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耶氏肺孢子菌肺炎的诊疗进展
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Abstract:
在人类免疫缺陷病毒(HIV)感染的患者中，耶氏肺孢子菌肺炎(PCP)是一种众所周知的机会性感染。然而，PCP已经成为对非HIV感染的免疫功能低下患者的新威胁，如接受免疫抑制治疗恶性肿瘤、器官移植或结缔组织疾病的患者。PCP的临床表现在HIV和非HIV的患者之间有很大不同。在非HIV的患者中，PCP进展迅速，导致严重的呼吸衰竭，并且预后不良。这种差异是由于非HIV患者体内相对较少的肺孢子菌引起了严重的炎症反应。最近的研究表明聚合酶链反应(PCR)和血清β-D-葡聚糖测定对PCP具有快速诊断价值，同时，宏基因组学测序(mNGS)也被越来越多的用于PCP的诊断。虽然皮质类固醇辅助治疗已被证明对某些人群有益，但最佳剂量和用药时间仍有待确定。最近的调查显示，肺孢子菌定植很普遍，无症状携带者有患PCP的风险，并且可以作为肺孢子菌的传播宿主。这些发现表明需要对免疫功能低下的患者预防。由于出现了多种新型免疫抑制疗法，因此需要进一步创新PCP的诊断和治疗。
Pneumocystis carinii pneumonia (PCP) is a well-known opportunistic infection in patients with hu-man immunodeficiency virus (HIV) infection. However, PCP has emerged as a new threat to non-HIV-infected immunocompromised patients, such as those undergoing immunosuppressive therapy for malignancy, organ transplantation, or connective tissue disease. The clinical manifesta-tions of PCP vary considerably between HIV- and non-HIV-infected patients. In non-HIV patients, PCP progresses rapidly, leads to severe respiratory failure, and has a poor prognosis. This difference is due to the severe inflammatory response caused by the relatively small number of Pneumocystis carinii in non-HIV patients. Recent studies have demonstrated the rapid diagnostic value of poly-merase chain reaction (PCR) and serum β-D-glucan assays for PCP, while macro-genomics sequenc-ing (mNGS) is increasingly being used for the diagnosis of PCP. Although adjuvant corticosteroid therapy has been shown to be beneficial in some populations, the optimal dose and duration of ad-ministration remain to be determined. Recent investigations have shown that Pneumocystis colo-nization is common, that asymptomatic carriers are at risk for PCP, and that they can serve as transmission hosts for Pneumocystis. These findings suggest the need for prophylaxis in immuno-compromised patients. Further innovations in the diagnosis and treatment of PCP are needed as a result of the emergence of several novel immunosuppressive therapies.
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