The First Department of Internal Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan.
Department of Rheumatology, Yokohama Rosai Hospital, Yokohama, Japan.
RMD Open. 2021 Mar;7(1). doi: 10.1136/rmdopen-2020-001508.
To investigate short-term prognosis and prognostic factors for connective tissue disease-associated pneumocystis pneumonia (CTD-PCP) using the Japanese nationwide diagnosis procedure combination (DPC) inpatient database.
The present retrospective cohort study from April 2014 to March 2016 included data of patients with CTD-PCP extracted from the DPC database using the 10 revision of International Classification of Diseases and Injuries codes.
In 15 901 766 cases registered from 1329 hospitals, 333 of 67 890 patients who were admitted with PCP were diagnosed with CTD-PCP and included in the study. The median age was 71.0 years, and 214 (64.3%), 80 (24.0%), and 29 (8.7%) patients received sulfamethoxazole/trimethoprim (ST) monotherapy and pentamidine-containing and atovaquone-containing therapy, respectively. There were 114 (34.2%) in-hospital deaths, and the 30-day and 60-day in-hospital survival rates after PCP treatment initiation were 66.0% and 53.7%, respectively. Older age (HR 1.06, 95% CI 1.03 to 1.08) and concomitant interstitial lung disease (ILD) (HR 1.65, 95% CI 1.12 to 2.42) were poor prognostic factors. Patients who completed PCP treatment with ST monotherapy had a significantly higher survival rate than those treated with those not treated with ST monotherapy (p=0.015; log-rank test). Pentamidine versus atovaquone as second-line therapy was significantly higher with atovaquone (p=0.012; log-rank test).
Older age and concomitant ILD were poor prognostic factors for CTD-PCP. ST was a reasonable first-line therapy in patients with CTD-PCP, and patients with inadequate response to ST treated with atovaquone tended to have a better prognosis than those treated with pentamidine.
利用日本全国诊断程序组合（DPC）住院患者数据库，研究结缔组织病相关卡氏肺孢子菌肺炎（CTD-PCP）的短期预后和预后因素。
本回顾性队列研究于 2014 年 4 月至 2016 年 3 月进行，从 DPC 数据库中使用国际疾病分类第 10 次修订版（ICD-10）代码提取 CTD-PCP 患者的数据。
在来自 1329 家医院的 15901766 例注册病例中，67890 例因肺炎住院的患者中有 333 例被诊断为 CTD-PCP，并纳入本研究。中位年龄为 71.0 岁，214 例（64.3%）、80 例（24.0%）和 29 例（8.7%）患者分别接受磺胺甲噁唑/甲氧苄啶（SMX/TMP）单药治疗、含喷他脒和含阿托伐醌治疗。共有 114 例（34.2%）院内死亡，PCP 治疗开始后 30 天和 60 天的院内生存率分别为 66.0%和 53.7%。年龄较大（HR 1.06，95%CI 1.03-1.08）和并发间质性肺病（ILD）（HR 1.65，95%CI 1.12-2.42）是预后不良的因素。接受 SMX/TMP 单药治疗的患者与未接受 SMX/TMP 单药治疗的患者相比，生存情况显著改善（p=0.015；log-rank 检验）。与喷他脒相比，二线使用阿托伐醌的比例更高（p=0.012；log-rank 检验）。
年龄较大和并发 ILD 是 CTD-PCP 的不良预后因素。SMX/TMP 是 CTD-PCP 患者合理的一线治疗药物，对 SMX/TMP 治疗反应不足的患者使用阿托伐醌治疗，其预后优于使用喷他脒。
