流行病学,危险因素和预防方法用于非艾滋病毒人口中的肺炎:加拿大北克的一项回顾性研究
Nicholas Quigley1,2, Laurence d'Amours1, Philippe Gervais3
1Department of Pulmonary Medicine, Institut Universitaire de Cardiologie et de Pneumologie de Québec (Québec Heart and Lung Institute), Université Laval, Québec City, Québec.
Open forum infectious diseases
|January 26, 2024
概括
皮质类固醇的使用是非艾滋病毒患者中Pneumocystis jirovecii肺炎 (PJP) 的主要危险因素. 目前的预防指导方针不足,需要更新,以更好地预防这种脆弱人群中的PJP.
科学领域:
- 传染性疾病 传染性疾病
- 免疫学 免疫学 免疫学
- 肺部病理学 肺部病理学
背景情况:
- 肺囊杆菌 (PJP) 的肺炎对免疫受损的个体构成重大风险.
- 在非艾滋病毒病例中,PJP的流行病学数据和风险因素有限.
- 目前针对PJP的预防指南对于非艾滋病毒感染者群体来说是不够的.
研究的目的:
- 调查非艾滋病毒免疫受损患者中PJP的流行病学和危险因素.
- 为了评估当前PJP预防策略在这个人群中的有效性.
- 为非艾滋病毒病例的PJP预防提供最新的指南.
主要方法:
- 多中心回顾性试验,包括加拿大北克市 (2011-2021) 的非艾滋病毒成年PJP病例.
- 评估患者的人口统计,潜在疾病,药物使用 (皮质类固醇,免疫抑制剂) 和PJP预防.
- 分析了当前预防建议对研究队列的适用性.
主要成果:
- 确定了129例非艾滋病毒PJP病例,其中大多数患有血液学,自身免疫或炎症性疾病.
- 超过80%的患者使用皮质类固醇,超过70%的患者在PJP诊断之前使用免疫抑制剂.
- 很大一部分患者 (48.8%) 不符合当前PJP预防建议的标准,只有4.7%接受了预防.
结论:
- 皮质类固醇的使用,无论是单独使用还是与其他免疫抑制剂一起使用,是非艾滋病毒患者中PJP的主要风险因素.
- 现有的PJP预防指南和实践对于这一群体来说是不够的.
- 迫切需要扩大和更新对非艾滋病毒免疫受损个体的PJP预防指南.
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