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目的 提高对卡氏肺囊虫肺炎 (PCP)的认识 ,探索电镜对卡氏肺囊虫肺炎的诊断意义以及预防PCP的方法。方法 通过对 95例肾移植术后受者中有发热、呼吸困难伴干咳的 1 6例患者作回顾性分析 ,X线胸片及肺部CT显示此 1 6例患者两肺弥漫性渗出性病变。其中 1 3例作支气管镜检 ,六胺银染色 (Jones)结合电镜活检确诊为卡氏肺囊虫肺炎。结果 选用复方磺胺甲基异恶唑(SMZco)治疗 ,1 5例康复 ,治疗过程中 4例血肌酐及胆红素轻度增高 ,停药后恢复正常 ,随访 2～ 1 2个月 ,PCP未复发。有 1例因呼吸衰竭死亡。结论 肾移植术后易罹患卡氏肺囊虫肺炎 ;PCP关键在于早期预防 ,早期诊断、早期治疗。电镜对诊断PCP有其重要的临床意义
Objective To improve the understanding of Pneumocystis carinii pneumonia (PCP) and to explore the diagnostic value of electron microscopy to Pneumocystis carinii pneumonia and to prevent PCP. Methods A total of 95 renal transplant recipients with fever, dyspnea and dry cough were retrospectively analyzed. X-ray and CT showed that diffuse exudation of both lungs Lesions. Thirteen of them were bronchoscopically and Jones combined with electron microscopy were diagnosed as Pneumocystis carinii pneumonia. Results The patients were treated with compound sulfamethoxazole (SMZco) and recovered in 15 cases. Serum creatinine and bilirubin were mildly elevated in 4 cases during treatment, and returned to normal after stopping the treatment. The patients were followed up for 2 to 12 months. PCP relapse. One patient died of respiratory failure. Conclusions Kidney disease is easy to develop after Pneumocystis carinii pneumonia. The key of PCP lies in early prevention, early diagnosis and early treatment. Electron microscope diagnosis of PCP has its important clinical significance