肺孢子菌肺炎的影像学表现

摘要/Abstract

摘要： 肺孢子菌肺炎（PJP）是一种真菌性机会性感染, 多见于免疫功能障碍或低下患者, 包括获得性免疫缺陷综合征、器官移植、免疫抑制剂或皮质类固醇长期使用、恶性肿瘤及其化疗等。PJP的临床表现以低热、干咳及进行性呼吸困难为主, 体征较轻且与症状不符;病情发展迅速, 若不及时诊断与治疗, 病死率较高。PJP典型的影像学表现为双肺以肺门周为中心的弥漫性磨玻璃影, 伴或不伴肺气囊, 向双肺斑片状及弥漫性实变影发展, 部分患者遗留间质性改变。影像学上将PJP分为5种类型, 即磨玻璃型、肺气囊型、斑片型、间质型及混合型, 其中以磨玻璃型及肺气囊型多见。若获得性免疫缺陷综合征患者并发肺气囊、自发性气胸, 则高度提示肺孢子菌感染。肺孢子菌肺炎的影像学表现具有特征性, 能给临床带来诊断提示, 对疾病的识别、后续病原性检查确诊、治疗及预后评估具有重要作用。

关键词: 肺炎, 肺囊虫性, 获得性免疫缺陷综合征, 体层摄影术, X线计算机

Abstract: Pneumocystis jiroveci pneumonia (PJP), previously named pneumocystis carinii pneumonia, one of the fungoid and opportunistic infections in lungs, is commonly found in dysfunction of immunity, including Acquired Immunodeficiency Syndrome (AIDS), organ transplantation, long-term treatment with immunosuppressant or corticosteroids, malignant tumor and suffering from chemotherapy, and so on. PJP has a characteristic that there is a discrepancy with a mild sign and a serious symptom of low-grade fever, nonproductive cough, and progressive dyspnea. If necessary diagnosis and treatment could not be implemented on time, its mortality rate would be increasingly high, with a sharp development. The typical image of PJP is bilateral, diffused, and symmetrical ground-glass opacity around the hilus pulmonis. The image of PJP can be divided into five types, including ground-glass opacities dominated, lung cysts dominated, consolidation dominated, interstitial lesions dominated, and mixed lesions pattern. If a patient with AIDS appears spontaneous pneumothorax, the most possible cause is the infection of pneumocystis. The early identification and diagnosis with typical image for PJP, and the following specific treatment, play an important role in prognosis of patients.

Key words: Pneumonia, Pneumocystis, Acquired Immunodeficiency Syndrome, Tomography, X-Ray Computed

丘金铭, 吴仁华. 肺孢子菌肺炎的影像学表现[J]. 新发传染病电子杂志, 2019, 4(4): 235-239.

QIU Jin-ming, WU Ren-hua. Imaging manifestations of pneumocystis jiroveci pneumonia[J]. Electronic Journal of Emerging Infectious Diseases, 2019, 4(4): 235-239.

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