Pneumocystis carinii pneumonia in patients without acquired immunodeficiency syndrome: Associated illnesses and prior corticosteroid therapy
Pneumocystis carinii pneumonia in patients without acquired immunodeficiency syndrome: Associated illnesses and prior corticosteroid therapy
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DOI：
10.4065/71.1.5
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发表时间：
1996-01-01
影响因子：
8.9
通讯作者：
Limper, AH
中科院分区：
文献类型：
--
作者：
Yale, SH;Limper, AH
目的：确定连续一系列非获得性免疫缺陷综合征 (AIDS) 患者中与卡氏肺孢子虫肺炎发展相关的免疫抑制病症和全身皮质类固醇治疗的临床谱。设计：我们回顾性分析了 116 名无艾滋病患者的连续系列，这些患者于 1985 年至 1991 年间在梅奥医疗中心接受了首次卡氏肺孢子虫肺炎评估。方法：检查医疗记录以确定潜在的潜在病因。免疫抑制性疾病、病前皮质类固醇剂量和治疗持续时间、相关感染以及随后的呼吸衰竭和院内死亡率。 结果：与卡氏疟原虫肺炎首次发作相关的疾病为血液系统恶性疾病（30.2%）、器官移植（25.0%）、炎症性疾病（22.4%）、实体瘤（12.9%）和其他疾病（9.5%）。无论相关的基础疾病如何，在诊断卡氏疟原虫肺炎前 1 个月内，105 名患者（90.5%）已全身接受过皮质类固醇治疗。平均每日皮质类固醇剂量相当于 30 毫克泼尼松；然而，25% 的患者每天只接受 16 毫克泼尼松。出现肺炎前，皮质类固醇治疗的中位持续时间为 12 周；然而，其中 25% 的患者在接受皮质类固醇治疗 8 周或更短时间后出现卡氏疟原虫肺炎。在艾滋病以外的情况下，卡氏疟原虫肺炎患者出现呼吸衰竭的比例为 43%，院内死亡率为 34%。 结论：虽然这些结果并不表明病前给予皮质类固醇是导致这些患者发生卡氏疟原虫肺炎的唯一因素，但他们表明，在他的大型连续系列研究中，大多数患者在发病前一个月内接受了全身性皮质类固醇治疗，即使是中等剂量。卡氏疟原虫肺炎。应考虑对接受长期全身性皮质类固醇治疗的患者进行卡氏疟原虫预防（当无禁忌时）。
Objective: To determine the clinical spectrum of immunosuppressive conditions and systemic corticosteroid therapy associated with the development of Pneumocystis carinii pneumonia in a consecutive series of patients without acquired immunodeficiency syndrome (AIDS).Design: We retrospectively analyzed a consecutive series of 116 patients without AIDS who were assessed at Mayo Medical Center for a first episode of P. carinii pneumonia between 1985 and 1991.Methods: Medical records were examined to determine underlying immunosuppressive disorders, premorbid corticosteroid dosage and duration of therapy, associated infections, and subsequent respiratory failure and in-hospital mortality.Results: Conditions associated with first episode of P. carinii pneumonia were hematologic malignant disorders (30.2%), organ transplantation (25.0%), inflammatory disorders (22.4%), solid tumors (12.9%), and miscellaneous conditions (9.5%). Regardless of the associated underlying disease, corticosteroids had been administered systemically in 105 patients (90.5%) within 1 month before the diagnosis of P. carinii pneumonia. The median daily corticosteroid dose was equivalent to 30 mg of prednisone; however, 25% of patients had received as little as 16 mg of prednisone daily. The median duration of corticosteroid therapy was 12 weeks before the development of pneumonia; however, P. carinii pneumonia developed after 8 weeks or less of corticosteroid therapy in 25% of these patients. Respiratory failure occurred in 43%, and in-hospital mortality was 34% for patients with P. carinii pneumonia in conditions other than AIDS.Conclusion: Although these results do not suggest that premorbid administration of corticosteroids is the only factor that contributes to the development of P. carinii pneumonia in these patients, they show that, in his large consecutive series, systemic corticosteroid therapy, even in moderate doses, was administered to most patients during the month preceding the onset of P. carinii pneumonia. Consideration should be given to instituting P. carinii prophylaxis (when not contraindicated) in patients for whom prolonged systemic corticosteroid therapy is prescribed.