Internal Medicine Department, Claude Huriez Hospital, Lille 59000, France.
Rheumatology (Oxford). 2011 Mar;50(3):569-77. doi: 10.1093/rheumatology/keq314. Epub 2010 Nov 18.
To determine the rate and identify risk factors of Pneumocystis jirovecii (P. jirovecii) colonization among patients with systemic autoimmune diseases.
We conducted an observational study in patients with systemic autoimmune diseases in an internal medicine department. Each week, five patients with systemic diseases were randomly selected for colonization screening. Patients complaining of recent respiratory symptoms were excluded. P. jirovecii PCR was performed on induced sputum samples. Univariate and multivariate logistic regression analyses of clinical and biological data were performed to determine predictors of Pneumocystis colonization. Pneumocystis pneumonia occurrence in P. jirovecii-positive PCR patients was recorded during a 1-year follow-up.
P. jirovecii was detected in 11/67 (16%) subjects. Comparing the features in P. jirovecii-positive and P. jirovecii-negative PCR patients, only male gender was significantly associated with Pneumocystis colonization. In multivariate analysis with regard to gender, the higher prevalence of P. jirovecii colonization in men was largely explained by higher daily CSs [odds ratio (OR) = 1.6; 95% CI 1.1, 2.3] and lower total lymphocyte level (OR = 0.9; 95% CI 0.8, 0.99). No P. jirovecii-positive PCR patient developed Pneumocystis pneumonia during the 1-year follow-up, but corticosteroid amounts were significantly lower at the end of follow-up than on inclusion.
This is the first study on P. jirovecii colonization in patients with systemic autoimmune diseases. We found a high prevalence of colonization and identified CS therapy and lymphocyte counts as risk factors for colonization. We recommend screening for P. jirovecii colonization in patients with systemic autoimmune diseases receiving immunosuppressant treatment. Further studies are needed to determine the role of subclinical colonization in disease transmission and the persistence of Pneumocystis colonization.
确定系统性自身免疫性疾病患者中肺孢子菌（P. jirovecii）定植的发生率并识别其相关危险因素。
我们在一个内科部门进行了一项针对系统性自身免疫性疾病患者的观察性研究。每周，随机选择五例患有系统性疾病的患者进行定植筛查。排除近期有呼吸道症状的患者。对诱导痰样本进行 P. jirovecii PCR。对临床和生物学数据进行单变量和多变量逻辑回归分析，以确定肺孢子菌定植的预测因素。在 1 年的随访期间，记录 P. jirovecii-PCR 阳性患者中发生的肺孢子菌肺炎。
在 67 例患者中检测到 11 例（16%）P. jirovecii。比较 P. jirovecii-PCR 阳性和 P. jirovecii-PCR 阴性患者的特征，仅男性与肺孢子菌定植显著相关。在考虑性别因素的多变量分析中，男性中 P. jirovecii 定植的更高发生率在很大程度上可以用更高的每日皮质类固醇剂量（比值比[OR] = 1.6；95%可信区间 1.1, 2.3）和更低的总淋巴细胞计数（OR = 0.9；95%可信区间 0.8, 0.99）来解释。在 1 年的随访期间，没有 P. jirovecii-PCR 阳性患者发生肺孢子菌肺炎，但在随访结束时皮质类固醇剂量明显低于纳入时。
这是第一项关于系统性自身免疫性疾病患者肺孢子菌定植的研究。我们发现了定植的高发生率，并确定了皮质类固醇治疗和淋巴细胞计数是定植的危险因素。我们建议对接受免疫抑制治疗的系统性自身免疫性疾病患者进行肺孢子菌定植筛查。需要进一步研究以确定亚临床定植在疾病传播和肺孢子菌定植持续存在中的作用。
