非造血干细胞移植血液病患者并发肺孢子菌肺炎7例临床分析

中国真菌学杂志　 2020, Vol. 15 　Issue (6): 344-348.

非造血干细胞移植血液病患者并发肺孢子菌肺炎7例临床分析

孙青刚¹, 张海燕², 刘楠¹, 王明辉¹, 时洪川¹, 王海兵³

1. 海军第971医院血液科, 青岛 266071;
2. 青岛市中心医院内二科, 青岛 266042;
3. 海军第971医院干部三科, 青岛 266071

收稿日期:2020-04-05 发布日期:2020-12-28
通讯作者: 王海兵,E-mail:sdwhb96@163.com E-mail:sdwhb96@163.com
作者简介:孙青刚(1977-),男(汉族),硕士,主治医师.E-mail:sqg030523@sohu.com

Clinical analysis of 7 cases suffered pneumocystis pneumonia in non-HSCT patients with hematological diseases

SUN Qing-gang¹, ZHANG Hai-yan², LIU Nan¹, WANG Ming-hui¹, SHI Hong-chuan¹, WANG Hai-bing³

1. Department of Hematology, No. 971 Hospital of Navy, Qingdao 266071, China;
2. Department of Second internal medicine, Qingdao Central Hospital, Qingdao 266042, China;
3. Third Department of Cadre's Ward, No. 401 Hospital of PLA, Qingdao 266071, China

Received:2020-04-05 Published:2020-12-28

摘要/Abstract

摘要： 目的探讨非造血干细胞移植（HSCT）血液病患者合并肺孢子菌肺炎（PCP）的临床特点及诊疗策略，提高对该类疾病的认识水平。方法回顾性分析本院2014年9月-2019年9月确诊的7例非造血干细胞移植患者并发PCP的临床表现、实验室检查、影像学特点、治疗策略、临床转归等。结果 1基础疾病为血液系统恶性肿瘤5例，自身免疫性血液系统疾病2例；均接受免疫抑制治疗；2确诊时间为5~30 d，主要临床表现包括发热、干咳、劳力性呼吸困难；37例乳酸脱氢酶升高，5例低氧血症；4肺部高分辨CT表现为双肺弥漫性磨玻璃影，伴有支气管充气征、含气囊腔；疾病晚期磨玻璃影融合成片；57例均在支气管肺泡灌洗液中查见耶氏肺孢子菌包囊。5例聚合酶链式反应检查PJ核酸呈阳性。血清1-3-β-D葡聚糖水平5例升高；6均首选甲氧嘧啶-磺胺甲恶唑治疗；5例联合应用卡泊芬净；2例接受机械通气；5例痊愈，2例死亡。结论血液科非造血干细胞移植患者是PCP发生的高危人群；PCP是一种可能致命的疾病，早期诊断早期治疗能提高疗效。

关键词: 血液肿瘤, 免疫受损患者, 肺孢子菌肺炎, 临床分析

Abstract: Objective To study the clinical characteristics, diagnosis and treatment strategy of pneumocystis pneumonia (PCP) in non-hematopoietic stem cell transplantation (HSCT) patients with hematological diseases, in order to improve the understanding of the disease. Methods The clinical manifestations, laboratory examinations, imaging features, treatment strategies and clinical outcomes of 7 non-HSCT patients with hematological diseases complicated with PCP confirmed from September 2014 to September 2019 in the hospital were retrospectively analyzed. Results 1 Basic diseases were hematological malignancies in 5 cases and autoimmune hematological diseases in 2 cases. All received immunosuppressive therapy. 2 The incubation period for the disease was between 5 and 30 days, and the main clinical manifestations include fever, dry cough and labored dyspnea. 3 Increased lactate dehydrogenase was found in 7 cases and hypoxemia in 5 cases. 4 Pulmonary high-resolution CT showed diffuse ground-glass shadow in both lungs, accompanied by bronchial inflation sign and air sac cavity. The ground-glass shadow fused into pieces in the late stage of the disease. 5 Pneumocystis jirovecii (PJ) cysts were found in bronchoalveolar lavage fluid in 7 cases. PJ nucleic acid was positive in 5 cases by polymerase chain reaction. Serum 1-3-β-D glucan level was increased in 5 cases. 6 Methoxypyrimidine-sulfamethoxazole was the first choice for treatment in all cases. Five cases were also treated with caspofungin, 2 cases received mechanical ventilation. Five cases recovered and 2 died. Conclusions PCP might be a fatal disease for patients received immunosuppressive agents. Early diagnosis and early treatment could improve the curative effect, and high-risk patients need preventive medication.

Key words: hematological malignancies, immunocompromised host, pneumocystis pneumonia, clinical analysis

中图分类号:

孙青刚, 张海燕, 刘楠, 王明辉, 时洪川, 王海兵. 非造血干细胞移植血液病患者并发肺孢子菌肺炎7例临床分析[J]. 中国真菌学杂志, 2020, 15(6): 344-348.

SUN Qing-gang, ZHANG Hai-yan, LIU Nan, WANG Ming-hui, SHI Hong-chuan, WANG Hai-bing. Clinical analysis of 7 cases suffered pneumocystis pneumonia in non-HSCT patients with hematological diseases[J]. Chinese Journal of Mycology, 2020, 15(6): 344-348.

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