Ando Taiki, Abe Yoshiyuki, Endo Yukari, Tada Kurisu, Yamaji Ken, Tamura Naoto
a Department of Internal Medicine and Rheumatology , Juntendo University School of Medicine , Tokyo , Japan.
Mod Rheumatol. 2019 Jul;29(4):656-661. doi: 10.1080/14397595.2018.1496873. Epub 2018 Aug 13.
Pneumocystis pneumonia (PCP) is a serious complication in patients with rheumatic diseases who are receiving immunosuppressive therapy. These patients have a higher mortality from PCP than those with human immunodeficiency virus. We examined factors associated with poor prognosis in patients with rheumatic diseases and evaluated PCP treatment in this population. This retrospective, single-center, observational cohort study included 31 patients with rheumatic diseases who were admitted to Juntendo University Hospital for PCP treatment from June 2006 to December 2017. The primary outcome was non-disease-specific mortality at discharge. The median age at PCP diagnosis was 64 years. The survival rate was 61.3% (19/31). Twelve patients died, in all cases due to respiratory failure due to PCP. Among variables at PCP diagnosis and those related to PCP treatment, the presence of coexisting pulmonary diseases and greater glucocorticoid dose at PCP diagnosis were associated with higher mortality. The mortality related to biological agents for PCP was low. Rapid tapering of glucocorticoids improved survivability. In the treatment of PCP in patients with rheumatic diseases, rapid tapering of glucocorticoids was associated with a higher survival rate than the use of conventional therapy.
肺孢子菌肺炎（PCP）是接受免疫抑制治疗的风湿性疾病患者的一种严重并发症。这些患者因PCP导致的死亡率高于感染人类免疫缺陷病毒的患者。我们研究了风湿性疾病患者预后不良的相关因素，并评估了该人群的PCP治疗情况。这项回顾性、单中心、观察性队列研究纳入了2006年6月至2017年12月期间因PCP治疗入住顺天堂大学医院的31例风湿性疾病患者。主要结局是出院时非疾病特异性死亡率。PCP诊断时的中位年龄为64岁。生存率为61.3%（19/31）。12例患者死亡，均死于PCP所致呼吸衰竭。在PCP诊断时的变量以及与PCP治疗相关的变量中，合并肺部疾病的存在以及PCP诊断时更高的糖皮质激素剂量与更高的死亡率相关。PCP生物制剂相关的死亡率较低。糖皮质激素快速减量可提高生存率。在风湿性疾病患者的PCP治疗中，糖皮质激素快速减量比使用传统疗法的生存率更高。
