Pneumocystis jiroveci pneumonia (PCP) in HIV-1-negative patients: A retrospective study 2002-2004
Pneumocystis jiroveci pneumonia (PCP) in HIV-1-negative patients: A retrospective study 2002-2004
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DOI：
10.1080/00365540601150497
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发表时间：
2007-01-01
影响因子：
--
通讯作者：
Helweg-Larsen, Jannik
中科院分区：
文献类型：
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作者：
Overgaard, Ulrik M.;Helweg-Larsen, Jannik
进行了一项回顾性研究，以描述艾滋病毒阴性患者中与耶氏肺孢子虫肺炎（PCP）相关的危险因素。2002-2004年期间，Rigshospitalet大学医院根据组织学、PCR和PCP临床症状确定了50例PCP。诱发疾病包括血液恶性肿瘤（72%）、炎症性疾病（14%）、实体器官移植（6%）和其他与免疫缺陷相关的疾病（8%）。最常见的治疗相关风险因素是类固醇使用（76%）和化疗（72%）。在88%接受类固醇的患者中，在症状发作前2周内降低剂量或给予脉冲治疗。仅1例患者在诊断时接受PCP预防，仅8例（16%）患者既往接受过PCP预防。诊断时，78%的患者淋巴细胞减少。17例患者的CD 4计数可用。仅9例患者（52%）的CD 4计数值低于300个细胞/μ l。PCP的总死亡率为14%，与延误诊断和治疗显著相关。在免疫功能低下的HIV阴性患者中，在类固醇治疗和淋巴细胞减少的情况下应特别怀疑PCP。尽管CD 4计数低与PCP风险较高相关，但使用CD 4计数作为HIV阴性患者风险识别或预防的指导似乎还不够。
A retrospective study was conducted to describe risk factors associated with Pneumocystis jiroveci pneumonia (PCP) among HIV-negative patients. During 2002-2004, 50 cases of PCP were identified at Rigshospitalet University Hospital on the basis of histology, PCR and clinical symptoms of PCP. Predisposing conditions included haematological malignancy (72%), inflammatory diseases (14%), solid organ transplantation (6%) and other conditions associated with immunodeficiency (8%). The most common treatment related risk factors were steroid usage (76%) and chemotherapy (72%). In 88% of patients who received steroids, dosage was either lowered or given as pulse-therapy in the 2 weeks preceding the onset of symptoms. Only I patient was on PCP prophylaxis at diagnosis and only 8 (16%) patients had previously been given PCP prophylaxis. At diagnosis, 78% of patients were lymphopenic. CD4 counts were available in 17 patients. Only 9 patients (52%) had CD4 count values below 300 cells/mu l. The overall mortality attributable to PCP was 14% and was significantly associated with delayed diagnosis and treatment. Among immunocompromized HIV-negative patients, PCP should be particularly suspected in the context of steroid treatment and lymphopenia. Although low CD4 count is associated with a higher risk of PCP, the use of CD4 count as guidance for risk identification or prophylaxis among HIV-negative patients appears insufficient.