Gao Congcong, Wei Gaohui, Zhang Chunyi, Wang Chenqiong, Li Chaoying, Li Ruxu, Su Zhaohui, Zheng Zhaohui
Department of Rheumatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Department of Clinical Laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Front Immunol. 2024 Nov 28;15:1504380. doi: 10.3389/fimmu.2024.1504380. eCollection 2024.
Anti-melanoma differentiation-associated gene 5 antibody-positive dermatomyositis (anti-MDA5+DM) patients are associated with considerable mortality, and opportunistic infections including Pneumocystis jirovecii pneumonia (PJP)is the main cause. This study was to identify clinical characteristics, risk factors, and prognostic factors of PJP diagnosed by bronchoalveolar lavage fluid (BALF) metagenomic next-generation sequencing (mNGS) in anti-MDA5+ DM patients.
In this retrospective observational study, all patients admitted with suspected pneumonia were detected for mNGS in BALF. The demographics, comorbidities, laboratory parameters, and treatments of the patients were compared and analyzed in both groups to identify the potential risk factors for PJP and death via Logistic regression and Cox proportional hazards regression, respectively.
Overall, 92 patients were included in this study, 46(50.0%) were defined as PJP+ group, and the other 46 (50.0%) as PJP- group, and 31(67.4%) PJP occurred in the first 3 months. Increased neutrophil-lymphocyte ratio (NLR) and CRP were independent risk factors for PJP occurrence, while trimethoprim-sulfamethoxazole (TMP/SMZ) prophylaxis was an independent protective factor (all p<0.05). The three-months mortality rate was higher in the PJP+ group compared to PJP- group (43.5% vs 23.9%, p=0.047). Rapidly progressive interstitial lung disease (RPILD) was a main predictor of mortality in anti-MDA5+DM patients with PJP, whereas glucocorticoid use was a significant protective factor.
PJP has high prevalence and mortality in anti-MDA5+DM, while TMP/SMZ prophylaxis significantly reduces PJP risk. Mortality in PJP+ patients is primarily concentrated within the first 3 months, associated with RPILD. Early intervention with corticosteroids and prophylactic measures are crucial in reducing mortality.
抗黑色素瘤分化相关基因5抗体阳性皮肌炎（抗MDA5+DM）患者死亡率较高，包括耶氏肺孢子菌肺炎（PJP）在内的机会性感染是主要原因。本研究旨在确定通过支气管肺泡灌洗（BALF）宏基因组下一代测序（mNGS）诊断的抗MDA5+DM患者中PJP的临床特征、危险因素和预后因素。
在这项回顾性观察研究中，对所有疑似肺炎入院患者的BALF进行mNGS检测。比较和分析两组患者的人口统计学、合并症、实验室参数和治疗情况，分别通过Logistic回归和Cox比例风险回归确定PJP和死亡的潜在危险因素。
本研究共纳入92例患者，46例（50.0%）被定义为PJP+组，另外46例（50.0%）为PJP-组，31例（67.4%）PJP发生在最初3个月内。中性粒细胞与淋巴细胞比值（NLR）和CRP升高是PJP发生的独立危险因素，而甲氧苄啶-磺胺甲恶唑（TMP/SMZ）预防是独立保护因素（均p<0.05）。PJP+组3个月死亡率高于PJP-组（43.5%对23.9%，p=0.047）。快速进展性间质性肺病（RPILD）是抗MDA5+DM合并PJP患者死亡的主要预测因素，而使用糖皮质激素是显著保护因素。
PJP在抗MDA5+DM中患病率和死亡率较高，而TMP/SMZ预防可显著降低PJP风险。PJP+患者的死亡主要集中在最初3个月内，与RPILD有关。早期使用糖皮质激素干预和预防措施对降低死亡率至关重要。
