Lundgren J D, Barton S E, Katlama C, Ledergerber B, González-Lahoz J, Pinching A J, Proenca R, Hemmer R, Pedersen C, Phillips A N
Hvidovre (Denmark) Hospital, University of Copenhagen.
Arch Intern Med. 1995 Apr 24;155(8):822-8.
Factors associated with improved survival over time for patients with the acquired immunodeficiency syndrome (AIDS) who have Pneumocystis carinii pneumonia at diagnosis are not clearly defined.
An inception cohort of 2533 patients with AIDS, diagnosed from 1979 to 1989, from 52 centers in 17 European countries was studied. Survival 3 months and 3 years after diagnosis was estimated by Kaplan-Meier life tables. Independent predictors of survival were analyzed by construction of Cox proportional hazards models.
Patients in whom AIDS and P carinii pneumonia had been diagnosed before 1988 had a poorer 3-month (ie, short-term) survival, whereas the survival 1 and 2 years after P carinii pneumonia was lower only for patients whose disease was diagnosed before 1987 compared with those with more recent diagnoses. Other variables associated with poorer outcome were greater age, infection via blood transfusion, diagnosis made in south Europe, and coexisting illnesses. After controlling for these prognostic markers in multivariate analysis, improvement in survival over time was still evident. For patients who survived the P carinii pneumonia episode, both zidovudine and secondary prophylaxis for P carinii pneumonia initiated around the time of diagnosis were associated with improved survival, and, after controlling for these treatment variables, no statistically significant improvement in survival over time was observed.
Survival after an episode of P carinii pneumonia has improved within recent years. Increased awareness of early symptoms of P carinii pneumonia and better treatment of the pneumonia may have led to improvement in short-term survival over time, whereas the introduction of zidovudine and increased use of secondary P carinii pneumonia prophylaxis may have resulted in the recent increase in survival 1 and 2 years after the diagnosis. However, 3-year survival remained unchanged over time, implying that the underlying human immunodeficiency virus infection and other complications are not effectively controlled.
对于诊断时患有卡氏肺孢子虫肺炎的获得性免疫缺陷综合征（AIDS）患者，随着时间推移生存率提高相关的因素尚未明确界定。
对1979年至1989年期间来自欧洲17个国家52个中心的2533例AIDS患者的起始队列进行研究。通过Kaplan-Meier生存表估计诊断后3个月和3年的生存率。通过构建Cox比例风险模型分析生存的独立预测因素。
1988年前诊断为AIDS和卡氏肺孢子虫肺炎的患者3个月（即短期）生存率较差，而与近期诊断的患者相比，仅1987年前诊断疾病的患者在卡氏肺孢子虫肺炎后1年和2年的生存率较低。与预后较差相关的其他变量包括年龄较大、通过输血感染、在南欧诊断以及并存疾病。在多变量分析中控制这些预后标志物后，随着时间推移生存率的改善仍然明显。对于在卡氏肺孢子虫肺炎发作后存活的患者，诊断时开始使用齐多夫定和卡氏肺孢子虫肺炎的二级预防均与生存率提高相关，并且在控制这些治疗变量后，未观察到随着时间推移生存率有统计学上的显著改善。
近年来卡氏肺孢子虫肺炎发作后的生存率有所提高。对卡氏肺孢子虫肺炎早期症状的认识提高以及对肺炎的更好治疗可能导致短期生存率随着时间推移有所改善，而齐多夫定的引入和卡氏肺孢子虫肺炎二级预防的使用增加可能导致诊断后1年和2年生存率近期有所提高。然而，3年生存率随时间保持不变，这意味着潜在的人类免疫缺陷病毒感染和其他并发症未得到有效控制。
