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目的 研究系统性红斑狼疮 (SLE)合并卡氏肺孢子虫肺炎 (PCP)的临床表现。方法 回顾分析 2例SLE合并PCP患者的临床资料 ,并复习相关文献。结果 2例患者均为 31岁 ,SLE并狼疮肾炎病程分别为 4年及 7年 ,并曾使用大剂量泼尼松及环磷酰胺治疗。在诊断PCP时已分别停用激素或免疫抑制剂 6个月及 12个月。 2例患者均表现为干咳、静息时气促、急性发热及进行性低氧血症。胸部X线表现为弥漫性网状阴影。支气管肺泡灌洗液 (BAF)均发现卡氏肺孢子虫。使用复方磺胺甲基异恶唑片 (SMZ)治疗后 ,1例患者临床症状及X线表现好转 ,另 1例死亡。结论 必须警惕SLE患者出现快速进行性低氧血症及Ⅰ型呼吸衰竭时PCP发生的可能性 ;SLE并发PCP病死率很高 ,早期诊断和治疗是改善预后的关键。PCP易复发 ,必须给以足够疗程的治疗
Objective To study the clinical manifestations of systemic lupus erythematosus (SLE) combined with pneumocystis carinii pneumonia (PCP). Methods The clinical data of 2 patients with SLE combined with PCP were reviewed and reviewed. Results Both patients were 31 years old. The duration of SLE with lupus nephritis was 4 years and 7 years, respectively. They were treated with high-dose prednisone and cyclophosphamide. Hormone or immunosuppressive agents have been discontinued for 6 months and 12 months, respectively, in the diagnosis of PCP. 2 patients showed dry cough, restlessness, shortness of breath, acute fever and progressive hypoxemia. Chest X-ray showed diffuse reticular shadows. Pneumocystis carinii were found in bronchoalveolar lavage fluid (BAF). After treatment with compound sulfamethoxazole tablets (SMZ), one patient showed improvement in clinical symptoms and X-ray findings, and another one died. Conclusion SLE patients should be alert to the occurrence of PCP in SLE patients with rapid progressive hypoxemia and type Ⅰ respiratory failure. The mortality of SLE complicated with PCP is very high. Early diagnosis and treatment are the keys to improve prognosis. PCP easy to relapse, must give enough treatment of treatment