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作 者:朱睿瑶[1] 喻淑慧 王璐[2] 邱涛[3] 全飞[4] 邵勉 邹捍东[2] 詹丽英[1,2] ZHU Ruiyao;YU Shuhui;WANG Lu;QIU Tao;QUAN Fei;SHAO Mian;ZOU Handong;ZHAN Liying(Infection Prevention and Control Office,Wuhan 430060,Hubei,China;Dept.of Critical Care Medicine,Wuhan 430060,Hubei,China;Dept.of Organ Transplantation,Wuhan 430060,Hubei,China;Information Center,Renmin Hospital of Wuhan University,Wuhan 430060,Hubei,China;Dept.of Emergency Medicine,Zhongshan Hospital,Fudan University,Shanghai 200032,China)
机构地区:[1]武汉大学人民医院感染预防与控制办公室,湖北武汉430060 [2]武汉大学人民医院重症医学科,湖北武汉430060 [3]武汉大学人民医院器官移植科,湖北武汉430060 [4]武汉大学人民医院信息中心,湖北武汉430060 [5]复旦大学中山医院急诊科,上海200032
出 处:《武汉大学学报(医学版)》2023年第11期1325-1329,共5页Medical Journal of Wuhan University
基 金:国家重点研发计划项目(编号:2021YFC2501800)。
摘 要:目的:探讨耶氏肺孢子菌肺炎(PJP)患者合并急性呼吸窘迫综合征(ARDS)的病因及危险因素。方法:对2019年12月至2022年3月收治入院的91例免疫受损合并ARDS患者进行回顾性分析,根据有无合并耶氏肺孢子菌感染的生物学证据分为PJP组(52例)和非PJP组(39例),比较两组间患者病因分类、临床特征及相关危险因素。结果:(1)免疫受损患者合并ARDS平均年龄在(53.0±15.0)岁,以男性为主(75.8%),大多数患者有发热(40.7%)和咳嗽(41.8%)症状,其中PJP组患者出现干咳(46.2%)、活动后气促(59.6%)的比例更高;(2)PJP组1,3-β-D-葡聚糖水平、CD3^(+)和CD8^(+)T细胞计数高于非PJP组,差异有统计学意义;(3)1,3-β-D-葡聚糖、CD3^(+)、CD4^(+)、CD8^(+)T细胞、WBC均为免疫受损患者合并ARDS的独立危险因素,其中CD8^(+)T细胞最高(OR=1.04,95%CI:1.01~1.06)。结论:耶氏肺孢子菌肺炎患者合并ARDS大多伴有发热和咳嗽症状,以干咳为主,PJP患者合并真菌感染机会较高,CD8^(+)T细胞是影响免疫受损患者合并ARDS的重要危险因素。Objective:To investigate the etiology and risk factor analysis of combined acute respiratory dis⁃tress syndrome(ARDS)in Pneumocystis jiroveci pneumonia(PJP)patients.Methods:A retrospective analysis was performed on 91 immunocompromised patients combined with ARDS from December 2019 to March 2022,the patients were divided into the PJP group(52 cases)and the non⁃PJP group(39 cases)according to the biological evidence of Pneumocystis jiroveci infection or not,and the etiological classification,clinical characteristics and related risk factors of the patients were compared be⁃tween the two groups.Results:①The mean age of immunocompromised patients with combined AR⁃DS was(53.0±15.0)years,and most patients were predominantly male(75.8%)and had fever(40.7%)and cough(41.8%),with a higher proportion of dry cough(46.2%)and shortness of breath after activity(59.6%)in the PJP group;②The levels of 1,3⁃beta⁃D⁃glucan,CD3^(+)T cells,and CD8^(+)T cells were higher in the PJP group than in the non⁃PJP group,and the differences were statis⁃tically significant;③The independent risk factors for immunocompromised patients combined with ARDS included 1,3⁃β⁃D⁃glucan,CD3^(+),CD4^(+),CD8^(+)T cells,and WBC,and the CD8^(+)T indicator was the most significant risk factor(OR=1.04,95%CI:1.01⁃1.06).Conclusion:Most PJP patients with ARDS are accompanied by fever and cough,mainly dry cough,with a higher risk of fungal infec⁃tion.CD8^(+)T cell count is an important risk factor for immunocompromised patients combined with ARDS.
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