HIV阳性及阴性合并肺孢子菌肺炎患者血液学指标及临床特征比较分析

Comparison of blood index and clinical characteristics in patients with Pneumocystis pneumonia co-infected with HIV-positive and HIV-negative status

目的探讨HIV阳性和阴性患者合并肺孢子菌肺炎(Pneumocystis pneumonia,PCP)后血液学指标及临床特征的差异。方法采用回顾性分析方法收集2017年1月至2022年12月在杭州市西溪医院和浙江省人民医院就诊的40例PCP患者血液中的相关因子数据,其中HIV阳性患者21例,HIV阴性患者19例。分析两组患者的血液学指标、合并症、临床特征,并比较他们的治疗和预后情况。结果HIV阳性PCP患者CD4+T淋巴细胞计数较低,均<200个/μL。HIV阴性PCP患者中性粒细胞/白细胞的比值、D-二聚体、乳酸脱氢酶、乳酸、降钙素原分别为88.10(81.10,93.90)%、3.91(1.03,6.04)mg/L、599.00(400.00,821.00)U/L、2.40(1.93,4.02)mmol/L和0.50(0.10,1.52)μg/mL,均高于HIV阳性PCP患者(Z=-2.94、-2.16、-2.90、-3.01和-2.73,P=0.003、0.031、0.004、0.003和0.006),其G试验阳性率为73.68%(14/19),亦显著高于HIV阳性PCP患者的33.33%(7/21),差异有统计学意义(χ^(2)=6.51,P=0.014)。结论HIV阴性PCP患者血液中炎症指标、凝血指标及G试验阳性率明显高于HIV阳性PCP患者,需引起临床早期关注。

Objective To explore the differences in hematological indicators and clinical characteristics between HIV-positive and HIV-negative patients with Pneumocystis pneumonia(PCP).Methods A retrospective analysis was conducted on data from 40 PCP patients treated at Xixi Hospital of Hangzhou and Zhejiang Provincial People's Hospital from January 2017 to December 2022.It included 21 HIV-positive and 19 HIV-negative patients.The hematological indicators,complications,clinical characteristics,treatment,and prognosis of the two groups were compared.Results Among HIV-positive patients co-infected with PCP,the CD4^(+)T lymphocyte count was lower,all below 200 cells/μL.In HIV-negative patients with PCP,the neutrophil-to-WBC ratio,D-dimer,lactate dehydrogenase,lactate,and procalcitonin were 88.10(81.10,93.90)%,3.91(1.03,6.04)mg/L,599.00(400.00,821.00)U/L,2.40(1.93,4.02)mmol/L,and 0.50(0.10,1.52)μg/mL,respectively,which were significantly higher than those in HIV-positive PCP patients(Z=-2.94,-2.16,-2.90,-3.01 and-2.73,P=0.003,0.031,0.004,0.003 and 0.006).The positive rate of G test was 73.68%(14/19)in HIV-negative PCP patients,which was significantly higher than the 33.33%(7/21)in HIV-positive PCP patients,and the difference was statistically significant(χ^(2)=6.51,P=0.014).Conclusions HIVnegative patients with PCP have significantly higher inflammatory indicators,coagulation indicators,and positive rate of G test in the blood compared to HIV-positive patients.Therefore,early clinical attention should be paid to these patients.