系统性红斑狼疮合并肺孢子菌肺炎患者的预后分析：一项回顾性研究。
Prognostic analysis of concurrent Pneumocystis jirovecii pneumonia in patients with systemic lupus erythematosus: a retrospective study.
机构信息
Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, #1 Shuaifuyuan Street, Dongcheng District, Beijing, 100730, China.
Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, #1 Shuaifuyuan Street, Dongcheng District, Beijing, China.
出版信息
BMC Infect Dis. 2024 Aug 28;24(1):874. doi: 10.1186/s12879-024-09757-4.
BACKGROUND
Systemic lupus erythematosus (SLE) has been less deadly since the advent of corticosteroid-sparing medications. SLE patients still have a higher mortality rate than the general population. Infectious disease is reported as one of the major causes of death in patients with SLE. Although bacteria are the most often isolated pathogens from patients with SLE, Pneumocystis jirovecii pneumonia (PJP) is more deadly than bacterial infection.
METHODS
We retrospectively enrolled consecutive patients with SLE concurrent with PJP (SLE-PJP) in our center between January 2014 and December 2022. The participants were classified into two groups: survivors and non-survivors. Cox regression models and Kaplan‒Meier survival analyses were conducted to explore prognostic factors for survival.
RESULTS
There were 57 patients with SLE (42.0 ± 15.8 years old, 78.9% female) complicated with PJP, 22 (38.6%) of whom died. Compared with the survival group, the non-survival group had more patients with hyperglycemia or diabetes mellitus, invasive ventilation (p < 0.01), respiratory failure, intensive care unit admission, non-invasive ventilation, and hospital-acquired pneumonia (p < 0.05). The non-survival group showed a higher neutrophil percentage, lactate dehydrogenase, D-dimer (p < 0.001), urea, high-sensitivity C-reactive protein (hsCRP), erythrocyte sedimentation rate (ESR), and ferritin (p < 0.05). It also had lower minimal albumin, hemoglobin (p < 0.001), immunoglobulin G, complement 3, peripheral lymphocyte count, platelet, NK cell count, and CD4 T-cell count (p < 0.05). Multivariate analysis indicated that hyperglycemia or diabetes mellitus (HR = 4.25, p < 0.01, 95% CI: 1.51-11.97), thrombocytopenia (HR = 4.22, p < 0.01, 95% CI: 1.63-10.91) and lower complement 3 (C3) (HR = 4.06, p < 0.01, 95% CI: 1.60-10.33) were independent risk factors for the survival of SLE-PJP patients.
CONCLUSIONS
The mortality rate of patients with SLE-PJP is still high. Hyperglycemia, decreased C3, and thrombocytopenia are independent survival risk factors.
背景
自皮质类固醇类药物问世以来，系统性红斑狼疮（SLE）的死亡率有所降低。SLE 患者的死亡率仍高于普通人群。传染病是 SLE 患者死亡的主要原因之一。尽管细菌是从 SLE 患者中分离出的最常见病原体，但卡氏肺孢子虫肺炎（PJP）比细菌感染更致命。
方法
我们回顾性纳入了 2014 年 1 月至 2022 年 12 月期间在我院住院的并发 PJP 的 SLE 患者（SLE-PJP）。将患者分为两组：存活组和死亡组。采用 Cox 回归模型和 Kaplan-Meier 生存分析探讨影响生存的预后因素。
结果
共纳入 57 例 SLE 患者（42.0±15.8 岁，78.9%为女性）并发 PJP，其中 22 例（38.6%）死亡。与存活组相比，死亡组患者中糖尿病或高血糖、有创机械通气（p<0.01）、呼吸衰竭、入住重症监护病房、无创机械通气和医院获得性肺炎（p<0.05）的比例更高。死亡组患者的中性粒细胞百分比、乳酸脱氢酶、D-二聚体（p<0.001）、尿素、高敏 C 反应蛋白（hsCRP）、红细胞沉降率（ESR）和铁蛋白（p<0.05）更高。而白蛋白、血红蛋白（p<0.001）、免疫球蛋白 G、补体 3、外周血淋巴细胞计数、血小板、NK 细胞计数和 CD4 T 细胞计数（p<0.05）更低。多因素分析表明，糖尿病或高血糖（HR=4.25，p<0.01，95%CI：1.51-11.97）、血小板减少症（HR=4.22，p<0.01，95%CI：1.63-10.91）和补体 3（C3）降低（HR=4.06，p<0.01，95%CI：1.60-10.33）是 SLE-PJP 患者生存的独立危险因素。
结论
SLE-PJP 患者的死亡率仍然较高。高血糖、C3 降低和血小板减少症是独立的生存危险因素。
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