«上一篇/Previous Article|本期目录/Table of Contents|下一篇/Next Article»

《中华肺部疾病杂志》[ISSN:1006-6977/CN:61-1281/TN]

卷:

期数:

2022年04期

页码:

473-476

栏目:

论著

出版日期:

2022-08-20

文章信息/Info

Title:

Analysis of clinical characteristics of Pneumocystis pneumonia

作者:

任腾; 刘伟; 焦娇; 李艳燕; 马瑞娜; 房延凤; 金发光

710038 西安,空军军医大学第二附属医院呼吸与危重症医学科

Author(s):

Ren Teng;  Liu Wei;  Jiao Jiao;  Li Yanyan;  Ma Ruina;  Fang Yanfeng;  Jin Faguang.

The Second Affiliated Hospital of Air Force Military Medical University, Xi'an 710038, China

关键词:

耶氏肺孢子菌肺炎;  HIV感染;  支气管肺泡灌洗液;  宏基因组二代测序

Keywords:

Pneumocystis pneumonia;  HIV infection;  Bronchoalveolar lavage fluid;  Metagenomic next generation sequencing

分类号:

R563

DOI:

10.3877/cma.j.issn.1674-6902.2022.04.004

摘要:

目的 分析耶氏肺孢子菌肺炎患者的临床特点,以提高对此类疾病的认识,做到早诊早治。方法 选择2017年3月1日至2022年3月1日,空军军医大学第二附属医院收治的耶氏肺孢子菌肺炎患者43例,按是否感染HIV分为非HIV感染组17例,HIV感染组26例。分析两组患者性别、年龄、吸烟史,基础疾病,既往用药,临床症状、实验室检查、胸部CT资料及治疗、疗效。结果 非HIV感染组年龄(52.29±13.59)岁大于HIV感染组(39.42±12.55)岁; 两组患者性别,临床症状,起病时间,白细胞总数、淋巴细胞总数及胸部CT表现差异无统计学意义(P>0.05),吸烟史、起病时间小于1周、既往用药基础疾病、合并症,静滴丙种球蛋白、使用机械通气及疗效差异有统计学意义(P<0.05)。非HIV感染组,胸部CT表现、起病时间、治疗中激素使用、丙种球蛋白使用无统计学意义(P>0.05),机械通气使用有统计学意义(P<0.05)。结论 中年,有吸烟史,基础疾病,服用激素或免疫抑制剂患者,在小于1周内出现双肺弥漫性病变后应考虑耶氏肺孢子菌肺炎可能,静滴丙种球蛋白有可能疗效亦不佳,使用机械通气可改善预后,完善宏基因组二代测序,精准治疗,降低病死率。

Abstract:

Objective To analyze the clinical characteristics of Pneumocystis pneumonia(PCP)patients, in order to improve its early diagnosis and treatment. Methods All of 17 patients with non-HIV PCP and 26 patients with HIV PCP were admitted to the Second Affiliated Hospital of the Air Force Medical University during March 1, 2017 to March 1, 2022. Their gender, age, smoking history, basic diseases, medication history, clinical symptoms, laboratory examinations, chest CT imaging, treatment and curative effect were analyzed. Results The age of non-HIV infected PCP group [(52.29±13.59)years] was higher than that of HIV infected PCP group [(39.42±12.55)years], gender, the onset time(within 3 weeks, 1 month, 3 months, greater than 3 months), the total number of white blood cells, total number of lymphocyte and chest CT imaging were showed no significant difference(P>0.05)and there were significant differences in smoking history, onset time less than 1 week, basic diseases, complications, intravenous immunoglobulin, mechanical ventilation and curative effect(P<0.05). In the non-HIV infected PCP group, chest CT imaging, onset time, hormone and intravenous immunoglobulin during treatment were showed no significant difference(P>0.05), but the use of mechanical ventilation was significant difference(P<0.05). Conclusion When middle-aged patients with a history of smoking, underlying diseases, hormonal or immunoglobulin therapy should consider the possibility of PCP, Intravenous gamma globulin may have poor curative effect, but mechanical ventilation can be used to improve its prognosis, so we should actively improve the metagenomic next generation sequencing as soon as possible, to obtain etiological examination, accurate treatment and reduce mortality.

参考文献/References:

