摘要【目的】探讨非人类免疫缺陷病毒(HIV)感染的肺孢子菌肺炎(PCP)患者的临床特征。【方法】收集2018年10月至2019年9月在本院呼吸与危重症医学科诊治的非HIV感染的PCP患者的临床资料,分析其临床特征。【结果】研究纳入45例患者, 19例(42.2%)死亡。基础疾病中最常见的为自身免疫性疾病,其次为恶性肿瘤、实体器官移植术后及肾脏疾病;PCP患者主要表现为非特异性的发热、咳嗽、呼吸困难,典型的胸部CT影像为双肺多发或散在磨玻璃影。和住院期间存活的患者相比,死亡患者入院时白蛋白更低(33.9±5.0 vs 27.7±4.3),乳酸脱氢酶更高(390.7±189.1 vs 524.1±246.9),血浆尿素氮水平更高[6.1(5.2~8.0) vs 9.4(5.0~15.5)],氧合指数更差[371.4(316.2~423.8) vs 300.0(257.1~354.8)],其差异均有统计学意义(均 P <0.05)。入院后44例均使用复方磺胺甲噁唑抗PCP治疗,其中31例联合使用卡泊芬净;41例(91.1%)患者在抗感染基础上接受糖皮质激素治疗。【结论】非HIV感染的PCP患者病死率较高,入院时低白蛋白、血浆乳酸脱氢酶和尿素氮升高及氧合指数差的患者预后不良。
Abstract：【Objective】To investigate clinical characteristics of pneumocystis pneumonia(PCP) in non-HIV-infected patients. 【Methods】 The clinical data of non HIV infected PCP patients diagnosed and treated in respiratory and critical care medicine department of our hospital from October 2018 to September 2019 were collected, and their clinical characteristics were analyzed.【Results】 Forty five patients were included in the study, and 19 (42.2%) died. The most common underlying diseases are autoimmune diseases, followed by malignant tumors, solid organ transplantation and kidney diseases; the main manifestations of PCP patients are nonspecific fever, cough and dyspnea, and the typical chest CT images are multiple or scattered ground glass shadows in both lungs. Compared with the patients who survived in hospital, the dead patients had lower albumin (33.9 ± 5.0 vs 27.7 ± 4.3), higher lactate dehydrogenase (390.7 ± 189.1 vs 524.1 ± 246.9), higher plasma urea nitrogen level [6.1 (5.2-8.0) vs 9.4 (5.0-15.5)] and worse oxygenation index [371.4 (316.2-423.8) vs 300.0 (257.1-354.8)], the differences were statistically significant (all P <0.05). After admission, 44 cases were treated with compound sulfamethoxazole anti PCP, 31 cases were treated with caspofungin; 41 cases (91.1%) were treated with glucocorticoid on the basis of anti infection.【Conclusion】The mortality of PCP patients without HIV infection is higher, and the prognosis of patients with low albumin, increased plasma lactate dehydrogenase and urea nitrogen and poor oxygenation index on admission is poor.
[1] Catherinot E, Lanternier F, Bougnoux ME, et al . Pneumocystis jirovecii pneumonia[J]. Infect Dis Clin North Am, 2010,24(1):107-138. [2] Maini R, Henderson KL, Sheridan EA, et al . Increasing pneumocystis pneumonia, England, UK, 2000-2010[J]. Emerg Infect Dis, 2013,19(3):386-392. [3] Liu CJ, Lee TF, Ruan SY, et al . Clinical characteristics, treatment outcomes, and prognostic factors of pneumocystis pneumonia in hon-HIV-infected patients[J]. Infect Drug Resist, 2019,12:1457-1467. [4] Cordonnier C, Cesaro S, Maschmeyer G, et al . Fifth European Conference on Infections in Leukemia (ECIL-5), a joint venture of The European Group for Blood and Marrow Transplantation (EBMT), The European Organization for Research and Treatment of Cancer(EORTC), the Immunocompromised Host Society (ICHS) and The European LeukemiaNet (ELN). Pneumocystis jirovecii pneumonia: still a concern in patients with haematological malignancies and stem cell transplant recipients[J]. J Antimicrob Chemother, 2016,71(9):2379-2385. [5] Roux A, Canet E, Valade S, et al . Pneumocystis jirovecii pneumonia in patients with or without aids, France[J]. Emerg Infect Dis, 2014,20(9):1490-1497. [6] Liu Y, Su LL, Jiang SJ, et al . Risk factors for mortality from pneumocystis carinii pneumonia(PCP) in non-HIV patients: a meta-analysis[J]. Oncotarget, 2017,8(35):59729-59739. [7] 孙岚,黄敏君,安亦军,等非艾滋病病毒感染临床病理肺孢子菌肺炎的流行病学研究[J].中国流行病学杂志. 2009,30(4)348-351. [8] 曹彬,王辉,王澎,等.非HIV感染/艾滋病患者人肺孢子菌肺炎的临床和预后研究[J].中国真菌学杂志,2006,1(1):31-35. [9] 孙成栋,张淑文,阴赪宏,等.重度脓毒症患者血清白蛋白、D-二聚体级胆碱酯酶水平的意义及预后的关系[J].中华医院感染学杂志,2006, 16(2):137-139. [10] Aoki Y,Iwamoto M, Kamata Y, et al . Prognostic indicators related to death in patients with pneumocystis pneumonia associated with collagen vascular diseases[J]. Rheumatol Int, 2009,29(11):1327-1330. [11] Chen MJ, Tian XL, Qin F, et al . Pneumocystis pneumonia in patients with autoimmune diseases: a retrospective study focused on clinical characteristics and prognostic factors related to death[J]. PLoS One, 2015,10(9):e0139144. [12] Schmidt JJ, Lueck C, Ziesing S, et al . Clinical course, treatment and outcome of pneumocystis pneumonia in immunocompromised adults: a retrospective analysis over 17 years[J]. Crit Care, 2018,22(1):307. [13] 李爱新,黄春洋,张宏伟,等.艾滋病合并肺孢子菌肺炎患者近期预后危因素分析[J].中华医学杂志,2017,97(11):833-837. [14] Kim SJ, Lee J, Cho YJ, et al . Prognostic factors of pneumocystis jirovecii pneumonia in patients without HIV infection[J]. J Infect, 2014,69(1):88-95. [15] Moon SM, Kim T, Sung H, et al . Outcomes of moderate-to-severe pneumocystis pneumonia treated with adjunctive steroid innon-HIV-infected patients[J]. Antimicrob Agents Chemother, 2011, 55(10):4613-4618.
2021, Vol. 38 
