2例儿童急性淋巴细胞白血病合并肺孢子肺炎并文献复习
Two Cases of Childhood Acute Lymphoblastic Leukemia Combined with Pneumocystis Pneumonia and Literature Review

目的：探讨儿童急性淋巴细胞白血病(Acute lymphoblastic leukemia, ALL)合并肺孢子肺炎(Pneumocystis pneumonia, PCP)与艾滋病(Acquired immunodeficiency syndrome, AIDS)合并PCP在临床症状、影像学及治疗方面的不同。方法：回顾性分析我院2015年至今经病原学确诊为PCP的ALL患儿，与从CNKI数据库、万方资源数据库、PubMed数据库、Science Online数据库中以“艾滋病/AIDS”、“肺孢子肺炎/Pneumocystis pneumonia”为关键词检索AIDS合并PCP的相关文献，比较两类患者的临床症状、影像学表现及治疗。结果：我院2例确诊为ALL合并PCP，余疑似病例在经验性用药后均治愈。2例病例起病时均有发热伴干咳、气促，双肺可闻及少量湿啰音，血氧饱和度下降，使用无创辅助通气治疗可维持正常，乳酸脱氢酶(LDH)无明显上升，HRCT均呈斑片状密度增高影，1例出现实变影，另1例出现散在结节状致密影。2例均行纤维支气管镜肺泡灌洗，高通量检查确诊为PCP，予卡泊芬净、TMP-SMZ、糖皮质激素治疗后好转。结论：ALL合并PCP与AIDS合并PCP的临床症状、影像学表现及治疗基本一致，但ALL合并PCP起病时LDH无明显上升，肺部阳性体征较AIDS合并PCP更为常见。
Objective: The objective is to explore the differences in clinical symptoms, imaging and treatment between childhood acute lymphoblastic leukemia (ALL) combined with Pneumocystis pneumonia (PCP) and AIDS combined with PCP. Methods: A retrospective analysis of childhood ALL diagnosed with PCP in our hospital from 2015 to the present, was compared with literature searched by “艾滋病/AIDS” and “卡氏肺孢子虫肺炎/Pneumocystis pneumonia” as keywords from CNKI database, Wanfang Resource database, PubMed database and Science Online database, to find out the differences in clinical symptoms, imaging manifestations and treatment of the two types of patients. Results: Two patients in our hospital were diagnosed with ALL combined with PCP, and the remaining suspected patients were cured after empirical treatment. Both patients had fever with dry cough and shortness of breath of onset, a few moist rales over lung fields and oxygen saturation decreased. Both could maintain the normal arterial oxygen with the help of non-invasive ventilation. Lactate dehydrogenase (LDH) didn’t increase significantly. Both HRCT showed patchy opacities, one case had consolidation, and the other had scattered nodules. Patients underwent fiberoptic bron-choscopies and bronchoalveolar lavage, high-throughput examination confirmed the diagnosis of PCP, and both improved after the treatment with caspofungin, TMP-SMZ, and glucocorticoids. Conclusion: The clinical symptoms, imaging manifestations and treatment of ALL combined with PCP and AIDS combined with PCP are similar, but LDH does not increase significantly at the onset of ALL combined with PCP, and positive lung signs are more common than AIDS combined with PCP.