Clinical and CT manifestations of pneumocystis pneumonia in AIDS patients and analysis of prognostic risk factors
Objective To investigate the clinical manifestations,CT performance and risk factors of Pneumocystis pneumonia(PCP)in AIDS patients,in order to provide evidence for early diagnosis and intervention.Methods The clinical and imaging data of 30 patients diagnosed with AIDS and PCP admitted to our hospital from January 2015 to December 2023 were retrospectively analyzed.Demographic information,clinical symptoms,laboratory indicators,treatment plan and course of disease were collected.High-resolution CT(HRCT)was used to evaluate the imaging features of lung lesions,including the incidence of ground glass shadows,interstitial lesions,bullosa,and pneumothorax.Univariate and multivariate Logistic regression analyses were used to assess independent risk factors for poor clinical outcomes and to calculate their relative risk(OR).Results A total of 30 patients were included,with an average age of 36.5 8.2 years,83.33％(25 cases)were males.The main clinical manifestations were dyspnea(80.00％,24 cases),dry cough(86.66％,26 cases)and fever(76.66％,23 cases),of which 66.66％(20 cases)were accompanied by weight loss of more than 10％.The mean CD4+T cell count was 92±28 cells/μL,and 56.66％(17 cases)had CD4 count lower than 50 cells/μL.Lactate dehydrogenase(LDH)levels increased in 70.00％(21 cases),with an average LDH of 566.3±154.8 U/L.The mean C-reactive protein(CRP)was 52.4±18.7 mg/L,and 57％(17 patients)had hypoxemia(PaO2＜70 mmHg),with a mean PaO2 of 65.4±10.2 mmHg.Among other laboratory indicators,D-dimer was elevated in 43.33％(13 cases),serum albumin was lower than normal in 66.66％(20 cases),and the mean hemoglobin was 98.7±15.2 g/L.Imaging findings showed that 93.33％(28 cases)had bilateral ground glass shadows,46.66％(14 cases)were accompanied by interstitial fibrosis,and 20.00％(6 cases)were accompanied by pneumothorax.Hypoxemia occurred in 80.95％(17/21 cases)of patients with ground glass shadow area greater than 50％,while no hypoxemia occurred in patients with ground glass shadow area less than 50％(P＜0.001).Multivariate Logistic regression analysis showed that CD4+T cell count was lower than 50 cells/μL(OR=4.98,95％CI:1.99-12.45,P=0.001)and LDH was higher than 500 U/L(OR=3.85,95％CI:1.37-10.78,P=0.010),PaO2＜70 mmHg(OR=6.14,95％CI:2.14-17.62,P=0.001),pneumothorax complications(OR=4.76,95％CI:1.10-20.55,P=0.037)and ground glass shadow area＞50％(OR=5.21,95％CI:1.31-20.71,P=0.019)were independent risk factors for poor prognosis in PCP patients.Conclusion The main clinical manifestations of AIDS patients with pneumocystis pneumonia are dyspnea,dry cough and fever.CT imaging features are typical of bilateral diffuse ground glass shadow,and some patients are accompanied by interstitial fibrosis and pneumothorax.CD4+T cell count less than 50 cells/μL,high lactate dehydrogenase level,pneumothorax complications and ground glass shadow area greater than 50％were independent risk factors for poor prognosis in PCP patients.Strengthening early identification and intervention of high-risk patients may help improve clinical outcomes.
NETL
NSTL
万方数据
