关键词: 关键词 , 重症肺部感染 糖皮质激素 足细胞病

Abstract:

ABSTRACT  Objective: To investigate the clinical features of severe pulmonary infection in patients treated with glucocorticosteroids for their podocyte injury.  Methodology : Eleven patients with podocytopathy who admitted to ICU because of severe pulmonary infection as well as ARDS was retrospectively reviewed. The clinical features of podocytopathy, time and efficacy of GC therapy, the clinical manifestations of pulmonary infection, immune function, pathogenic characteristics, treatment through and prognosis were investigated. Results: They were 7 males and 4 females with an average age of 28.5±12.7 years old ranged from16 to 50. All patients with biopsy-proved podocytopathy, Among them, 8 cases used full-dose methylprednisolone (48mg/day), and 3 cases used prednisone (50 to 60mg/day). At the 8th week, 11 patients (100%) had total remission. However, all of them developed pulmonary infection after taking glucocorticosteroids within 9～16weeks, with an average time of 13±2 weeks. They complained of progressive dyspnea and fever, cough and a little white sputum. Their temperature was higher at 39.9±0.76°C (38.9 to 41.2°C). Rapid progression was observed in the patients, with difficulty breathing and severe hypoxemia as the significant symptoms. The oxygenation indices were below 200 with an average of 118±42.1 (57.5 to 200). Coarse breath sounds was heard initially and a few wet and dry rales later on lung auscultation. Chest CT or chest radiography was suggestive of bilateral diffuse interstitial inflammation. Laboratory examination revealed a lower level of cellular immune function and reduced count of peripheral blood lymphocytes（539±166/µl）, as well as significantly decreased CD4+ T lymphocyte count at 133±45.4/µl . On the contrary, IgG and IgM levels were with the normal range. All patients were given suspected diagnosis of pneumocystis carinii pneumonia and need ventilatory support therapy. The triple therapy of antiinfection drugs was SMZ, micafungin and methylprednisolone. 6 patients required continuous renal replacement therapy (CRRT), one of them given extracorporeal membrane oxygenation therapy (ECMO). After therapy, 8(72.7%) patients recovered and 3 (27.3%) died or gave up treatment. The average ICU stay was 18±7.0 days (11 to 33), and the overall average length of stay 24±14 days (13 to 55). Conclusion: steroid-sensitive patients who were treat with glucocorticosteroids for their podocyte injury may appears severe pulmonary infections even though they had complete remission. Regard to immunodeficiency, the disease can rapidly progress and mortality is high.

Key words: Key words：Severe pulmonary infection , glucocorticosteroid , podocytopathy