非艾滋病患者伊氏肺孢子菌感染和定植的流行病学特点

Epidemiological characteristics of Pneumocystis jirovecii infection and colonization in non-AIDS patients

目的分析非艾滋病患者伊氏肺孢子菌感染和定植的流行病学特点。方法对2010年1月到2017年12月在北京大学第一医院行支气管镜肺泡灌洗的非艾滋病患者应用六甲基四胺银（GMS）染色和实时荧光定量PCR方法（qPCR）检测支气管肺泡灌洗液（BALF）中的伊氏肺孢子菌，同时对北京大学第一医院环境中的伊氏肺孢子菌进行检测，探讨其流行病学特点。结果8年中共有1 407例非艾滋病患者的BALF送检伊氏肺孢子菌，经过GMS染色，伊氏肺孢子菌感染114例（8.10%），定植3例（0.21%）。其中非艾滋病免疫抑制患者946例，伊氏肺孢子菌感染113例（11.95%），定植2例（0.21%）；免疫健全患者461例，伊氏肺孢子菌感染1例（0.22%），定植1例（0.22%）。同时进行GMS染色和qPCR检测196例，伊氏肺孢子菌感染36例（18.37%），定植33例（16.84%）。其中非艾滋病免疫抑制患者175例，伊氏肺孢子菌感染36例（20.57%），定植30例（17.14%）；免疫健全患者21例，伊氏肺孢子菌感染0例，定植3例（14.29%）。通过GMS染色和qPCR方法，未从北京大学第一医院环境中检测到伊氏肺孢子菌。结论伊氏肺孢子菌感染在非艾滋病免疫抑制患者中并不少见，在免疫健全患者中罕见；伊氏肺孢子菌定植均较为少见。环境中可能不存在伊氏肺孢子菌。

ObjectiveTo analyze the epidemiological characteristics of Pneumocystis jirovecii infection and colonization in non-AIDS patients.MethodsFrom January 2010 to December 2017, bronchoalveolar lavage fluid （BALF） was detected by Grocott′s methenamine silver （GMS） staining and real-time fluorescence quantitative PCR （qPCR） in non-AIDS patients with bronchoscopic alveolar lavage at Peking University First Hospital. At the same time, Pneumocystis jirovecii was detected in the environment of the hospital.ResultsWithin 8 years, Pneumocystis jirovecii were detected in BALF of a total of 1 407 non-AIDS patients. GMS staining was performed in all these 1 407 cases, of which 114 （8.10%） cases were with Pneumocystis jirovecii infection and 3 （0.21%） cases with colonization. There were totally 946 non-AIDS immunocompromised patients, of which 113 （11.95%） cases were infected and 2 （0.21%） cases with colonization; there were 461 non-AIDS immunocompetent patients, of which only 1 （0.22%） case was infected and 1 （0.22%） case with colonization. GMS staining and qPCR were both performed in 196 cases, of which 36 （18.37%） cases were infected and 33 （16.84%） cases with colonization. There were totally 175 non-AIDS immunocompromised patients, of which 36 （20.57%） cases were infected and 30 （17.14%） cases with colonization; there were 21 non-AIDS immunocompetent patients, of which no one was infected and 3 （14.29%） cases with colonization. By means of GMS staining and qPCR, no Pneumocystis jiroveci were detected in the environment of Peking University First Hospital.ConclusionsPneumocystis pneumonia is rare in immunocompetent patients, but not in non-AIDS immunocompromised patients. And colonization is rare in both of them. There may be no Pneumocystis jiroveci in the environment.