非HIV感染者与HIV感染者肺孢子菌肺炎的临床特征比较及预后分析  

Comparison of clinical characteristics of pneumocystis jiro-vecii pneumonia between non-HIV-infected and HIV-infected people and their prognosis analysis

作　　者：马雪晨 郑凌[1] 马长秀[1] MA Xuechen;ZHENG Ling;MA Changxiu(Department of Respiratory Medicine,the Second Affiliated Hospital of Anhui Medical University,Hefei,Anhui 230601,China)

机构地区：[1]安徽医科大学第二附属医院呼吸内科,安徽合肥230601

出　　处：《临床肺科杂志》2024年第12期1820-1827,共8页Journal of Clinical Pulmonary Medicine

基　　金：安徽省科研编制计划项目(No.2022AH050694);安徽医科大学第二附属医院临床研究计划项目(No.2020LCZD15)。

摘　　要：目的分析比较非HIV感染者与HIV感染者耶氏肺孢子菌肺炎(pneumocystis jiro-vecii pneumonia,PJP)的临床特点,同时探讨影响非HIV组患者预后的危险因素,为临床诊疗提供参考。方法选取2021年9月-2023年9月就诊于安徽医科大学第二附属医院诊断为PJP的成年患者共58例,按照是否感染HIV分为非HIV感染组(n=38)和HIV感染组(n=20),收集并分别比较两组患者发病特点、实验室指标、影像学表现、合并感染情况、治疗以及预后等临床资料,采用多因素Logistic回归对非HIV组PJP预后相关影响因素进行分析。结果两组患者起病时间、影像学表现、血清乳酸脱氢酶、血清1,3-β-D葡聚糖、C-反应蛋白、降钙素原、淋巴细胞计数、氧合指数、肺泡灌洗液NGS中肺孢子菌序列数之间的差异无统计学意义(P>0.05),两组患者白细胞计数、中性粒细胞计数以及CD4^(+)T淋巴细胞计数之间的差异有统计学意义(P<0.05)。非HIV感染组患者入院时肺炎严重程度评分(pneumonia severity score,PSI)、CURB-65评分均大于HIV感染组,差异具有统计学意义(P<0.05)。非HIV感染组合并感染肺炎克雷伯菌及曲霉菌的患者所占比例高于HIV感染组,HIV感染组合并感染巨细胞病毒的患者所占比例高于非HIV感染组,差异具有统计学意义(P<0.05)。非HIV组患者死亡率高于HIV感染组患者,差异具有统计学意义(P<0.05)。对非HIV组进行多因素Logistic回归分析显示高CURB-65评分(OR:12.3,95%CI:1.9~77.9,P=0.008)以及气管插管(OR:9.9,95%CI:1.1~89.8,P=0.042)是非HIV感染组预后不良的独立危险因素。结论非HIV感染患者合并PJP时病情严重程度及病死率高于HIV感染患者,非HIV感染组PJP患者更容易合并肺炎克雷伯菌和曲霉感染,HIV感染组更容易合并巨细胞病毒感染,高CURB-65评分和气管插管是非HIV感染组PJP患者预后不良的独立危险因素。Objective To analyze and compare the clinical characteristics of pneumocystis jiro-vecii pneumonia(PJP)between HIV-infected patients and non-HIV-infected patients,and to explore the risk factors affecting the prognosis of non-HIV patients,so as to provide reference for clinical diagnosis and treatment.Methods A total of 58 adult patients diagnosed with PJP in the Second Affiliated Hospital of Anhui Medical University from September 2021 to September 2023 were selected and divided into the non-HIV infection group(n=38)and the HIV infection group(n=20)according to whether they were infected with HIV or not.The clinical data of the two groups were collected and compared,including the characteristics of onset,laboratory indicators,imaging manifestations,co-infection,treatment and prognosis.The prognostic factors of PJP in non-HIV group were analyzed by multivariate logistic regression analysis.Results There was no significant difference in onset time,imaging manif-estations,serum lactate dehydrogenase,serum 1,3-β-D glucan,C-reactive protein,procalcitonin,lymphocyte count,oxygenation index and pneumocystis sequence number in NGS of alveolar lavage fluid between the two groups(P>0.05).There were significant differences in white blood cell count,neutrophil count and CD4^(+)T lymphocyte count between the two groups(P<0.05).The pneumonia severity score(PSI)and CURB-65 score of non-HIV patients were higher than those of HIV patients,and the differences were statistically significant(P<0.05).The proportion of patients infected with Klebsiella pneumoniae and Aspergillus in the non-HIV group was higher than that in the HIV group,and the proportion of patients infected with cytomegalovirus in the HIV group was higher than that in the non-HIV group,and the differences were statistically significant(P<0.05).The mortality rate of non-HIV patients was higher than that of HIV patients,and the difference was statistically significant(P<0.05).Multivariate logistic regression analysis showed that high CURB-65 score(OR=12.3,95%CI:1.9~

关 键 词：耶氏肺孢子菌肺炎 非HIV感染 HIV感染 预后 

分 类 号：R512.91[医药卫生—内科学] R519[医药卫生—临床医学]