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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。
Objective To study the clinical features and prognostic factors of pneumocystis pneumonia (PCP) in patients with lymphoma. Methods The clinical data of patients with lymphoma and PCP admitted from March 2010 to December 2014 in our hospital were retrospectively analyzed. Results Twenty cases of lymphoma were diagnosed with PCP, all of whom were non-Hodgkin’s lymphoma. The specific gene fragment of PJ was detected in sputum of 5 patients, and the specific gene fragment of PJ was detected in the alveolar lavage fluid of more than 15 patients. The first and main clinical manifestations were fever (18 cases) and dyspnea (13 cases). Blood gas analysis was hypoxemia in 10 patients and respiratory failure in 10 patients, of which 7 patients were given mechanical ventilation and 4 died. Chemotherapy was performed in all patients. Leukopenia was found in 15 patients (75%) with an average of (3.2 ± 2.8) × 10 ~ 9 / L and serum lactate dehydrogenase (LDH) averaged (374.6 ± 197.2) U / L . The average score of acute physiology and chronic health assessment Ⅱ (APACHEⅡ) score (12.6 ± 4.4). No specific performance of bronchoscopy. Imaging mainly from the hilar to the outer ground glass shadow, less involvement of the pleura. Univariate analysis showed that there was no significant difference in chemotherapy cycle, leukocyte count and G test between survival group and death group, but the difference was significant between serum LDH, APACHEⅡscore, delayed diagnosis and combined infection. Conclusions Fever and progressive dyspnea are the main clinical manifestations of non-Hodgkin’s lymphoma and PCP. Elevated serum LDH, high APACHE II score, delayed diagnosis, combined infection of four factors suggest that patients with poor prognosis.