Pneumocystis pneumonia in HIV-infected and immunocompromised non-HIV infected patients: a retrospective study of two centers in China.
Pneumocystis pneumonia in HIV-infected and immunocompromised non-HIV infected patients: a retrospective study of two centers in China.
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HIV 感染者和免疫功能低下的非 HIV 感染者的肺孢子虫肺炎：中国两个中心的回顾性研究
DOI：
10.1371/journal.pone.0101943
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发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
Tong ZH
中科院分区：
文献类型：
--
作者：
Guo F;Chen Y;Yang SL;Xia H;Li XW;Tong ZH
肺孢子虫肺炎（PCP）是一种免疫功能低下宿主的新发传染病。然而，中国大陆对这些患者的临床特征了解甚少。我们对2008年至2012年的PCP进行了回顾性研究。收集有关临床表现、住院和结局的信息。使用考克斯回归模型进行预后分析。其中包括151例PCP病例; 46例非艾滋病毒病例和105例艾滋病毒病例。非HIV和HIV感染病例的全因死亡率（15.2% vs. 12.4%，p = 0.64）和至事件发生时间分析结果（对数秩检验，p =0.62）分别相似。 从2008年到2012年，非艾滋病毒感染的PCP患者从入院到初次治疗的时间呈下降趋势[中位数（范围）20（9-44）vs. 12（4-24）vs. 9（2-23）vs. 7（2-22）vs. 7（1-14）天]。全因死亡率也观察到类似趋势（33.3% vs. 20.0% vs. 14.3% vs. 14.3% vs. 6.7%）。在非HIV感染的PCP患者中，具有以下四种或四种以上临床表现（咳嗽、呼吸困难、发热、胸痛和体重减轻）[校正HR（AHR）29. 06，95% CI 2. 13 - 396. 36，P = 0. 01]和入住重症监护室（ICU）[AHR 22. 55，95% CI 1. 36 - 375. 06，P =0. 03]的患者与全因死亡率独立相关。 与HIV感染PCP患者死亡率相关的变量为入住ICU（AHR 72.26，95% CI 11.76-443.87，P<0.001）和白蛋白≤30 g/L（AHR 9.93，95% CI 1.69-58.30，P = 0.01）。 入院时进行综合临床评估，包括评估非HIV感染的PCP患者的四种或四种以上临床表现（咳嗽、呼吸困难、发热、胸痛和体重减轻），以及HIV感染患者的白蛋白≤30 g/L，可能会改善预后。
Pneumocystis pneumonia (PCP) is an emerging infectious disease in immunocompromised hosts. However, the clinical characteristics of these patients are poorly understood in mainland China. We performed a retrospective study of PCP from 2008 to 2012. Information was collected regarding clinical manifestations, hospitalization, and outcome. A prognostic analysis was performed using a Cox regression model. 151 cases of PCP were included; 46 non-HIV and 105 HIV cases. All-cause mortality (15.2% vs. 12.4%, p = 0.64) and the results of time-to-event analysis (log-rank test, p = 0.62) were similar between non-HIV and HIV infected cases, respectively. From 2008 to 2012, time from admission to initial treatment in non-HIV infected PCP patients showed declining trend [median (range) 20 (9–44) vs. 12 (4–24) vs. 9 (2–23) vs. 7 (2–22) vs. 7 (1–14) days]. A similar trend was observed for all-cause mortality (33.3% vs. 20.0% vs.14.3% vs. 14.3% vs. 6.7%). Patients with four or more of the following clinical manifestations (cough, dyspnea, fever, chest pain, and weight loss) [adjusted HR (AHR) 29.06, 95% CI 2.13–396.36, P = 0.01] and admission to intensive care unit (ICU) [AHR 22.55, 95% CI 1.36–375.06, P = 0.03] were independently associated with all-cause mortality in non-HIV infected PCP patients. Variables associated with mortality in HIV infected PCP patients were admission to ICU (AHR 72.26, 95% CI 11.76–443.87, P<0.001) and albumin ≤30 g/L (AHR 9.93 95% CI 1.69–58.30, P = 0.01). Upon admission comprehensive clinical assessment including assessment of four or more clinical manifestations (cough, dyspnea, fever, chest pain, and weight loss) in non-HIV infected PCP patients and albumin ≤30 g/L in HIV infected patients might improve prognosis.
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