HIV阴性肺孢子菌肺炎51例临床特征及预后因素分析  

Clinical characteristics and prognostic factors of HIV negative pneumocystis jirovecii pneumonia:an analysis of 51 cases

作　　者：崔顺顺 段植 CUI Shunshun;DUAN Zhi(Department of Respiratory and Critical Care Medicine,Fuyang People's Hospital,Fuyang,Anhui 236000,China;Laboratory Department,The Second Hospital of Anhui Medical University,Hefei,Anhui 230601,China)

机构地区：[1]阜阳市人民医院呼吸与危重症医学科,安徽阜阳236000 [2]安徽医科大学第二附属医院检验科,安徽合肥230601

出　　处：《安徽医药》2025年第3期519-523,共5页Anhui Medical and Pharmaceutical Journal

基　　金：国家自然科学基金资助项目(82102460)。

摘　　要：目的分析人类免疫缺陷病毒(HIV)阴性肺孢子菌肺炎(PJP)临床特征和影响预后危险因素,为临床诊疗提供参考。方法收集阜阳市人民医院2021年12月至2023年10月51例成人HIV阴性PJP住院病人的病历资料和治疗转归。根据预后将病人分为存活组与死亡组,比较两组病人的一般资料、临床资料、治疗转归等,将变量纳入到单因素和多因素logistic回归中筛选与预后相关的风险因素,并建立受试者操作特征曲线(ROC曲线)对预后模型进行评估。结果51例HIV阴性PJP住院病人,多合并混合感染84.31%(43/51),以曲霉菌37.21%(16/43)最常见;间质性肺病23.53%(12/51)、激素52.94%(27/51)应用为主要危险因素;影像学表现以肺部磨玻璃影82.35%(42/51)为主;主要临床症状为呼吸困难76.47%(39/51)、咳嗽64.71%(33/51)、发热60.78%(31/51)。HIV阴性PJP病人死亡组白细胞(10.85±4.50)×10^(9)/L、中性粒细胞比(88.20±4.74)%、C反应蛋白(CRP)139.45(95.37,263.17)mg/L、乳酸脱氢酶(LDH)600.15(469.90,771.65)U/L均高于存活组[(6.97±3.00)×10^(9)/L、(70.93±14.97)%、32.82(12.16,101.71)mg/L、301.0(234.8,398.7)U/L](P<0.05);死亡组淋巴细胞比8.45(4.93,10.28)%、白蛋白(30.88±4.16)g/L均低于存活组[15.80(9.00,27.00)%、(34.30±5.12)g/L](P<0.05)。多因素logistic回归分析发现,HIV阴性PJP病人死亡的独立危险因素为CRP[OR=1.02,95%CI:(1.00,1.03),P=0.023]、LDH[OR=1.01,95%CI:(1.00,1.02),P=0.009]。利用LDH、CRP和二者联合建立ROC曲线,曲线下面积分别为0.92、0.85和0.95。结论HIV阴性PJP多为混合感染,主要表现为呼吸困难、咳嗽、发热,影像学以双肺磨玻璃影为主,白细胞、中性粒细胞比、淋巴细胞比、CRP、白蛋白、AST、LDH和D-二聚体影响预后,LDH和CRP是不良预后的独立危险因素。Objective To analyze the clinical characteristics and prognostic risk factors of HIV negative Pneumocystis jirovecii pneumonia(PJP),so as to provide reference for clinical diagnosis and treatment.Methods Medical records and treatment outcomes of 51 adult HIV negative PJP inpatients admitted to Fuyang People's Hospital from December 2021 to October 2023 were collected.According to the prognosis,patients were assigned into a survival group and a death group,and their general information,clinical data,and treatment outcomes were compared between the two groups.Variables were included in univariate and multivariate logistic regression to screen for risk factors related to prognosis,and a receiver operating characteristic curve(ROC curve)was established to evaluate the prognosis model.Results Most of the 51 hospitalized HIV negative PJP patients(84.31%,43/51)had mixed infections,with Aspergillus being the most common at 37.21%(16/43).The main risk factors were interstitial lung disease(23.53%,12/51)and hormone use(52.94%,27/51).The imaging findings mainly showed ground glass opacities on the lungs,accounting for 82.35%(42/51).The main clinical symptoms were dyspnea(76.47%,39/51),cough(64.71%,33/51),and fever(60.78%,31/51).The white blood cell count,neutrophil ratio,C-reactive protein(CRP),and lactate dehydrogenase(LDH)in the death group of HIV negative PJP patients were all higher than those in the survival group[(10.85±4.50)×10^(9)/L vs.(6.97±3.00)×10^(9)/L,(88.20±4.74)%vs.(70.93±14.97)%,139.45(95.37,263.17)mg/L vs.32.82(12.16,101.71)mg/L,600.15(469.90,771.65)U/L vs.301.0(234.8,398.7)U/L](P<0.05).The lymphocyte ratio and albumin in the death group were lower than those in the survival group[8.45(4.93,10.28)%vs.15.80(9.00,27.00)%,(30.88±4.16)g/L vs.(34.30±5.12)g/L,respectively](P<0.05).Multivariate logistic regression analysis found that the independent risk factors for death in HIV negative PJP patients were CRP[OR=1.02,95%CI:(1.00,1.03),P=0.023]and LDH[OR=1.01,95%CI:(1.00,1.02),P=0.009].ROC curves were estab

关 键 词：肺孢子菌肺炎 人类免疫缺陷病毒阴性 肺部磨玻璃影 乳酸脱氢酶 C反应蛋白 

分 类 号：R519[医药卫生—内科学]