风湿患者肺孢子菌肺炎的流行病学、死亡率和预防效果：全港研究。

Epidemiology, mortality and effectiveness of prophylaxis for Pneumocystis jiroveci pneumonia among rheumatic patients: a territory-wide study.

机构信息

Division of Rheumatology and Clinical Immunology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.

出版信息

Ann Clin Microbiol Antimicrob. 2021 Nov 11;20(1):78. doi: 10.1186/s12941-021-00483-2.

DOI:10.1186/s12941-021-00483-2

PMID:34763703

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8582139/

Abstract

BACKGROUND

Pneumocystis jiroveci pneumonia (PJP) is an opportunistic infection affecting immunocompromised individuals. However, evidence regarding the burden and effectiveness of prophylaxis among rheumatic patients remains limited. Delineating the epidemiology and efficacy of prophylaxis among rheumatic patients is urgently needed.

METHODS

We performed a territory-wide cohort study of rheumatic patients in Hong Kong. All patients with a diagnosis of anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV), immune-mediated myositis (IMM), rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), systemic sclerosis (SSc), or spondyloarthritis (SpA) between 2015 and 2019 were included. Prevalence, frequency of prophylaxis and mortality of PJP were calculated. Number needed to treat (NNT) analysis was also performed.

RESULTS

Out of 21,587 patients (54% RA, 25% SLE, 13% SpA, 5% IMM, 2% AAV and 1% SSc), 1141 (5.3%) patients were prescribed PJP prophylaxis. 48/21,587 (0.2%) developed PJP. No patients who developed PJP received prophylaxis prior to infection. The incidence of PJP was highest among SSc, AAV, and IMM patients. Among these diseases, the majority of PJP occurred while patients were on glucocorticoids at daily prednisolone-equivalent doses of 15 mg/day (P15) or above. PJP prophylaxis was effective with NNT for SSc, AAV and IIM being 36, 48 and 114 respectively. There were 19 PJP-related mortalities and the mortality rate was 39.6%.

CONCLUSION

PJP is an uncommon but important infection among rheumatic patients, PJP prophylaxis is effective and should be considered in patients with SSc, AAV and IMM, especially those receiving glucocorticoid doses above P15.

摘要

背景

卡氏肺孢子虫肺炎（PJP）是一种影响免疫功能低下个体的机会性感染。然而，风湿患者中预防的负担和效果的证据仍然有限。迫切需要描述风湿患者中预防的流行病学和效果。

方法

我们在香港进行了一项全港范围的风湿患者队列研究。所有在 2015 年至 2019 年期间被诊断为抗中性粒细胞胞浆抗体相关性血管炎（AAV）、免疫介导的肌炎（IMM）、类风湿关节炎（RA）、系统性红斑狼疮（SLE）、系统性硬化症（SSc）或脊柱关节炎（SpA）的患者均被纳入研究。计算了 PJP 的患病率、预防频率和死亡率。还进行了需要治疗的人数（NNT）分析。

结果

在 21587 名患者（54%为 RA、25%为 SLE、13%为 SpA、5%为 IMM、2%为 AAV 和 1%为 SSc）中，有 1141 名（5.3%）患者接受了 PJP 预防治疗。21587 名患者中有 48 名（0.2%）发生了 PJP。感染前没有接受预防治疗的 PJP 患者。SSc、AAV 和 IMM 患者中 PJP 的发生率最高。在这些疾病中，大多数 PJP 发生在患者接受每日泼尼松等效剂量为 15mg/d 或以上的糖皮质激素治疗时。PJP 预防治疗有效，SSc、AAV 和 IIM 的 NNT 分别为 36、48 和 114。有 19 例与 PJP 相关的死亡，死亡率为 39.6%。