中华肾脏病杂志
中華腎髒病雜誌
중화신장병잡지
2008年
8期
555-559
,共5页
叶文玲%于阳%李航%陈丽萌%高瑞通%李明喜%刘冬妍%曾学军%王京岚%王辉%李雪梅%李学旺
葉文玲%于暘%李航%陳麗萌%高瑞通%李明喜%劉鼕妍%曾學軍%王京嵐%王輝%李雪梅%李學旺
협문령%우양%리항%진려맹%고서통%리명희%류동연%증학군%왕경람%왕휘%리설매%리학왕
肾疾病%肺炎,肺囊虫性%机会致病菌感染
腎疾病%肺炎,肺囊蟲性%機會緻病菌感染
신질병%폐염,폐낭충성%궤회치병균감염
Kidney disease%Pneumocystis pneumonia%Opportunistic infection
目的 探讨慢性肾脏疾病并发肺孢子菌肺炎(PCP)的临床特点及预后.方法 回顾性分析北京协和医院经病原学确诊的原发和继发性肾脏疾病(除外肾移植)并发PCP 21例的临床资料.结果 原发性肾脏疾病6例,继发性肾脏疾病15例.在合并PCP时,20例(95.2%)正在接受糖皮质激素和(或)免疫抑制剂治疗.PCP起病急骤,以发热、不同程度的胸闷憋气、呼吸困难、干咳少痰为主要临床表现.20例患者以发热起病,病程中17例患者出现高热.20例入院时即存在明显低氧血症,其中12例为Ⅰ型呼吸衰竭.12例患者检测了T细胞亚群,8例CD4+T细胞低于0.2×109/L,其中5例低于0.1×109/L.除1例表现为双肺团块影外,20例胸部x线片提示弥漫性肺间质病变或CT示肺部磨玻璃样改变.所有患者接受三甲氧苄氨嘧啶.磺胺甲基异恶唑(TMP-SMZ)治疗,死亡11例,占52.3%.与治愈组相比,死亡组患者发病年龄较大[(60.91±15.08)岁比(44.50+14.83)岁,P＜0.05],就诊时血氧分压较低[(48.11±19.05)mm Hg比(65.91±13.13)mm Hg,P＜0.01].需要呼吸机辅助呼吸及并发其他病原菌感染的比例更高.存活者平均随访16个月,无PCP复发.结论 PCP是慢性肾脏疾病激素和免疫抑制剂治疗过程中的一个严重并发症,病情进展迅速,常导致死亡,早期诊断及治疗至关重要.
目的 探討慢性腎髒疾病併髮肺孢子菌肺炎(PCP)的臨床特點及預後.方法 迴顧性分析北京協和醫院經病原學確診的原髮和繼髮性腎髒疾病(除外腎移植)併髮PCP 21例的臨床資料.結果 原髮性腎髒疾病6例,繼髮性腎髒疾病15例.在閤併PCP時,20例(95.2%)正在接受糖皮質激素和(或)免疫抑製劑治療.PCP起病急驟,以髮熱、不同程度的胸悶憋氣、呼吸睏難、榦咳少痰為主要臨床錶現.20例患者以髮熱起病,病程中17例患者齣現高熱.20例入院時即存在明顯低氧血癥,其中12例為Ⅰ型呼吸衰竭.12例患者檢測瞭T細胞亞群,8例CD4+T細胞低于0.2×109/L,其中5例低于0.1×109/L.除1例錶現為雙肺糰塊影外,20例胸部x線片提示瀰漫性肺間質病變或CT示肺部磨玻璃樣改變.所有患者接受三甲氧芐氨嘧啶.磺胺甲基異噁唑(TMP-SMZ)治療,死亡11例,佔52.3%.與治愈組相比,死亡組患者髮病年齡較大[(60.91±15.08)歲比(44.50+14.83)歲,P＜0.05],就診時血氧分壓較低[(48.11±19.05)mm Hg比(65.91±13.13)mm Hg,P＜0.01].需要呼吸機輔助呼吸及併髮其他病原菌感染的比例更高.存活者平均隨訪16箇月,無PCP複髮.結論 PCP是慢性腎髒疾病激素和免疫抑製劑治療過程中的一箇嚴重併髮癥,病情進展迅速,常導緻死亡,早期診斷及治療至關重要.
목적 탐토만성신장질병병발폐포자균폐염(PCP)적림상특점급예후.방법 회고성분석북경협화의원경병원학학진적원발화계발성신장질병(제외신이식)병발PCP 21례적림상자료.결과 원발성신장질병6례,계발성신장질병15례.재합병PCP시,20례(95.2%)정재접수당피질격소화(혹)면역억제제치료.PCP기병급취,이발열、불동정도적흉민별기、호흡곤난、간해소담위주요림상표현.20례환자이발열기병,병정중17례환자출현고열.20례입원시즉존재명현저양혈증,기중12례위Ⅰ형호흡쇠갈.12례환자검측료T세포아군,8례CD4+T세포저우0.2×109/L,기중5례저우0.1×109/L.제1례표현위쌍폐단괴영외,20례흉부x선편제시미만성폐간질병변혹CT시폐부마파리양개변.소유환자접수삼갑양변안밀정.광알갑기이악서(TMP-SMZ)치료,사망11례,점52.3%.여치유조상비,사망조환자발병년령교대[(60.91±15.08)세비(44.50+14.83)세,P＜0.05],취진시혈양분압교저[(48.11±19.05)mm Hg비(65.91±13.13)mm Hg,P＜0.01].수요호흡궤보조호흡급병발기타병원균감염적비례경고.존활자평균수방16개월,무PCP복발.결론 PCP시만성신장질병격소화면역억제제치료과정중적일개엄중병발증,병정진전신속,상도치사망,조기진단급치료지관중요.
Objective To investigate the clinical features of pneumocystis pneumonia (PCP) in patients with chronic kidney disease. Methods Clinial data of 21 cases of the primary and secondary kidney diseases complicated with PCP,excluding renal transplantation,were analyzed retrospectively. Results Twenty-one cases consisted of 6 cases of primary renal diseases and 15 eases of secondary renal diseases.Twenty patients (95.2%) were receiving immunesuppressive therapy at the PCP onset.Main manifestations were fever,progressive dyspnea,cough with no or seldom sputum.Twenty patients presented obvious hypoxemia and 12 of them were type I respiratory failure.X-ray and CT imaging of 20 patients revealed diffuse pulmonary interstitial shadows or ground glass opacities in both lungs.All the patients were treaed with trimethoprim-sulfamethoxazole.Eleven patients died accounting for 52.3%.Compared with the survivors,elder age (60.91±15.08 vs 44.50±14.83,P＜0.05),lower blood oxygen pressure at onset [(48.11±19.05)mm Hg vs (65.91±13.13)mm Hg,P＜0.01],higher percentage of respirator application and other secondary lung infection were found in dead patients.No PCP relapsed after average 16-month follow-up in the survival patients. Conclusions PCP is a severe complication with high mortality during immunosuppressive therapy in patients with chronic renal disease.Early diagnosis and proper treatment are important to improve prognosis.
