【摘要】 目的探讨糖皮质激素长期应用宿主合并肺孢子菌肺炎(G-PCP)的死亡危险因素。方法回顾性分析2014年1月至2017年12月中日友好医院病房收治的57例G-PCP患者,根据住院生存情况分为存活组(44例)和死亡组(13例)。对两组患者的年龄、性别、基础疾病、糖皮质激素应用情况、症状、疾病严重程度、影像学表现、病原学特征、是否合并呼吸衰竭、机械通气、是否应用血管活性药物、抗感染药物应用情况等进行比较分析,并运用Logistic回归探讨PCP的预后因素。结果死亡组患者年龄、氧合指数、CD4~+/CD8~+T淋巴细胞、CD5~+CD19~+B细胞比例、肺部CT合并实变或团块、合并空洞、合并蜂窝或胸腔积液、呼吸衰竭、入住ICU、无创机械通气、有创机械通气、脓毒性休克、入院后平均每日糖皮质激素应用剂量明显高于存活组(均P<0.05);氧合指数、外周血淋巴细胞计数、CURB65评分、PSI评分预测G-PCP患者住院病死率的ROC曲线下面积分别为0.899、0.634、0.608,0714,以氧合指数<160 mmHg(1 mmHg=0.133 kPa)预测患者住院病死率,敏感度为76.3%,特异度为92.3%。Logistic回归提示年龄、气胸或纵隔气肿、休克为预后的独立预测因素。结论氧合指数能评估G-PCP患者疾病严重程度,若合并高龄、气胸或纵隔气肿、休克则提示不良预后。更多还原

【Abstract】 Objective To explore the prognostic risk factors of Pneumocystis pneumoniae(G-PCP) with long-term glucocorticoid users. Methods A retrospective study of 57 patients hospitalized with pulmonary infection stay in the Department of respiration or intensive care unit(ICU) of China-Japan Friendship Hospital, all patients were long-term glucocorticoid users with G-PCP. According to the living conditions of the hospital, the survival group(44 cases) and the death group(13 cases). The general data were collected,age, gender, underlying diseases, corticosteroids, symptoms, disease severity, imaging manifestations, etiology, whether patients with respiratory failure, mechanical ventilation, whether the application of vasoactive drugs, antibiotics application of the two groups, the prognostic factors of G-PCP were investigated by using Logistic regression. Results The age of patients, the oxygenation index, CD4+T/CD8+T lymphocyte, CD5+CD19+ B lymphocyte cell ratio, CT with pulmonary consolidation or merger with mass, cavitation, honeycomb or pleural effusion, respiratory failure, ICU admission, noninvasive mechanical ventilation, mechanical ventilation, septic shock after admission, the average daily use of glucocorticoids the dose in the death group were significantly higher than the survival group. It was shown by ROC curve that the maximum area under the ROC curve(AUC) of The oxygenation index and peripheral blood lymphocyte count, CURB65 score and PSI score in predicting G-PCP patients hospitalized mortality were 0.899, 0.634, 0.608,0.714. When the oxygen index <160 mm Hg as a predictor of cut-off value of hospitalized mortality, the sensitivity was 76.3%, specificity was 92.3%. Logistic regression showed that age, pneumothorax or mediastinal emphysema and shock were independent predictors of prognosis in G-PCP. Conclusion the oxygenation index can predict the severity of the disease in G-PCP patients. If the patient had elderly age(OR 0.004, 95%CI 0.000-0.234; P<0.05), pneumothorax or mediastinal emphysema(OR 0.004, 95%CI 0.000-0.234; P<0.05) and shock(OR 0.004, 95%CI 0.000-0.234; P<0.05), it suggested a poor prognosis.更多还原