摘要
目的:采用病例对照研究的方法,总结非-HIV相关卡氏肺孢子菌肺炎(NH-PCP)的临床特点,为此类患者的临床诊治提供经验。方法:回顾性分析了302医院住院的NH-PCP患者,及在Pubmed、CHKD和万方数据库中检索到的NH-PCP患者共202例,选择65例HIV相关卡氏肺孢子菌肺炎(HIV-PCP)患者作为对照研究,比较分析前者在临床表现、病程、预防、治疗及预后等方面的特征,为今后此类疾病的临床诊治提供经验。结果:与HIV-PCP组对比,NH-PCP组采用预防性治疗的比例低(5.24%vs.29.2%,P<0.001);确诊后开始抗感染治疗的时间晚(5.19±0.95天vs.1.1±0.27天,P<0.005);两组患者应用激素治疗的比例无统计学差异(69.3%vs.76.9%,P=0.238),病死率无统计学差异(36.6%vs.27.7%,P=0.487)。结论:NH-PCP组患者采取预防治疗的比例低,开始抗感染治疗的时间也较HIV-PVP延迟。这提示我们,重视NH-PCP的风险预测,给予积极的预防治疗及PCP经验性早期治疗至关重要。
Objective： To investigate the clinical features in patients with non-human immunodeficiency virus（HIV）-related Pneumocystis jirovecii pneumonia（NH-PCP）.Methods： A retrospective case-control study of NH-PCP was performed and all the cases of data were collected from pubmed,CHKD and Wangfang database from 1996 to 2011.Data on clinical presentation,medical treatment,and prognosis were collected using standardized data collection software.Statistical analysis of prophylaxis,corticosteroid usage and clinical outcomes were performed between the two groups of patients with HIV-related PCP（HIV-PCP） and NH-PCP.Results： 267 cases of PCP including 65 HIV-PCP and 202 NH-PCP cases were included in our study.Compared with HIV-PCP group,NH-PCP cases rarely received primary prophylaxis（5.24% vs.29.2%,P0.001） and received appropriate antibiotics later in the course of hospitalization（5.19± 0.95 vs.1.1 ± 0.27 days,P0.005）.No significant differences in corticosteroid therapy（69.3% vs.76.9%,P=0.238） and mortality（36.6% vs.27.7%,P =0.487） were detected.Conclusions： Patients who received organ or stem cell transplant remain at risk for PCP for many years after transplantation.In our study,patients who developed NH-PCP were rarely given prophylaxis,and initiation of appropriate antibiotics was significantly delayed compared to cases of HIV-PCP.Medical providers should be aware of the ongoing risk for NH-PCP,even late after transplantation,and consider more aggressive approaches to both prophylaxis and earlier empirical therapy for PCP.
出处
《现代生物医学进展》
CAS
2012年第35期6842-6845,共4页
Progress in Modern Biomedicine
基金
国家科技重大专项(2010ZXJ0900X-004-002)
