关键词: 慢性肾脏病, 肺孢子菌肺炎, 免疫缺陷

Abstract:

Ｏｂｊｅｃｔｉｖｅ：To identify clinical significance and prognostic factors of pneumocystis pneumonia (PCP) in chronic kidney disease (CKD) patients with secondary immunodeficiency.
Ｍｅｔｈｏｄｏｌｏｇｙ：This is a retrospective analysis. The clinical and laboratory data of CKD patients who diagnosed as PCP were collected. According to the outcome, these patients were divided into survivors and nonsurvivors, whose clinical significance and the relationship between immunologic function and prognosis were analyzed.
Ｒｅｓｕｌｔｓ：Among the fifty two cases, 14 were renal transplantation recipients. All of them had received immunosuppressive treatment and circulating CD4+ lymphocyte count were below 200/μl. Clinical presentations of onset were mainly chest stuffiness and fever. The chest radiographic images of all the patients showed bilateral, symmetric, reticular or granular opacities, and serum (13) βDglucan (BDG) levels were all above normal. 13 patients dead while 39 recovered after treatment. Multivariate logistic regression analysis revealed that lower CD4+ lymphocyte count, increased BDG and severe acute respiratory distress syndrome (ARDS) were prognostic factors of PCP. Receiver operating characteristic (ROC) curve indicated that CD4+ lymphocyte count >64/μl predicted satisfactory outcome. Covariance analysis of repeated sequencing variables showed the lymphocyte count persisted lower in the first 6 days after hospitalization indicated poor prognosis.Ｃｏｎｃｌｕｓｉｏｎ：
Lower CD4+ lymphocyte count, increased BDG and severe ARDS indicated poor prognosis in CKD patients with PCR. The immune state and reconstructive ability were the most important factors affecting the prognosis.

Key words: chronic kidney disease, secondary immunodeficiency, pneumocystis pneumonia