艾滋病合并中重度肺孢子菌肺炎患者的激素治疗时长及影响因素分析  

Duration of corticosteroid use in HIV-1-infected pneumocystis pneumonia with moderate and severe disease and its influencing factor analysis

作　　者：李侗曾[1] 牟丹蕾[1] 段忠辉[1] 蔡妙甜[1] 梁连春[1] LI Tong-zeng;MOU Dan-lei;DUAN Zhong-hui;CAI Miao-tian;LIANG Lian-chun(Infectious Diseases Department,Beijing Youan Hospital Affiliated to Capital Medical University,Beijing 100069,China)

机构地区：[1]首都医科大学附属北京佑安医院感染综合科

出　　处：《临床肺科杂志》2019年第9期1582-1586,共5页Journal of Clinical Pulmonary Medicine

基　　金：首都医科大学附属北京佑安医院中青年人才孵育项目(No YNKTTS20180120)

摘　　要：目的观察临床实践中艾滋病合并中重度感染肺孢子菌肺炎(PCP)患者激素应用情况,分析影响激素治疗时长的因素。方法回顾性分析北京佑安医院感染科病房在2010年5月至2017年5月收治的艾滋病合并中重度PCP患者的临床资料,对于重度感染患者,根据患者激素用药时长,将患者分为两组,比较两组患者基线资料。结果共入选179例患者,激素使用中位时间为19天(IQR 18~22天),对于中度感染患者,激素治疗的中位时间为18天(IQR 9~21天);重度感染者激素中位使用时间为23天(IQR 21~25天),其中73.2%(52/71)患者激素治疗时间大于21天,治疗时间>21天患者的P(A-a)O 2、LDH水平显著高于治疗时间<21天患者(P<0.001和P=0.040),且其CD4^+计数(个/μL)相对偏低(P=0.007)。结论艾滋病合并中重度PCP感染患者的激素使用应当个体化,对于重度感染患者可以适当延长激素治疗时间。影响激素治疗时长可能的因素包括P(A-a)O 2、血清CD4水平和CD4^+计数等。Objective To observe the application of corticosteroid in patients with Pneumocystis pneumonia in the clinical practice,and to analyze the factors that affect the length of corticosteroid therapy.Methods The AIDS patients with Pneumocystis jirovecii pneumonia in Beijing Youan Hospital from May 2010 to May 2017 were retrospectively selected.For patients with severe infection,they were divided into two groups according to the length of corticosteroid therapy,and the baseline data of the two groups were compared.Results 179 patients were enrolled in this study,and the length of corticosteroid therapy was a median of 19 days(18~22 days IQR).For moderate infection patients,the median duration of corticosteroid therapy was 18 days(IQR 9~21 days),and the median duration of corticosteroid was 23 days(IQR 21~25 days)for severe infection patients.73.2%(52/71)patients with corticosteroid therapy was more than 21 days,and for more than 21 days in patients with P(A-a)O 2,LDH level was significantly higher than those less than 21~days treatment(P<0.001 and P=0.040),and the count of CD4^+(/μL)was relatively lower(P=0.007).Conclusion The use of corticosteroid for AIDS patients with moderate to severe PCP infection should be individualized,and the time of corticosteroid treatment can be extended in patients with severe infection.The dilration of corticosteroid trealment could be influenced by P(A-a)O 2,serum LDH and CD4^+ count.

关 键 词：艾滋病 肺孢子菌肺炎(PCP) 激素 

分 类 号：R51[医药卫生—内科学]