Liu Yang, Zheng Ke, Liu Yecheng, Zhu Huadong
Department of Emergency Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
Department of Nephrology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
Can J Infect Dis Med Microbiol. 2020 Feb 20;2020:4631297. doi: 10.1155/2020/4631297. eCollection 2020.
With immunosuppressants being widely used, pneumonia (PCP) has been increasing and could be life-threatening among HIV-negative patients. This study aimed at identifying prognostic factors of PCP in patients with nephrotic syndrome.
We retrospectively investigated patients with nephrotic syndrome who were diagnosed with PCP. The diagnosis of PCP was based on clinical manifestations, radiological findings, and microbiological confirmatory tests. Predictors of outcome were determined with multivariate logistic regression analysis.
A total of 57 patients were included in this study. The PCP mortality was 33.3%, which increased to 48.6% if ICU admission was required and to 60% when mechanical ventilation was needed. The T lymphocyte count and CD4/CD8 ratio independently predicted the outcome of PCP, so did the CD4 T lymphocyte count (OR, 0.981; 95% CI, 0.967-0.996; =0.001). The cut-off value of 71 cells/l for the CD4 T lymphocyte count was determined to identify patients with poor prognosis. No association was found between PCP mortality and the type of immunosuppressant used.
PCP is a fatal complication among nephrotic syndrome patients receiving immunosuppressive therapy. The CD4 T lymphocyte count is suggested as an independent predictor of prognosis, which can be used clinically to identify patients with high risk of unfavorable outcomes.
随着免疫抑制剂的广泛应用，肺炎（肺孢子菌肺炎，PCP）的发病率不断上升，且在HIV阴性患者中可能危及生命。本研究旨在确定肾病综合征患者PCP的预后因素。
我们回顾性调查了诊断为PCP的肾病综合征患者。PCP的诊断基于临床表现、影像学检查结果和微生物学确诊试验。通过多因素逻辑回归分析确定预后的预测因素。
本研究共纳入57例患者。PCP的死亡率为33.3%，如果需要入住重症监护病房（ICU），死亡率升至48.6%，如需机械通气则升至60%。T淋巴细胞计数和CD4/CD8比值可独立预测PCP的预后，CD4 T淋巴细胞计数也是如此（比值比，0.981；95%可信区间，0.967 - 0.996；P = 0.001）。确定CD4 T淋巴细胞计数的临界值为71个细胞/微升，以识别预后不良的患者。未发现PCP死亡率与所用免疫抑制剂类型之间存在关联。
PCP是接受免疫抑制治疗的肾病综合征患者的致命并发症。建议将CD4 T淋巴细胞计数作为预后的独立预测指标，可在临床上用于识别预后不良风险高的患者。
