非艾滋耶氏肺孢子菌肺炎患者临床特点及预后因素分析

Clinical characteristics and prognostic factors of patients with non-HIV pneumocystis jirovecii pneumonia

目的分析北京市怀柔地区非艾滋耶氏肺孢子菌肺炎(PJP)患者的临床特点和预后不良的危险因素。方法回顾性分析2016年1月-2022年1月在北京怀柔医院住院治疗的36例成人非艾滋耶氏肺孢子菌肺炎患者的临床特征和出院结局。根据患者出院时生存状态将纳入患者分为存活组与死亡组,比较两组患者的人口学基线资料、临床特征、治疗转归等,将有统计学意义的变量纳入到单因素和多因素Logistic回归中筛选与住院死亡相关的独立风险因素,并建立ROC曲线对预后模型进行评估。结果最终纳入研究的32例非艾滋PJP住院患者平均年龄为(52.5±15.9)岁。其中存活组22例,死亡组10例。单因素分析结果显示怀柔地区PJP患者住院死亡相关危险因素为:白蛋白、谷草转氨酶、乳酸脱氢酶、合并CMV感染、气胸。多因素Logistic回归分析发现,PJP患者死亡的独立风险因素为低白蛋白血症(OR=0.714,95%CI:0.512-0.996,P=0.047)、气胸(OR=91.487,95%CI:1.510-5542.678,P=0.031)。利用白蛋白和气胸建立ROC曲线,曲线下面积分别为0.791和0.727。结论气胸和低白蛋白血症是怀柔地区PJP患者住院死亡的独立风险因素,住院期间防止气胸的发生和及时纠正低白蛋白血症或许可以降低患者的死亡风险,提高生存率。

Objective To analyze the clinical characteristics and risk factors of poor prognosis in patients with pneumocystis jirovecii pneumonia(PJP)in Huairou district of Beijing.Methods The clinical characteristics and discharge outcomes of 36 patients with pneumocystis yerbii pneumonia hospitalized in Beijing Huairou Hospital from January 2016 to January 2022 were retrospectively analyzed.These patients were divided into survival group and death group according to their survival status at discharge.Demographics,clinical features and treatment of patients in the two groups were analyzed.Chi-square test and other method of univariate statistical analysis were performed.Logistic regression analysis was used to analyze the independent risk factors associated with the outcome of in-hospital death for PJP.ROC curve was established to evaluate the prognosis model.Results Of the 32 non-HIV-PJP patients,the age was(52.5±15.9)years.There were 22 patients in the survival group and 10 in the death group.Univariate analysis showed that risk factors of PJP patients associated with death were albumin,aspartate aminotransferase,lactate dehydrogenase,coinfection of CMV,pneumothorax.Multivariate Logistic regression analysis showed that independent risk factors of PJP patients associated with death were hypoalbuminemia(OR=0.714,95%CI:0.512-0.996,P=0.047)and pneumothorax(OR=91.487,95%CI:1.510-5542.678,P=0.031).The ROC curve was established using albumin and pneumothorax,and the area under the curve was 0.791 and 0.727,respectively.Conclusions Pneumothorax and hypoalbuminemia were independent risk factors for in-hospital death of PJP patients in Huairou area.Prevention of pneumothorax and correction of hypoalbuminemia during hospitalization may reduce the risk of death and improve survival.