Chen Minjiang, Tian Xinlun, Qin Fang, Zhou Jiong, Liu Jinjing, Wang Mengzhao, Xu Kai-Feng
Department of Respiratory Medicine, Peking Union Medical College Hospital, Beijing, China.
Department of Respiratory Medicine, China Meitan General Hospital, Beijing, China.
PLoS One. 2015 Sep 30;10(9):e0139144. doi: 10.1371/journal.pone.0139144. eCollection 2015.
With the increasing use of immunosuppressive agents, the number of opportunistic infections has risen in patients with autoimmune diseases. Pneumocystis pneumonia (PCP) is one of these opportunistic infections that have a high mortality rate. However, only a few studies have described PCP in these patients, and these studies are limited in scope. We conducted this retrospective study to describe the clinical characteristics and factors associated with outcomes of PCP in patients with autoimmune diseases.
A retrospective study was performed in laboratory diagnosed PCP patients with autoimmune diseases in an academic hospital over a 10-year period. Patients with human immunodeficiency virus (HIV) infection were not included. Clinical characteristics were collected and the factors related to death were analysed.
A total of 69 patients with PCP during the study period were included. Common clinical features included fever (81%), cough (56%), and dyspnea (35%). Ground glass opacity (81%) and reticulation (52%) were the most common radiological findings. Concurrent pulmonary infections including bacterium, aspergillus and cytomegalovirus were found in 34% of the patients. The overall in-hospital mortality rate was 32%. High mortality was associated with lower PaO2/FiO2 ratios and albumin levels. The lymphocyte count, CD4+ T cell count, previous usage of immunosuppressive agents, the duration and dose of glucocorticoids did not affect the outcome.
The mortality rate in PCP patients with autoimmune diseases is high. Low PaO2/FiO2 ratios and albumin levels are independent prognostic factors of mortality.
随着免疫抑制剂使用的增加，自身免疫性疾病患者的机会性感染数量有所上升。肺孢子菌肺炎（PCP）是这些机会性感染之一，死亡率很高。然而，仅有少数研究描述了这些患者中的PCP情况，且这些研究范围有限。我们开展这项回顾性研究以描述自身免疫性疾病患者中PCP的临床特征及与预后相关的因素。
对一家学术医院10年间实验室诊断为PCP的自身免疫性疾病患者进行回顾性研究。不包括人类免疫缺陷病毒（HIV）感染患者。收集临床特征并分析与死亡相关的因素。
研究期间共纳入69例PCP患者。常见临床特征包括发热（81%）、咳嗽（56%）和呼吸困难（35%）。磨玻璃影（81%）和网状影（52%）是最常见的影像学表现。34%的患者并发肺部感染，包括细菌、曲霉和巨细胞病毒感染。总体院内死亡率为32%。高死亡率与较低的PaO2/FiO2比值和白蛋白水平相关。淋巴细胞计数、CD4+T细胞计数、既往免疫抑制剂使用情况、糖皮质激素的使用时长和剂量均不影响预后。
自身免疫性疾病合并PCP患者的死亡率较高。低PaO2/FiO2比值和白蛋白水平是死亡率的独立预后因素。
