耶氏肺孢子菌肺炎临床特点及KL-6诊断价值

目的分析本地区耶氏孢子菌肺炎(Pneumocystis jirovecii pneumonia,PJP)患者的流行趋势、临床特征、血清学标志物,为PJP患者的早预防、早诊断提供理论依据。方法回顾性分析江西省3所综合性医院2016年1月至2019年12月诊断为PJP的49例住院患者,收集患者临床资料,包括基本信息、危险因素、临床表现、实验室结果、影像学报告、预后等。结果49例PJP患者绝大多数HIV阴性(89.8%),且以中年男性为主。AIDS、肾脏疾病(47.7%)和结缔组织疾病(29.6%)为PJP患者主要危险因素,临床表现以干咳(83.7%)、白色黏痰,发热(79.6%)为主,其次为呼吸困难。PJP患者以低剂量/短时间(<3个月)使用糖皮质激素或免疫抑制剂为特征。85%以上PJP患者实验室指标超过参考范围的有中性粒细胞百分比、C反应蛋白、氧分压、乳酸脱氢酶和涎液化糖链抗原-6(KL-6)。结论HIV阴性患者感染PJ逐渐增多,肾脏疾病和结缔组织疾病是其主要危险因素,LDH、BG和KL-6可作为PJP患者的重要辅助检查。

Clinical characteristics and diagnostic value of KL-6 in Pneumocystis jirovecii pneumonia

Objective To analyze the prevalence,clinical characteristics and serological markers of pneumocystis jirovecii pneumonia(PJP)patients in this region,and to provide theoretical basis for early prevention and early diagnosis of PJP.Methods A retrospective study of 49 hospitalized patients with PJP from January 2016 to December 2019 in three general hospitals in jiangxi province was conducted.Information was collected regarding patient demographics,clinical manifestations,risk factors,laboratory analyses,radiological images,and treatment outcomes.Results The vast majority of PJP were HIV negative(89.8%)and were predominantly found in middle-aged males.HIV/AIDS,kidney disease(47.7%)and connective tissue disease(29.6%)were the main risk factors for PJP.The main clinical manifestations were dry cough(83.7%),white phlegm,and fever(79.6%),followed by dyspnea.The PJP patients had received glucocorticoid,immunosuppressant and/or chemotherapy in a low dose or for a short duration(<3 months).Biochemical investigations of Neu%,CRP,PO 2,LDH,and KL-6 showed that over 85%of cases exceeded the reference range of indicators.Conclusion HIV-negative patients infected with PJ were increasing,and renal disease and connective tissue disease might be main risk factors.LDH,BG and kl-6 might be used as important auxiliary examinations for PJP patients.