Department of Clinical Infectious Diseases, Aichi Medical University, Nagakute, Aichi, Japan; Department of Pathology, University of Michigan, Ann Arbor, MI, 48109, USA.
Department of Rheumatology & Allergy, Shonan Fujisawa Tokushukai Hospital, Fujisawa, Kanagawa, Japan.
Respir Investig. 2022 Jul;60(4):522-530. doi: 10.1016/j.resinv.2022.04.002. Epub 2022 Apr 29.
While Pneumocystis jirovecii pneumonia (PCP) can occur in immunocompromised patients with HIV infection, the prognosis of non-HIV PCP is still poor, showing a high mortality rate of 30%-75%. The pathophysiological mechanism of non-HIV PCP is quite different from that of HIV-PCP. Aging, underlying disease, dysbiotic gut microbiome, and Th1 predominance, leads to macrophagic polarization shifting from M2 to M1. These cause dysregulation in the host immunity against P. jirovecii, resulting in severe lung injury and a high mortality rate among non-HIV PCP patients. This review describes poor prognostic factors, an issue of predictive values used for general pneumonia practice, and new aspects, including the dysbiosis of the gut microbiome and macrophagic polarization in the treatment of non-HIV PCP.
虽然卡氏肺孢子虫肺炎（PCP）可发生于 HIV 感染的免疫功能低下患者，但非 HIV 相关 PCP 的预后仍较差，死亡率高达 30%-75%。非 HIV 相关 PCP 的病理生理学机制与 HIV-PCP 有很大不同。衰老、基础疾病、肠道微生物群失调和 Th1 优势导致巨噬细胞极化从 M2 向 M1 转移。这导致宿主对卡氏肺孢子虫的免疫失调，导致非 HIV 相关 PCP 患者发生严重的肺部损伤和高死亡率。本综述描述了非 HIV 相关 PCP 的不良预后因素，包括一般肺炎临床实践中预测值的问题，以及包括肠道微生物群失调和巨噬细胞极化在内的新方面。
