间质性肺疾病中肺囊虫肺炎的高患病率：一项回顾性研究。
High prevalence of pneumocystis pneumonia in interstitial lung disease: a retrospective study.
机构信息
Department of Respiratory and Critical Care Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, China.
出版信息
Infection. 2024 Jun;52(3):985-993. doi: 10.1007/s15010-023-02148-y. Epub 2023 Dec 26.
BACKGROUND
Interstitial lung disease (ILD) is a new risk category for pneumocystis pneumonia (PCP) with a high mortality rate. The definite diagnostic criteria of PCP in ILD patients have not been established until now. The aims of this study were to identify potential risk factors of PCP in patients with ILD, and to evaluate the performance of metagenomic next-generation sequencing (mNGS), CD4 + T cell count, (1-3)-β-D-Glucan (BG) and lactate dehydrogenase (LDH) in the diagnosis of PCP in ILD patients.
METHODS
This is a retrospective, single-center, case-control study. ILD patients who underwent mNGS from December 2018 to December 2022 were included in the study. Based on the diagnosis criteria of PCP, these patients were divided into PCP-ILD and non-PCP-ILD groups. The potential risk factors for PCP occurrence in ILD patients were analysed via logistic regression. The diagnostic efficacy of mNGS was compared with serological biomarkers.
RESULTS
92 patients with ILD were enrolled, 31 of which had a definite PCP and were assigned to the PCP-ILD group while 61 were to the non-PCP-ILD group. The infection rate of PJ in ILD patients was 33.7% (31/92). The history of glucocorticoid therapy, CD4 + T cell count, BG level and traction bronchiectasis on HRCT were associated with PCP occurrence in ILD patients. LDH level did not reach statistical significance in the logistic regression analysis. mNGS was confirmed as the most accurate test for PCP diagnosis in ILD patients.
CONCLUSION
ILD is a new risk group of PCP with high PCP prevalence. Clinicians should pay close attention to the occurrence of PCP in ILD patients who possess the risk factors of previous glucocorticoid therapy, decreased CD4 + T cell count, increased BG level and absence of traction bronchiectasis on HRCT. mNGS showed the most excellent performance for PCP diagnosis in ILD patients. Peripheral blood CD4 + T cell count and BG level are alternative diagnostic methods for PCP in ILD patients. However, the diagnostic value of serum LDH level was limited in ILD patients.
背景
间质性肺疾病（ILD）是一种新的卡氏肺孢子菌肺炎（PCP）风险类别，其死亡率较高。ILD 患者的 PCP 明确诊断标准至今尚未确立。本研究旨在确定ILD 患者中 PCP 的潜在危险因素，并评估宏基因组下一代测序（mNGS）、CD4+T 细胞计数、（1-3）-β-D-葡聚糖（BG）和乳酸脱氢酶（LDH）在ILD 患者中诊断 PCP 的性能。
方法
这是一项回顾性、单中心、病例对照研究。纳入 2018 年 12 月至 2022 年 12 月期间接受 mNGS 的 ILD 患者。根据 PCP 的诊断标准，这些患者分为 PCP-ILD 组和非 PCP-ILD 组。通过逻辑回归分析ILD 患者发生 PCP 的潜在危险因素。比较 mNGS 与血清学标志物的诊断效能。
结果
共纳入 92 例 ILD 患者，其中 31 例确诊为 PCP，归为 PCP-ILD 组，61 例归为非 PCP-ILD 组。ILD 患者中 PJ 感染率为 33.7%（31/92）。糖皮质激素治疗史、CD4+T 细胞计数、BG 水平和 HRCT 上的牵引性支气管扩张与 ILD 患者发生 PCP 有关。LDH 水平在逻辑回归分析中无统计学意义。mNGS 被确认为诊断 ILD 患者 PCP 的最准确试验。
结论
ILD 是 PCP 的一个新的高危人群，PCP 发病率较高。临床医生应密切关注具有糖皮质激素治疗史、CD4+T 细胞计数减少、BG 水平升高和 HRCT 上无牵引性支气管扩张等危险因素的 ILD 患者 PCP 的发生。mNGS 对 ILD 患者 PCP 的诊断性能最佳。外周血 CD4+T 细胞计数和 BG 水平是ILD 患者 PCP 的替代诊断方法。然而，血清 LDH 水平在 ILD 患者中的诊断价值有限。
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