Travis J, Hart E, Helm J, Duncan T, Vilar J
Department of Infectious Diseases, The Monsall Unit, North Manchester General Hospital, Manchester, UK.
Int J STD AIDS. 2009 Mar;20(3):200-1. doi: 10.1258/ijsa.2008.008198.
The aim of the study was to compare a retrospective case note review of all cases of Pneumocystis carinii (now Pneumocystis jirovecii) pneumonia (PJP) over the period 1997-2004 at North Manchester General Hospital with a previous audit covering the years 1986-1995. During 1986-1995, 777 patients were diagnosed with HIV. One hundred and eighty-one were also diagnosed with PJP. Of these, 11 patients required ventilation with a mortality rate of 100%. For the current review during 1997-2004, 210 patients were diagnosed with PJP, and 64 with severe PJP. Median age was 39 years (interquartile range [IQR] 22-61). Twenty-four patients had a prior diagnosis of HIV (median 43 months, IQR 6-72 months), and for 38 patients this was the presenting diagnosis of HIV. Median CD4 was 34 cells/L (IQR of 12-80 cells/L). Median viral load was 3.5 x 10(5) copies/mL (IQR 1-5.8 x 10(5) copies/mL). Eighteen patients required intubation during this period. Nine (50%) were alive at 30 days postextubation. We believe that the 50% reduction in mortality seen between 1997-2004 in intubated patients with severe PJP is due to the improvement in intensive care management of severe respiratory failure rather than changes in the specific management of PJP. The necessity of ventilation in HIV patients is no longer a mandatory death sentence.
该研究的目的是将1997 - 2004年期间在北曼彻斯特综合医院对所有卡氏肺孢子菌（现称耶氏肺孢子菌）肺炎（PJP）病例进行的回顾性病例记录审查，与之前涵盖1986 - 1995年的审计进行比较。在1986 - 1995年期间，777名患者被诊断出感染艾滋病毒。其中181人也被诊断出患有PJP。在这些患者中，11名患者需要通气，死亡率为100%。对于1997 - 2004年期间的本次审查，210名患者被诊断出患有PJP，64名患有严重PJP。中位年龄为39岁（四分位间距[IQR]为22 - 61岁）。24名患者先前被诊断出感染艾滋病毒（中位时间为43个月，IQR为6 - 72个月），38名患者以此作为艾滋病毒的初发诊断。中位CD4细胞计数为34个/微升（IQR为12 - 80个/微升）。中位病毒载量为3.5×10⁵拷贝/毫升（IQR为1 - 5.8×10⁵拷贝/毫升）。在此期间，18名患者需要插管。9名（50%）患者在拔管后30天仍存活。我们认为，1997 - 2004年期间，插管的严重PJP患者死亡率降低50%，是由于对严重呼吸衰竭的重症监护管理得到改善，而非PJP具体治疗方法的改变。艾滋病毒患者进行通气已不再是必死无疑的判决。
