[全身性疾病患者中的肺孢子菌肺炎]

[Pneumocystis pneumonia among patients with systemic diseases].

作者信息

Khellaf Mehdi, Godeau Bertrand

机构信息

Service de Médecine Interne, Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, Université Paris XII, Créteil Cedex, France.

出版信息

Presse Med. 2009 Feb;38(2):251-9. doi: 10.1016/j.lpm.2008.11.004. Epub 2008 Dec 4.

Abstract

The termPneumocystis carinii is now reserved for the animal form of the disease, for humans Pneumocystis jiroveci is appropriated. Incidence of pneumocystis pneumonia (PCP) among patients with systemic rheumatic diseases varies from 0.2% for rheumatoid arthritis to up 12% for Wegener's granulomatosis. Clinical and radiological presentation of pneumocystis pneumonia among non-VIH patients is often difficult to diagnose and the installation can be abrupt. Most of cases of PCP occur during the first 3 months following the beginning of immunosuppressant agents. Mortality during PCP is high with an average of 40% of death, rising 60% in case of mechanical ventilation. Prophylaxis of PCP is needed (without support by randomised studies) for patients with Wegener's granulomatosis, in case of cyclophosphamide or high-dose of methotrexate use except for rheumatoid patients, if a simultaneous treatment by corticosteroids and immunosuppressant agent is required, if a prolonged corticosteroid treatment (> 2 months) is used with dose of prednisone-equivalent > 16mg per day or > 20mg per day > 1month associated with one or more risk factors of PCP among advanced age, denutrition or deep lymphopenia. The best prophylaxis of PCP is cotrimoxazole.

摘要

术语“卡氏肺孢子菌”现仅用于指该疾病在动物中的形式,对于人类则使用“耶氏肺孢子菌”。系统性风湿疾病患者中肺孢子菌肺炎(PCP)的发病率有所不同,类风湿关节炎患者为0.2%,韦格纳肉芽肿患者则高达12%。非艾滋病患者中肺孢子菌肺炎的临床和影像学表现往往难以诊断,病情可能突然发作。大多数PCP病例发生在开始使用免疫抑制剂后的前3个月。PCP期间的死亡率很高,平均死亡率为40%,机械通气情况下死亡率升至60%。对于韦格纳肉芽肿患者,在使用环磷酰胺或高剂量甲氨蝶呤时(类风湿患者除外),如果需要同时使用皮质类固醇和免疫抑制剂,如果使用等效剂量泼尼松>16mg/天或>20mg/天>1个月的长期皮质类固醇治疗且伴有高龄、营养不良或严重淋巴细胞减少等一项或多项PCP危险因素,则需要进行PCP预防(尽管缺乏随机研究支持)。预防PCP的最佳药物是复方新诺明。

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