肺泡蛋白沉积症患者肺孢子菌定植的临床分析  

Pneumocystis jirovecii colonization in patients with pulmonary alveolar proteinosis

作　　者：赵婷婷[1] 李燕[1] 马苗[1] 高玉娟[1] 石沈云 曹孟淑[1] 辛小燕 肖永龙[1] 苏欣 ZHAO Tingting;LI Yan;MA Miao;GAO Yujuan;SHI Shenyun;CAO Mengshu;XIN Xiaoyan;XIAO Yonglong;SU Xin(Department of Respiratory and Critical Care Medicine,Nanjing Drum Tower Hospital,The Affiliated Hospital of Nanjing University Medical School,Nanjing,Jiangsu 210008,P.R.China;Department of Radiology,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing,Jiangsu 210008,P.R.China)

机构地区：[1]南京大学医学院附属鼓楼医院呼吸与危重症医学科,江苏南京210008 [2]南京大学医学院附属鼓楼医学影像科,江苏南京210008

出　　处：《中国呼吸与危重监护杂志》2023年第8期572-577,共6页Chinese Journal of Respiratory and Critical Care Medicine

基　　金：国家自然科学基金面上项目(82070011)。

摘　　要：目的探讨肺泡蛋白沉积症(pulmonary alveolar proteinosis,PAP)患者中耶氏肺孢子菌(Pneumocystis jirovecii,P.jirovecii)的定植情况、危险因素及其对预后的影响。方法回顾性分析2019年3月—2022年12月在南京鼓楼医院呼吸与危重症医学科住院的PAP患者,收集其临床表现、实验室检查、影像学特点、治疗和转归等临床数据,应用聚合酶链反应或宏基因组二代测序法检测灌洗液中肺孢子菌的定植情况,探讨PAP患者中肺孢子菌的定植率、危险因素及转归。结果共25例患者纳入研究,其中有肺孢子菌定植者7例,定植率28.0%;定植组入院前抗菌药物使用率明显高于非定植组(85.7%比33.3%,P=0.030);定植组入院时血淋巴细胞总数(1.4×10^(9)/L比1.8×10^(9)/L,P=0.048)、CD3^(+)T细胞(0.83×10^(9)/L比1.34×10^(9)/L,P=0.010)、CD4~^(+)T细胞(0.48×10^(9)/L比0.85×10^(9)/L,P=0.010)均明显低于非定植组;乳酸脱氢酶(469.9U/L比277.3U/L,P=0.005)明显高于非定植组;定植组需要联合治疗(需要两种及以上治疗PAP的方法)的比例更高(57.1%比11.1%,P=0.032);但在病变范围、肺功能、氧和及转归方面无明显差异。乳酸脱氢酶与PAP的病变范围呈正相关,与氧合指数、用力肺活量、弥散量呈负相关。结论PAP患者的耶氏肺孢子菌定植率较高。PAP患者外周血淋巴细胞计数减少、诊断前应用抗菌药物是耶氏肺孢子菌定值的危险因素。Objective To investigate the colonization,risk factors and prognosis of Pneumocystis jirovecii(P.jirovecii)colonization in patients with Pulmonary alveolar proteinosis(PAP).Methods The patients with Pulmonary alveolar proteinosis who were admitted to the Department of Respiratory and Critical Care Medicine,Nanjing Drum Tower Hospital from March 2019 to December 2022 were retrospectively analyzed.Polymerase chain reaction/nextgeneration metagenomic sequencing were used to detect the colonization of P.jirovecii in bronchoalveolar lavage fluid,and then to investigate the colonization rate,risk factors and outcome of P.jirovecii in PAP patients.Results A total of 25 patients were included in the study,of which 7 were colonized by P.jirovecii(28.0%).The rate of using antibiotics before admission in the colonizing group was significantly higher than that in the non-colonizing group(85.7%vs 33.3%,P=0.030).Total blood lymphocytes(1.4×10^(9)/L vs.1.8×10^(9)/L,P=0.048),CD3^(+)T cells(0.83×10^(9)/L vs.1.34×10^(9)/L,P=0.010),CD4^(+)T cells(0.48×10^(9)/L vs.0.85×10^(9)/L,P=0.010)were significantly lower than those in the non-colonizing group,lactate dehydrogenase(469.9 U/L vs.277.3 U/L,P=0.005)was significantly higher than those in the non-colonizing group.A higher proportion of colonizing group required combination therapy(57.1%vs.11.1%,P=0.032);but there was no significant difference in the percentage of whole-lung ground-glass opacification,lung function,oxygen index and outcome.Lactate dehydrogenase was positively correlated with the percentage of whole-lung ground-glass opacification of PAP,but negatively correlated with oxygen index,percentage of predicted forced vital capacity and percentage of predicted diffusion capacity for carbon monoxide.Conclusions The colonization rate of P.jirovecii in PAP patients was high.Reduced lymphocyte count in peripheral blood of PAP patients and antibiotic use before diagnosing were risk factors for P.jirovecii colonization.

关 键 词：肺泡蛋白沉积症 肺孢子菌 定植 危险因素 

分 类 号：R563[医药卫生—呼吸系统]