Morris A M, Swanson M, Ha H, Huang L
Department of Medicine, San Francisco General Hospital, University of California, San Francisco, San Francisco, California, USA.
Am J Respir Crit Care Med. 2000 Nov;162(5):1622-6. doi: 10.1164/ajrccm.162.5.2002065.
The epidemiology of Pneumocystis carinii pneumonia (PCP) and its geographic distribution are incompletely understood. We examined the influence of geographic location as a risk factor for PCP through a retrospective case-control study of HIV-infected persons evaluated for PCP at San Francisco General Hospital. Subjects had microscopically confirmed PCP diagnosed between January 1996 and June 1999. Control subjects had a presentation suggestive of PCP, but had bronchoalveolar lavage examination that did not reveal P. carinii. Medical chart review was performed to obtain demographic and clinical characteristics of the subjects as well as their addresses at time of PCP evaluation. Multivariate analyses were performed in order to identify variables associated with PCP. Lack of P. carinii prophylaxis and a CD4 cell count </= 50 cells/microl were independent predictors of an increased risk of PCP. Interestingly, subjects living in the 94103 zip code had a significantly lower risk of PCP than subjects in other areas (odds ratio = 0.2, 95% confidence interval 0.1-0.6, p < 0.01). This effect was present despite controlling for risk factors for PCP such as use of prophylaxis or antiretroviral therapy, CD4 cell count, and HIV RNA level. We conclude that residence in the 94103 zip code of San Francisco is associated with a substantially lower risk of PCP than residence in other areas of the city.
卡氏肺孢子虫肺炎（PCP）的流行病学及其地理分布尚未完全明确。我们通过一项回顾性病例对照研究，调查了地理位置作为PCP风险因素的影响，该研究对象为在旧金山总医院接受PCP评估的HIV感染者。研究对象为1996年1月至1999年6月间经显微镜确诊为PCP的患者。对照对象有提示PCP的表现，但支气管肺泡灌洗检查未发现卡氏肺孢子虫。通过查阅病历获取研究对象的人口统计学和临床特征以及他们在接受PCP评估时的住址。进行多变量分析以确定与PCP相关的变量。未进行卡氏肺孢子虫预防以及CD4细胞计数≤50个/微升是PCP风险增加的独立预测因素。有趣的是，居住在邮政编码为94103地区的研究对象患PCP的风险显著低于其他地区的研究对象（比值比=0.2，95%置信区间0.1 - 0.6，p<0.01）。尽管对PCP的风险因素如预防措施或抗逆转录病毒疗法的使用、CD4细胞计数和HIV RNA水平进行了控制，但这种效应仍然存在。我们得出结论，与居住在旧金山其他地区相比，居住在旧金山邮政编码为94103地区的居民患PCP的风险要低得多。
