糖皮质激素不会提高人类免疫缺陷病毒阴性耶氏肺孢子菌肺炎患者的存活率

Glucocorticoids do not improve the survival rate of human immunodeficiency virus negative Pneumocystis jirovecii pneumonia

目的探讨糖皮质激素(简称激素,下同)是否可以降低人类免疫缺陷病毒(human immunodeficiency virus,HIV)阴性耶氏孢子菌肺炎(Pneumocystis jirovecii pneumonia,PJP)患者的病死率。方法回顾性分析2019年4月—2022年4月在江西省人民医院住院的93例HIV阴性PJP患者的临床资料。按照动脉血氧分压(the partial pressure of oxygen in arterial blood,PaO_(2))是否大于70 mm Hg分为高低2组,分析病死率与基础疾病占比、激素使用情况、机械通气情况等因素之间的关系。结果3年内诊断HIV阴性PJP患者共93例。基础疾病主要为实体器官移植34例(36.6%)、风湿系统疾病26例(28.0%)、恶性肿瘤15例(16.1%)。93例患者中动脉PaO_(2)≥70 mm Hg者共51例,PaO_(2)<70 mm Hg者共42例。93例中19例行有创通气、39例使用无创通气、50例使用鼻导管吸氧。93例患者共病死31例,存活62例,总体病死率为33.3%。动脉PaO_(2)≥70 mm Hg组HIV阴性PJP患者使用激素较不使用激素,病死率没有显著性差异(P>0.05);动脉PaO_(2)<70 mm Hg组HIV阴性PJP患者使用激素较不使用激素,病死率没有显著性差异(P>0.05)。结论HIV阴性PJP患者,无论动脉PaO_(2)高低,使用激素均不能提高存活率。

Objective To investigate the potential effect of glucocorticoids(referred to as'hormones'here)on decreasing case fatality rate in patients with human immunodeficiency virus(HIV)negative Pneumocystis jirovecii pneumonia(PJP).Methods The clinical data of a cohort of 93 patients that were diagnosed with HIV-negative PJP at Jiangxi Provincial People's Hospital between April 2019 and April 2022 were retrospectively analyzed.These patients were classified into two groups based on the partial pressure of oxygen in arterial blood(PaO_(2)),specifically PaO_(2)≥70 mm Hg and PaO_(2)<70 mm Hg.The association between case fatality rate and various factors such as underlying diseases,hormone use,mechanical ventilation,and others was examined.Results Over a period of three years,93 cases of HIV-negative PJP were identified.The most prevalent underlying diseases were solid organ transplantation(n=34,36.6%),rheumatic system diseases(n=26,28.0%),and malignant tumors(n=15,16.1%).51 cases had arterial PaO_(2)levels≥70 mm Hg,while 42 cases had levels<70 mm Hg.Moreover,19 patients required invasive ventilation,39 patients were treated with non-invasive ventilation,while 50 patients received oxygenation using a nasal cannula.Out of the 93 patients,31 died from the disease,resulting in an overall case fatality rate of 33.3%.Meanwhile,62 patients survived.In patients with arterial PaO_(2)levels≥70 mm Hg,the administration of hormones did not significantly affect the case fatality rate(P>0.05);In patients with arterial PaO_(2)level<70 mm Hg,the administration of hormones did not significantly affect the case fatality rate(P>0.05).Conclusion Hormone use did not contribute to improved survival rates in HIV-negative PJP patients,regardless of arterial PaO_(2)level.