty-one cases (88.4 %) had elevated serum lactate dehydrogenase (LDH) level. Bilateral diffused interstitial change (46.4%) and ground-glass shadow (29.0%) were the most common abnormal chest radiological findings. Pneumocystis organisms were detected in the BALF from 2 patients and in the transbronchial biopsy (TBB) tissue from 35 patients. All patients were treated with compound sulfamethoxazole. Thirty-three were treated with corticosteroid simultaneously and 27 were assisted with mechanical ventilation. Fifty patients recovered or got improved, eleven died, and eight left hospital because of deteriorated condition. Conclusions When an AIDS patient represents with fever, cough, dyspnea, hypoxemia, elevated serum I.DH level, CD4+ T lymphocyte count below 100 × 106/L, and interstitial pneumonia or ground-glass shadow in chest images, the diagnosis of PCP could be made presumptively. It is difficult to make a nosogenic diagnosis of PCP, but TBB considerably increases the positive rate of pneumocystis. Compound sulfamethoxazole is recommended as the first selected drug. In severe cases, corticosteroid and assisted mechanical ventilation combined with compound sulfamethoxazole could remarkably improve the prognosis of PCP.