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耶氏肺孢子菌肺炎与炎症性肠病:何时应考虑预防?

Pneumocystis jiroveci pneumonia in inflammatory bowel disease: when should prophylaxis be considered?

机构信息

Section of Gastroenterology, Boston Medical Center, Boston, MA, USA.

出版信息

Inflamm Bowel Dis. 2013 Jul;19(8):1764-71. doi: 10.1097/MIB.0b013e318281f562.

Abstract

BACKGROUND

The incidence of inflammatory bowel disease (IBD) has increased over the past several decades with a corresponding increase in the number of patients on combination immunosuppressive therapy including corticosteroids, anti-metabolites and biologic agents. The exact incidence of pneumocystis jiroveci pneumonia (PJP) in IBD patients is unknown but there has been an increase in the number of reports of PJP in IBD patients on combination immunosuppressive therapy.

METHODS

We evaluated the published literature describing PJP infections in IBD patients, as well as other non-HIV cohorts and identified risk factors for PJP infection in this group of patients. Prophylaxis and treatment regimens were reviewed.

RESULTS

Corticosteroid therapy, lymphopenia (total lymphocyte count < 600 cells/mm), and age greater than 55 years appear to be risk factors for developing pneumocystis jiroveci pneumonia. In addition, PJP mortality is greater in the non-HIV cohort in contrast to the HIV population. No evidence-based guidelines for primary PJP prophylaxis exist to direct practice for gastroenterology providers.

CONCLUSIONS

Better surveillance and reporting of opportunistic infections including PJP are needed to elucidate risk factors for acquisition of infection. Gastroenterology providers should continue to evaluate the need for PJP prophylaxis on a case-by-case basis to recognize patients who may benefit from primary PJP prophylaxis. In particular, older patients on corticosteroids, multiple immunosuppressive agents, and patients with lymphopenia should be considered for prophylaxis.

摘要

背景

在过去几十年中,炎症性肠病(IBD)的发病率有所增加,接受包括皮质类固醇、抗代谢物和生物制剂在内的联合免疫抑制治疗的患者数量也相应增加。IBD 患者中肺囊虫肺炎(PJP)的确切发病率尚不清楚,但接受联合免疫抑制治疗的 IBD 患者中 PJP 病例报告数量有所增加。

方法

我们评估了描述 IBD 患者中 PJP 感染的已发表文献,以及其他非 HIV 队列,并确定了该组患者中发生 PJP 感染的危险因素。审查了预防和治疗方案。

结果

皮质类固醇治疗、淋巴细胞减少症(总淋巴细胞计数<600 细胞/mm)和年龄大于 55 岁似乎是发生肺囊虫肺炎的危险因素。此外,与 HIV 人群相比,非 HIV 队列中的 PJP 死亡率更高。目前尚无针对初级 PJP 预防的循证指南来指导胃肠病学提供者的实践。

结论

需要更好地监测和报告包括 PJP 在内的机会性感染,以阐明感染获得的危险因素。胃肠病学提供者应继续根据具体情况评估 PJP 预防的必要性,以识别可能受益于初级 PJP 预防的患者。特别是,应考虑对接受皮质类固醇、多种免疫抑制剂治疗且淋巴细胞减少症的老年患者进行预防。

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