儿童非HIV感染者耶氏肺孢子菌肺炎的临床特征及危险因素分析

Clinical characteristics and risk factors of Pneumocystis jirovecii pneumonia in children with non-HIV infection:an analysis study

目的分析儿童非HIV感染者耶氏肺孢子菌肺炎(非HIV-PJP)的临床特征及相关危险因素。方法收集128例肺炎患儿的临床资料,根据支气管肺泡灌洗液靶向高通量测序结果分为PJP组(n=63)和非PJP组(n=65)。对比两组患儿的临床特征,并采用多因素Logistic回归模型分析非HIV感染肺炎患儿发生PJP感染的危险因素。结果两组患者的性别、年龄、发热情况、呼吸困难情况、喘息情况、早产儿比例、合并基础疾病情况、肺部湿啰音合并喘鸣音情况、超敏C反应蛋白水平、淋巴细胞计数、中性粒细胞计数、IgG水平、IgA水平、IgM水平比较,差异均有统计学意义(均P<0.05)。多因素Logistic回归分析结果显示,肺部湿啰音合并喘鸣音为非HIV-PJP的独立危险因素(P<0.05)。结论儿童非HIV-PJP在男性、早产儿、合并基础疾病患儿中多见,常以呼吸困难、喘息为主要表现,肺部查体多伴有湿啰音合并喘鸣音,辅助检查多提示超敏C反应蛋白水平降低、淋巴细胞计数升高、中性粒细胞计数降低、IgG水平降低、IgA水平降低、IgM水平降低,其中肺部听诊闻及湿啰音合并喘鸣音是儿童非HIV-PJP的独立危险因素。临床中对于有相关特征的肺炎患儿应警惕PJP的可能,尤其是肺部听诊闻及湿啰音合并喘鸣音患儿。

Objective To analyze the clinical characteristics and related risk factors of Pneumocystis jirovecii pneumonia in non-human immunodeficiency virus(non-HIV-PJP)infectious children.Methods The clinical data of 128 children diagnosed with pneumonia were collected.According to the results of targeted high-throughput sequencing of bronchoalveolar lavage fluid,they were divided into the PJP group(n=63)and the non-PJP group(n=65).The clinical characteristics of the two groups were compared,and the risk factors of PJP occurring in children with non-HIV infection pneumonia were analyzed by multivariate Logistic regression model.Results There were statistically significant differences in gender,age,fever,dyspnea,gasping,proportion of premature infants,combination of basic diseases,pulmonary moist rales with wheezing,hypersensitive C-reactive protein levels,lymphocyte count,neutrophil count,IgG levels,IgA levels,and IgM levels between the two groups(all P<0.05).Multivariate Logistic regression analysis showed that pulmonary moist rales with wheezing was an independent risk factor of non-HIV-PJP(P<0.05).Conclusion Pediatric with non-HIV-PJP is common in boys,premature infants,and children with basic diseases,usually combined with main manifestations like dyspnea and wheezing.And their pulmonary physical examination is often accompanied by moist rales with wheezing.The auxiliary examination of the patients often shows that the lymphocyte count is increased,while the hypersensitive C-reactive protein levels,neutrophil counts,IgG levels,IgA levels,and IgM levels are decreased.Moist rales with wheezing heard in their lung auscultation is the independent risk factor for non-HIV-PJP in children.In clinic,for children with pneumonia with related characteristics,the possibility of PJP should be alerted,especially those with moist rales with wheezing heard in auscultation.