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-  2016 

淋巴瘤并肺孢子菌肺炎临床分析及预后研究

DOI: doi:10.7507/1671-6205.2016128

Keywords: 肺孢子菌肺炎, 淋巴瘤, 预后

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Abstract:

目的研究淋巴瘤患者发生肺孢子菌肺炎(PCP)的临床特点和预后影响因素。 方法回顾分析2010年3月至2014年12月我院收治淋巴瘤合并PCP患者的临床资料。 结果20例淋巴瘤患者确诊合并PCP, 均为非霍奇金淋巴瘤。5例患者的痰中检出耶氏肺孢子菌(PJ)的特异性基因片段, 余15例患者的肺泡灌洗液中检出PJ的特异性基因片段。首发及主要临床表现为发热(18例)、呼吸困难(13例)。10例患者诊断时血气分析为低氧血症, 10例为呼吸衰竭, 其中7例给予机械通气, 死亡4例。所有患者均接受化疗, 15例患者(75%)起病时存在白细胞下降, 平均(3.2±2.8)×10 9/L, 血清乳酸脱氢酶(LDH)平均(374.6±197.2) U/L。平均急性生理学和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分(12.6±4.4)分。支气管镜下无特异性表现。影像学主要表现为自肺门向外周的磨玻璃影, 较少累及胸膜。单因素分析显示, 存活组及死亡组在化疗周期、白细胞计数、G试验方面, 差异均无统计学意义, 但血清LDH、APACHEⅡ评分、延迟诊断、合并感染比较, 差异有统计学意义。 结论发热及渐进性呼吸困难, 是非霍奇金淋巴瘤并PCP主要的临床表现。血清LDH增高、高APACHEⅡ评分、延迟诊断、合并感染四种因素提示患者预后不良

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