关键词: 肾脏病, 耶氏肺孢子菌肺炎, 糖皮质激素, 临床特征, 预后

Abstract: Objective:A retrospective analysis was conducted on the clinical characteristics and prognosis of patients with Pneumocystis jirovecii Pneumonia (PJP) secondary to kidney disease with immunodeficiency,with a focus on evaluating the efficacy of adjunctive glucocorticoid therapy in these patients. Methods:Patients with PJP admitted to the National Clinical Research Center for Kidney Diseases from August 2009 to June 2025 were included and divided into improvement and mortality groups based on prognosis. Their clinical characteristics and prognosis were analyzed. Patients were divided into a standard-dose glucocorticoid group (MP=80 mg/d) 272 cases and a low-dose glucocorticoid group (MP≤40 mg/d) 84 cases based on different methylprednisolone treatment doses,to analyze the role of adjunctive glucocorticoid therapy. Results:A total of 356 patients with kidney disease and secondary immunodeficiency were clinically diagnosed with PJP. The primary kidney diseases included 131 cases(36.8%)of post⁃allogeneic renal transplantation,48 cases(13.5%)of lupus nephritis,43 cases(12.1%)of podocytopathy,and 40 cases(11.2%)of membranous nephropathy among others. After treatment,257 cases(72.2%)improved and were discharged,while 99 cases(27.8%)died. Multivariate logistic regression analysis revealed that advanced age,high fever on the third day of admission,low platelet count,low oxygenation index,and low CD4+T cell count indicated a poor prognosis. The ROC curve demonstrated that the combined prediction model has a high AUC(0.925). Compared with the low⁃dose glucocorticoid group,the standard⁃dose group showed significantly lower mortality,higher mechanical ventilation weaning rate,and faster reduction in CRP levels and body temperature. There was no significant difference in the incidence of adverse events such as secondary infections and gastrointestinal bleeding between the two groups (P>0.05). Conclusion: Adjuvant use of standard-dose glucocorticoids can significantly reduce mortality in Pneumocystis jirovecii Pneumonia patients with immunodeficiency kidney disease,improve mechanical ventilation weaning rates,accelerate the reduction of inflammatory markers,and does not increase adverse events such as infections or gastrointestinal bleeding.

Key words: kidney disease, pneumocystis jirovecii pneumonia, glucocorticoid, clinical characteristics, prognosis