住院肺孢子菌肺炎患者的基础病和概况分析

Host factors and characteristics of hospitalized patients with pneumocystis jirovecii pneumonia

目的总结因肺孢子菌肺炎(PJP)住院的患者的基础病、病原学检查、病情程度,提高临床医生对该病的认识。方法回顾性分析自2014—2021年在北京协和医院住院接受诊疗、有病原学证据的485例PJP临床资料。结果男237例,女248例,年龄14~88(53.3±16.2)岁;≥60岁209例。根据患者的主要基础病分为8组,包括结缔组织疾病(CTD)209例、非血液系统恶性肿瘤29例、血液系统肿瘤38例、各种肾脏病81例、特发性间质性肺炎(IIP)33例、人类免疫缺陷病毒(HIV)感染30例及其他疾病42例。CTD组以女性为主,恶性肿瘤和HIV感染组均以男性为主。肺孢子菌检测过程中,痰肺孢子菌阳性率44.95%(218/485),气管镜标本肺孢子阳性率92.01%(265/288):痰和气管镜标本涂片染色找肺孢子菌的阳性率分别为4.95%(24/485)、9.72%(28/288),而分子检测肺孢子菌阳性率分别为43.09%(209/485)、90.63%(261/288)。本组HIV感染者发生PJP时合并巨细胞病毒血症、呼吸衰竭的比例最高,但接受机械通气和入住重症监护室(ICU)的比率、病死率却最低;IIP患者发生PJP时入住ICU和接受机械通气的比率虽很低(仅次于HIV感染者),但病死率却最高。结论CTD是本组PJP患者最常见的基础病,HIV感染者发生PJP时易合并巨细胞病毒血症、呼吸衰竭,但预后好;而IIP患者发生PJP时病情重、进展迅速、预后很差。

Objectives To describe the underlying diseases,microbiologic examination and severity of hospitalized patients with Pneumocystis jirovecii pneumonia(PJP)in a tertiary Chinese hospital.Methods We conducted a retrospective analysis of 485 identified PJP patients who were admitted to our hospital between January 2013 and December 2021.Results Among the 485 enrolled PJP cases,there were 237 males and 248 females,aging(53.3±16.2)years(range from 14 y to 88 y).They were divided into 8 subgroups with variable underlying diseases.There were 209 cases with connective tissue diseases(CTD),27 cases with non-hematologic malignancies,38 cases with hematologic malignancies,81 cases with kidney diseases,33 cases with idiopathic interstitial pneumonia(IIP),30 cases infected with human immunodeficiency virus(HIV),and 42 cases with miscellaneous underlying diseases.In the CTD group,there was more females than males,while male patients were predominant in both the malignant and the HIV groups.The Pneumocystis was identified in 44.95%(218/485)sputum samples and 92.01%(265/288)bronchoscopic samples.Pneumocystis asci were observed at direct microscopic examination with Grocott′s methenamine silver stain in 4.95%(24/485)sputum samples and 9.72%(28/288)bronchoscopic samples.Pneumocystis DNA fragments were identified by PCR analysis in 43.09%(209/485)sputum samples and 90.63%(261/288)bronchoscopic samples.Among the 8 groups,cytomegaviremia and respiratory failure were most common in the HIV-infected PJP group,but the rates of mechanic ventilation,intensive care unit(ICU)admission and death were the lowest.There were less PJP patients in the IIP group(IIP-PJP)who received mechanic ventilation and admitted to ICU than the other groups except HIV-infected PJP group.However,the mortality rate was highest for the IIP-PJP group.Conclusions CTD was the most common predisposed underlying disease for our enrolled PJP cases.Cytomegaviremia and respiratory failure were common in HIV-infected PJP patients,but the prognosis of HIV-PJP was slightly better than the others.The disease was more severe,rapidly progressive and fatal in the IIP-PJP group.