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目的探讨获得性免疫缺陷综合征(艾滋病)并肺孢子菌肺炎(PCP)的误诊原因及防范措施。方法对我院艾滋病并PCP误诊54例的临床资料进行回顾性分析。结果本组因发热、咳嗽、呼吸困难就诊,误诊为细菌性肺炎28例,肺结核14例,心力衰竭5例,支气管炎3例,肺出血2例,支气管扩张症2例。经详细询问病史,结合血常规、胸部CT、CD4+T淋巴细胞计数、艾滋病病毒抗体阳性、复方磺胺甲口恶唑治疗后效果确诊为艾滋病并PCP。予相应治疗后,治愈28例,好转6例,死亡20例。结论 PCP临床表现和体征缺乏特异性,影像学检查方法不当,基层医生缺乏PCP相关知识及诊断思维局限是该病误诊的主要原因。提高基层医生对PCP的认识,加强临床与影像科室的合作交流,对可疑艾滋病并PCP者及时行相关医技检查可避免或减少误诊。
Objective To investigate the causes of misdiagnosis of acquired immunodeficiency syndrome (AIDS) and pneumocystis pneumonia (PCP) and its preventive measures. Methods The clinical data of 54 cases misdiagnosed by AIDS and PCP in our hospital were analyzed retrospectively. Results This group was diagnosed with fever, cough and dyspareunia, misdiagnosed as bacterial pneumonia in 28 cases, tuberculosis in 14 cases, heart failure in 5 cases, bronchitis in 3 cases, pulmonary hemorrhage in 2 cases and bronchiectasis in 2 cases. After detailed history, combined with blood, chest CT, CD4 + T lymphocyte count, HIV antibody positive, compound sulfamethoxazole treatment effect was diagnosed as AIDS and PCP. After corresponding treatment, 28 cases were cured, 6 cases improved and 20 died. Conclusions The clinical manifestations and signs of PCP are not specific and the methods of imaging examination are improper. The lack of knowledge of PCP and the limitations of diagnostic thinking are the main reasons for the misdiagnosis of PCP. Improve primary care doctors on PCP awareness, strengthen clinical and imaging departments of the cooperation and exchange, the suspicious AIDS and PCP timely medical technology related inspection can avoid or reduce the misdiagnosis.