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目的提高临床医生对非艾滋病(AIDS)患者肺孢子菌肺炎(PCP)的临床、实验室检查、影像学特点的认识。方法选取2014年1月—2015年8月在南京大学附属鼓楼医院呼吸科住院并诊断为PCP的患者7例,均经检查排除AIDS。总结其临床、实验室检查、影像学特点。结果 PCP患者均接受了糖皮质激素治疗,均表现为发热伴呼吸困难、咳嗽,且进行性加重;7例患者氧合指数均<300mm Hg,CD+4T淋巴细胞计数均<200/μl,血清β-D-葡聚糖均升高,胸部CT表现为双肺弥漫性磨玻璃影伴斑片影;患者均至少联合应用了复方磺胺甲恶唑和卡泊芬净抗PCP治疗,28.6%的患者病情恶化、死亡。结论长期应用激素患者出现发热伴呼吸困难、咳嗽,低氧血症,CD+4T淋巴细胞计数<200/ul,血清β-D-葡聚糖升高,胸部CT提示双肺弥漫性磨玻璃影伴斑片影时,需高度警惕PCP感染可能。
Objective To improve clinicians’ understanding of the clinical, laboratory and imaging characteristics of pneumococcal pneumonia (PCP) in non-AIDS patients. Methods From January 2014 to August 2015, 7 patients were hospitalized in Department of Respiratory Medicine of Drum Tower Hospital of Nanjing University and were diagnosed as PCP. All patients were examined to exclude AIDS. Summary of clinical, laboratory tests, imaging features. Results All patients with PCP received glucocorticoid therapy. All patients presented with fever with dyspnea, cough, and progressive exacerbations. The oxygenation index of all 7 patients were less than 300 mm Hg, the counts of CD + 4T lymphocytes were all less than 200 / β-D-glucan were elevated, chest CT showed diffuse ground glass shadow with shadow patch; patients were at least combined with sulfamethoxazole and caspofungin anti-PCP treatment, 28.6% of the The patient’s condition deteriorated and died. Conclusion Long-term use of hormones in patients with fever and respiratory difficulties, cough, hypoxemia, CD 4T lymphocyte count <200 / ul, elevated serum β-D-glucan, chest CT showed diffuse ground glass With patchy shadow, the need to be highly vigilant PCP infection may be.