Department of Respiratory Medicine, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-0052, Japan.
Department of Diagnostic Radiology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan.
BMC Pulm Med. 2019 Feb 21;19(1):47. doi: 10.1186/s12890-019-0813-y.
In patients with non-HIV Pneumocystis jirovecii pneumonia (PjP), computed tomography imaging reveals ground grass opacities (GGO). Previous reports show that some patients with non-HIV PjP exhibit GGO with crazy paving. However, there have been no studies on the association between crazy paving GGO and non-HIV PjP clinical outcomes. Here, at the diagnosis of non-HIV PjP, we reviewed high-resolution computed tomography (HRCT) findings that included GGO types and evaluated the prognostic impact of crazy paving GGO on the clinical outcomes of non-HIV PjP immunocompromised patients.
We retrospectively reviewed the clinical information including the HRCT findings of patients diagnosed with non-HIV PjP from five institutions between 2006 and 2015. The GGO types included those with or without crazy paving. The associations between clinical factors such as HRCT findings and in-hospital mortality were assessed using the Cox regression model.
Sixty-one patients were included in our study. Nineteen patients died at a hospital. All patients exhibited GGO on HRCT imaging at diagnosis of non-HIV PjP. The HRCT findings included crazy paving GGO (29 patients, 47.5%), consolidations (23 patients, 37.7%), bronchiectasis (14 patients, 23.0%), and centrilobular small nodules (30 patients, 49.2%). Cysts were not observed in any patient. Multivariate analysis revealed that crazy paving GGO and low serum albumin levels were independent risk factors for mortality.
At the diagnosis of non-HIV PjP, patients with crazy paving GGO on HRCT imaging and low serum albumin levels may have a poor prognosis.
在非 HIV 肺孢子菌肺炎（PjP）患者中，计算机断层扫描（CT）成像显示磨玻璃影（GGO）。先前的报告显示，一些非 HIV PjP 患者的 GGO 表现为铺路石征。然而，目前还没有关于铺路石征 GGO 与非 HIV PjP 临床结局之间关联的研究。在这里，在诊断非 HIV PjP 时，我们回顾了高分辨率 CT（HRCT）发现，包括 GGO 类型，并评估了铺路石征 GGO 对非 HIV PjP 免疫功能低下患者临床结局的预后影响。
我们回顾性分析了 2006 年至 2015 年间五家机构诊断为非 HIV PjP 的患者的临床信息，包括 HRCT 发现。GGO 类型包括有无铺路石征。使用 Cox 回归模型评估 HRCT 发现等临床因素与住院死亡率之间的关联。
本研究共纳入 61 例患者。19 例患者在医院死亡。所有患者在诊断为非 HIV PjP 时的 HRCT 影像上均显示 GGO。HRCT 发现包括铺路石征 GGO（29 例，47.5%）、实变（23 例，37.7%）、支气管扩张（14 例，23.0%）和小叶中心小结节（30 例，49.2%）。没有患者观察到囊肿。多变量分析显示，铺路石征 GGO 和低血清白蛋白水平是非死亡的独立危险因素。
在诊断非 HIV PjP 时，HRCT 成像上出现铺路石征 GGO 和低血清白蛋白水平的患者可能预后不良。