1 钟 艳, 柴旭煜, 王 健. 抗逆转录病毒药物制剂的研究进展[J]. 中国医药工业杂志, 2019, 50(6): 589-595.
2 江 怡, 李 航, 李学旺. IgA肾病免疫抑制治疗中并发肺孢子菌肺炎10例分析[J]. 中华肾脏病杂志, 2013, 29(12): 930-931.
3 孙 丹, 李世军. 接受免疫抑制治疗患者肺孢子菌肺炎的诊治进展[J]. 肾脏病与透析肾移植杂志, 2017, 26(6): 567-572.
4 曹文彬, 刘庆珍, 周卢坤, 等. HIV阴性急性白血病患者化疗后并发耶氏肺孢子菌肺炎1例报告及文献复习[J].吉林大学学报(医学版), 2019, 45(1): 148-152.
5 陆 丹, 庞桂芬, 孙小方, 等. 肺孢子菌肺炎的诊断及治疗最新进展[J]. 世界最新医学信息文摘, 2020, 20(34): 91-93.
6 Salzer HJF, Schäfer G, Hoenigl M, et al. Clinical, diagnostic, and treatment disparities between HIV-infected and non-HIV-infected immunocompromised patients with pneumocystis jirovecii pneumonia[J]. Respiration, 2018, 96(1): 52-65.
7 Liu Y, Su LL, Jiang SJ, et al. Risk factors for mortality from Pneu mocystis carinii pneumonia( PCP)in non-HIV patients: a meta-analysis[J].Oncotarget, 2017, 8(35): 59729- 59739.
8 Bienvenu AL, Traorek, Plekhaova I, et al. Pneumocystis pneumonia suspected cases in 604 non-HIV and HIV patients[J]. Int J Infect Dis, 2016, 46: 11-17.
9 张健惠, 蒋梦瑶, 赵方圆, 等. 21例非艾滋病合并耶氏肺孢子菌肺炎患者的临床特点[J]. 河南医学研究, 2020, 29(31): 5791-5794.
10 Li J, Zhang Q, Su B. Clinical characteristics and risk factors of severe infections in hospitalized adult patients with primary nephrotic syndrome[J] J Int Med Res, 2017, 45(6): 2139-2145.
11 张 健, 陈 平, 宋芹霞, 等. AIDS 合并卡氏肺孢子菌肺炎的多排螺旋CT表现及鉴别诊断[J]. 中华全科医学, 2020, 18: 1901-1903.
12 吴磊迪, 陈 艳, 韩 萍. 新型冠状病毒肺炎影像学研究进展[J]. 临床放射学杂志, 2020, 39: 853-856.
13 谢正平, 朱 斌. 艾滋病合并肺孢子菌肺炎的CT表现分型与预后相关性[J]. 临床放射学杂志, 2018, 37(2): 228-232.
14 Rouyer M, Stoclin A, Blanc FX. La pneumocystose chez le patient adulte non infecté parle VIH [Pneumocystis pneumonia in HIV-negative adults][J]. Rev Mal Respir, 2015, 32(10): 985-990.
15 Mang S, Kaddu-Mulindwa D, Metz C, et al. Pneumocystis jirovecii pneumonia and severe acute respiratory syndrome coronavirus 2 coinfection in a patient with newly diagnosed HIV-1 infection[J]. Clin Infect Dis, 2021, 72(8): 1487-1489.
16 Weyant RB, Kabbani D, Doucette K, et al. Pneumocystis jirovecii: a review with a focus on prevention and treatment[J]. Expert Opin Pharmacother, 2021, 22(12): 1579-1592.
17 中华医学会呼吸病学分会呼吸危重症医学学组. 急性呼吸窘迫综合征患者机械通气指南[J]. 中华医学杂志, 2016, 96(6): 404-424.
18 中华医学会重症医学分会重症呼吸学组. 急性呼吸窘迫综合征患者俯卧位通气治疗规范化流程[J]. 中华内科杂志, 2020, 59(10): 781-787.
19 杜转环, 张海丹, 李言鹏, 等. 急性呼吸窘迫综合征患者俯卧位通气获益机制的研究进展[J]. 中国急救医学, 2018, 38(10): 915-920.
20 Fan LC, Lu HW, Cheng KB, et al. Evaluation of PCR in bronchoalveolar lavage fluid for diagnosis of Pneumocystis jirovecii pneumonia: a bivariate meta-analysis and systematic review[J]. PLoS One, 2013, 8(9): e73099.
21 Georges O, Risso K, Lemiale V, et al. Place du lavage broncho-alvéolaire dans l'exploration d'une pneumopathie de l'immunodéprimé[The place of bronchoalveolar lavage in the diagnosis of pneumonia in the immunocompromised patient][J]. Rev Mal Respir, 2020, 37(8): 652-661.
22 Guegan H, Robert-Gangneux F. Molecular diagnosis of pneumocystis pneumonia in immunocompromised patients[J]. Curr Opin Infect Dis, 2019, 32(4): 314-321.
23 Besser J, Carleton HA, Gerner-Smidt P, et al. Next generation sequencing technologies and their application to the study and control of bacterial infections[J]. Clin Microbiol Infect, 2018, 24(4): 335-341.
24 Goodwin S, McPherson JD, McCombie WR. Coming of age: ten years of next-generation sequencing technologies[J]. Nat Rev Genet, 2016, 17(6): 333-351.
25 Wang J, Han Y, Feng J. Metagenomic next-generation sequencing for mixed pulmonary infection diagnosis[J]. BMC Pulm Med, 2019, 19(1): 252.
26 Wu X, Li Y, Zhang M, et al. Etiology of severe community-acquired pneumonia in adults based on metagenomic next-generation sequencing: A prospective multicenter study[J]. Infect Dis Ther, 2020, 9: 1003-1015.
27 Bateman M, Oladele R, Kolls JK. Diagnosing pneumocystis jirovecii pneumonia: A review of current methods and novel approaches[J]. Med Mycol, 2020, 58(8): 1015-1028.
28 Rego de Figueiredo I, Vieira Alves R, Drummond Borges D, et al. Pneumocystosis pneumonia: A comparison study between HIV and non-HIV immunocompromised patients[J]. Pulmonology, 2019, 25(5): 271-274.
29 Li Y, Sun B, Tang X, et al. Application of metagenomic nextgeneration sequencing for bronchoalveolar lavage diagnostics in critically ill patients[J]. Eur J Clin Microbiol Infect Dis, 2020, 39(2): 369-374.
30 Bienvenu AL, Traore K, Plekhanova I, et al. Pneumocystis pneumonia suspected cases in 604 non-HIV and HIV patients[J]. Int J Infect Dis, 2016, 46: 11-17.
31 王 杰, 王德生, 黄华萍, 等. 获得性免疫缺陷综合征患者并临床诊断肺孢子菌肺炎10例回顾性分析[J/CD]. 中华肺部疾病杂志(电子版), 2016, 9(5): 498-502.

备注/Memo

备注/Memo:

通信作者: 刘 伟, Email: liuweilung@163.com

常用功能

更新日期/Last Update: 2022-08-20