免疫抑制治疗的肾脏疾病患者并发肺孢子菌肺炎的临床特点及死亡风险因素分析  

Clinical features and death risk factors of pneumocystis jirovecii pneumonia in kidney disease patients with immunosuppressive therapy

作　　者：沈存[1] 许戎[2] Shen Cun;Xu Rong(Department of Nephrology,Beijing Hospital of Traditional Chinese Medicine,Capital Medical University,Beijing 100010,China;Renal Division,Peking University First Hospital,Peking University Institute of Nephrology,Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases,Chinese Academy of Medical Sciences,Beijing 100034,China)

机构地区：[1]首都医科大学附属北京中医医院肾病科,北京100010 [2]北京大学第一医院肾内科,北京大学肾脏疾病研究所,中国医学科学院免疫介导肾病诊治创新单元,北京100034

出　　处：《中华预防医学杂志》2024年第5期673-678,共6页Chinese Journal of Preventive Medicine

基　　金：北京市医院管理中心科研培育计划(PZ2022019)。

摘　　要：探讨免疫抑制治疗的肾脏疾病患者并发耶氏肺孢子菌肺炎(PJP)的临床特点及死亡风险因素。采用回顾性病例系列研究。收集2006年1月1日至2021年8月31日在北京大学第一医院肾内科或呼吸科就诊的接受免疫抑制治疗的肾脏疾病合并PJP的52例患者,根据患者临床结局,分为存活组(36例)和死亡组(16例),单因素分析比较两组病例临床特点的差异,进一步采用多因素logistic回归模型分析其死亡风险因素。结果显示,临床资料分析显示52例患者入院时中位血肌酐192.5(109.8,293.7)μmol/L,急性肾损伤发生率为63.5%(33/52例)。单因素分析示存活组和死亡组在年龄(t=1.197,P=0.030)、C反应蛋白水平(t=2.378,P=0.022)、PJP起病至确诊时间(χ^(2)=6.62,P=0.010)、PJP严重程度(χ^(2)=5.482,P=0.019)、并发脓毒症休克(χ^(2)=3.997,P=0.046)、机械通气(χ^(2)=11.755,P=0.001)和血液净化治疗(χ^(2)=4.748,P=0.029)方面均差异有统计学意义。两组在性别、PJP发病前激素治疗时间和使用剂量、甲基泼尼松龙冲击、免疫抑制剂的使用和住院抗PJP治疗前后血肌酐水平方面差异均无统计学意义(均P>0.05)。进一步多因素分析显示PJP起病至确诊时间>10 d(OR=40.945,95%CI:1.738~451.214;P=0.021)和重度PJP(OR=25.502,95%CI:1.426~74.806;P=0.028)为免疫抑制治疗的肾脏疾病合并PJP患者发生死亡的独立危险因素。综上,PJP起病至确诊时间和重度PJP是免疫抑制治疗的肾脏疾病合并PJP患者发生死亡的独立危险因素,临床应密切关注患者氧合情况,早期确诊以预防PJP加重并改善预后。To investigate the clinical features and death risk factors of pneumocystis jirovecii pneumonia(PJP)in kidney disease patients with immunosuppressive patients.A Retrospective case series study was performed in 52 PJP patients with kidney disease who received immunosuppressive therapy in Nephrology or Respiratory department of Peking University First Hospital from January 1,2006 to August 31,2021.Patients were divided into survival group(36 cases)and death group(16 cases)according to their clinical outcomes.Univariate analysis was performed to compare the differences of clinical features between the two groups.Multivariate logistic regression model was used to analyze the death risk factors.The results showed that the median serum creatinine was 192.5(109.8,293.7)μmol/L,and the incidence of acute kidney injury was 63.5%(33/52).Univariate analysis showed that age(t=1.197,P=0.030),C-reactive protein level(t=2.378,P=0.022),time from onset to diagnosis(χ^(2)=6.62,P=0.010),PJP severity(χ^(2)=5.482,P=0.019),complicated with septic shock(χ^(2)=3.997,P=0.046),mechanical ventilation(χ^(2)=11.755,P=0.001),and blood purification therapy(χ^(2)=4.748,P=0.029)were statistically significant.There were no statistically significant differences between the two groups in gender,duration and dosage of hormone therapy before PJP onset,intravenous methylprednisolone pulse therapy,immunosuppressant use,and serum creatinine level before and after hospitalization for anti-PJP treatment(all P>0.05).Multivariate analysis showed that the time from onset to diagnosis of PJP was>10 days(OR=40.945,95%CI:1.738-451.214;P=0.021)and severe PJP(OR=25.502,95%CI:1.426-74.806;P=0.028)was an independent death risk factor for kidney disease complicated with PJP of immunosuppressive therapy.In conclusion,the time from onset to diagnosis of PJP and PJP severity are independent death risk factors in patients with kidney disease complicated with PJP of immunosuppressive therapy.Close attention should be paid to oxygenation condition and early diagnosis

关 键 词：肺孢子菌肺炎 肾脏疾病 免疫抑制治疗 临床特点 死亡危险因素 

分 类 号：R692[医药卫生—泌尿科学] R519[医药卫生—外科学]