克林霉素联合伯氨喹补救治疗非HIV感染的肺孢子菌肺炎患者的效果

Abstract

目的 观察克林霉素联合伯氨喹(C-P方案)补救治疗非人类免疫缺陷病毒(HIV)感染的肺孢子菌肺炎(PCP)患者的效果.方法 回顾性分析2010年1月至2016年5月北京大学第一医院使用C-P方案补救治疗的非HIV感染的PCP患者病例资料,评价其临床疗效.结果 共纳入19例非HIV感染的PCP患者,平均年龄(44.4±16.1)岁.患者均有糖皮质激素用药史,临床症状表现为发热、干咳和进行性加重的呼吸困难.该组患者均通过诱导痰或支气管肺泡灌洗液六胺银染色镜检确诊.其中,13例患者因一线治疗失败、6例患者因不能耐受甲氧苄啶/磺胺甲嗯唑(TMP-SMX)而换用C-P方案补救治疗.19例患者中10例治愈,9例死亡.一线治疗失败的13例患者中4例治愈,而不能耐受TMP-SMX的6例患者均治愈(P=0.011).发生不良反应3例,均为高铁血红蛋白血症.结论 非HIV感染的PCP患者一线治疗失败或不耐受时采用C-P方案补救治疗仍有可能收效.

Objective To evaluate the efficacy of clindamycin-primaquine as the salvage treatment for pneumocystis pneumonia (PCP) in non-HIV-infected patients.Methods Clinical data of non-HIV-infected patients with PCP who were treated with clindamycin-primaquine as the salvage treatment in Peking University First Hospital from Jan 2010 to May 2016 were collected and reviewed in this retrospective study.Clinical outcomes were analyzed to evaluate the efficacy of clindamycin-primaquine as a salvage treatment.Results A total of 19 non-HIV-infected patients with PCP were included.The average age was 44.6 ± 16.1 years old.All patients had a history of glucocorticoids usage,and presented with fever,nonproductive cough and progressive dyspnea.The diagnoses were confirmed by positive methenamine silver staining in the induced sputum or bronchoalveolar lavage fluid.The reasons for the change of treatment were either failure of the first line therapy (13 cases) or severe adverse effects of the original treatment (6 cases).Ten patients were cured with the salvage treatment,while nine patients died.Four of thirteen patients who were switched due to treatment failure responded to clindamycin-primaquine treatment,while all the 6 patients who switched the treatment due to the severe adverse effects of trimethoprim-sulfamethoxazole were cured,the difference was statistically significant (P =0.011).Adverse reactions occurred in 3 cases,all of which were methemoglobinemia.Conclusion In non-HIV-infected patients with PCP who have failed or can not tolerate the first-line therapy,clindamycin-primaquine may still be effective as a salvage treatment.