肺孢子菌肺炎在 AIRD 患者中的特征及相关危险因素：一项回顾性研究。

Characterization and associated risk factors of Pneumocystis jirovecii pneumonia in patients with AIRD: a retrospective study.

机构信息

Department of Rheumatology and Immunology, Tongji Hospital, Tongji Medical College Huazhong University of Science and Technology, Wuhan, China.

出版信息

Rheumatology (Oxford). 2022 Aug 30;61(9):3766-3776. doi: 10.1093/rheumatology/keab941.

DOI:10.1093/rheumatology/keab941

PMID:34962999

Abstract

OBJECTIVES

To explore clinical features of autoimmune inflammatory rheumatic disease (AIRD) patients with Pneumocystis jirovecii pneumonia (PJP) and identify potential risk factors and prognostic factors.

METHODS

AIRD patients who had respiratory symptoms and underwent P. jirovecii detection were identified from the database in our department from November 2018 to October 2020. These patients were categorized into PJP and non-PJP groups according to the diagnostic criteria of PJP. Univariate and multivariate analyses were conducted.

RESULTS

A total of 173 patients were enrolled and 46 of them had laboratory-confirmed PJP. Glucocorticoid increased the risk of PJP in a dose-dependent manner. In addition, shorter duration of immunosuppressive therapy (IST), combination therapy with CSA and chronic pulmonary comorbidities were also strongly associated with a higher risk of PJP. Combination of IgM and IgA could well identify AIRD patients with PJP from other AIRD patients with respiratory symptoms, with the optimal cut-off value of -0.96 g/l. Seven of 46 AIRD patients with PJP died (15.2%). A higher level of serum LDH, dyspnoea and ARDS, and the presence of extensive ground glass opacity (GGO) in radiologic examinations were more common in deceased patients.

CONCLUSIONS

AIRD patients with high-dose glucocorticoid treatment, recent initiation of IST, combination therapy with CSA and history of chronic pulmonary diseases had a greater risk of PJP infection. PJP patients with a higher level of serum LDH, dyspnoea, moderate and severe ARDS, and the presence of extensive GGO in radiologic examinations had poorer prognosis.

TRIAL REGISTRATION

Chinese Clinical Trial Register; https://www.chictr.org.cn/; ChiCTR2100044095.

摘要

目的

探讨肺孢子菌肺炎（PJP）的自身免疫性炎症性风湿病（AIRD）患者的临床特征，并确定潜在的风险因素和预后因素。

方法

从 2018 年 11 月至 2020 年 10 月，从我科数据库中筛选出出现呼吸系统症状并进行肺孢子菌检测的 AIRD 患者，根据 PJP 的诊断标准将这些患者分为 PJP 组和非 PJP 组。进行单因素和多因素分析。

结果

共纳入 173 例患者，其中 46 例实验室确诊为 PJP。糖皮质激素呈剂量依赖性增加 PJP 的风险。此外，较短的免疫抑制治疗（IST）持续时间、CSA 联合治疗和慢性肺部合并症也与 PJP 的高风险密切相关。IgM 和 IgA 的联合检测可以很好地将有呼吸系统症状的 AIRD 患者与其他 AIRD 患者区分开来，最佳截断值为-0.96g/l。46 例 PJP 的 AIRD 患者中有 7 例死亡（15.2%）。死亡患者的血清 LDH 水平较高、呼吸困难和 ARDS 程度较重、影像学检查中广泛磨玻璃影（GGO）的存在更为常见。