|
|
特发性炎性肌病合并耶氏肺孢子虫肺炎进展
|
Abstract:
耶氏肺孢子虫肺炎(Pneumocystis Jirovecii Pneumonia, PJP)是一种机会性感染，其发病率低但死亡率高，既往多发于人类免疫缺陷病毒(Human Immunodeficiency Virus, HIV)患者中。由于免疫抑制治疗的广泛使用，PJP已成为免疫功能低下的非HIV感染患者的新威胁。PJP患者的临床表现、诊断方法、危险因素、治疗及预后在HIV患者及非HIV患者中不完全相同。在非HIV患者中PJP往往进展迅速，容易出现呼吸衰竭导致预后不良。PJP的诊断方法有多种包括肺囊虫镜检、聚合酶链反应(PCR)、宏基因组二代测序(NGS)，但上述方法均为有创操作且适用范围受限。血清学检查β-D葡聚糖( beta-D glucan, β-DG)是一种较为简便的无创操作，有较高的灵敏度及阴性预测值，目前越来越多地运用于PJP的辅助诊断。因合并PJP往往导致较差结局，故寻找其危险因素很重要，以便早期预防及治疗。有研究表明PJP好发于特发性炎性肌病(Idiopathic Inflammatory Myopathies, IIM)患者中，故本文对PubMed及知网数据库进行了全面的文献检索，对特发性炎性肌病合并耶氏肺孢子虫肺炎患者的发病机制、临床特征、诊断方法、危险因素、治疗及预防等方面做一个系统阐述。
Pneumocystis jirovecii pneumonia (PJP) is an opportunistic infection with low morbidity but high mortality that has been prevalent in patients with human immunodeficiency virus (HIV). Due to the widespread use of immunosuppressive therapy, PJP has emerged as a new threat to immunocompromised non-HIV-infected patients. The clinical presentation, diagnostic approach, risk factors, treatment, and prognosis in patients with PJP are not identical in HIV patients and non-HIV patients. In non-HIV patients, PJP tends to progress rapidly and is prone to respiratory failure, leading to a poor prognosis. There are a variety of methods for the diagnosis of PJP, such as microscopic examination of pneumocystis, polymerase chain reaction (PCR), and metagenomic next-generation sequencing (NGS), but these methods are invasive and have limited applicability. Serological beta-D glucan (β-DG) is a relatively simple and non-invasive operation with high sensitivity and negative predictive value, which is increasingly used as an auxiliary diagnosis of PJP. Because the combination of PJP tends to lead to worse outcomes, it is important to look for risk factors for early prevention and treatment. Studies have shown that PJP is more common in idiopathic inflammatory myopathy (IIM), so this paper conducted a comprehensive literature search of PubMed and CNKI databases to systematically elaborate on the pathogenesis, clinical features, diagnostic methods, risk factors, treatment and prevention of idiopathic inflammatory myopathies complicated with pneumocystis jirovecii pneumonia.
| [1] | Lundberg, I.E., Fujimoto, M., Vencovsky, J., Aggarwal, R., Holmqvist, M., Christopher-Stine, L., et al. (2021) Idiopathic Inflammatory Myopathies. Nature Reviews Disease Primers, 7, Article No. 86. https://doi.org/10.1038/s41572-021-00321-x |
| [2] | Mariampillai, K., Granger, B., Amelin, D., Guiguet, M., Hachulla, E., Maurier, F., et al. (2018) Development of a New Classification System for Idiopathic Inflammatory Myopathies Based on Clinical Manifestations and Myositis-Specific Autoantibodies. JAMA Neurology, 75, 1528-1537. https://doi.org/10.1001/jamaneurol.2018.2598 |
| [3] | Salzer, H.J.F., Schäfer, G., Hoenigl, M., Günther, G., Hoffmann, C., Kalsdorf, B., et al. (2018) Clinical, Diagnostic, and Treatment Disparities between HIV-Infected and Non-HIV-Infected Immunocompromised Patients with Pneumocystis jirovecii Pneumonia. Respiration, 96, 52-65. https://doi.org/10.1159/000487713 |
| [4] | Bienvenu, A., Traore, K., Plekhanova, I., Bouchrik, M., Bossard, C. and Picot, S. (2016) Pneumocystis Pneumonia Suspected Cases in 604 Non-HIV and HIV Patients. International Journal of Infectious Diseases, 46, 11-17. https://doi.org/10.1016/j.ijid.2016.03.018 |
| [5] | Chen, X., Shu, X., He, L., Yang, H., Lu, X., Wang, G., et al. (2023) High Prevalence and Mortality of Pneumocystis jirovecii Pneumonia in Anti-Mda5 Antibody-Positive Dermatomyositis. Rheumatology, 62, 3302-3309. https://doi.org/10.1093/rheumatology/kead063 |
| [6] | Thompson, C., Piguet, V. and Choy, E. (2017) The Pathogenesis of Dermatomyositis. British Journal of Dermatology, 179, 1256-1262. https://doi.org/10.1111/bjd.15607 |
| [7] | 郝伟丽, 周晓鸿. 免疫因素在特发性炎症性肌病中的作用机制[J]. 皮肤病与性病, 2010, 32(2): 17-19. |
| [8] | Tournadre, A. and Miossec, P. (2009) Chemokines and Dendritic Cells in Inflammatory Myopathies. Annals of the Rheumatic Diseases, 68, 300-304. https://doi.org/10.1136/ard.2008.095984 |
| [9] | Shamim, E.A., Rider, L.G., Pandey, J.P., O’Hanlon, T.P., Jara, L.J., Samayoa, E.A., et al. (2002) Differences in Idiopathic Inflammatory Myopathy Phenotypes and Genotypes between Mesoamerican Mestizos and North American Caucasians: Ethnogeographic Influences in the Genetics and Clinical Expression of Myositis. Arthritis & Rheumatism, 46, 1885-1893. https://doi.org/10.1002/art.10358 |
| [10] | Apostolopoulou, A. and Fishman, J.A. (2022) The Pathogenesis and Diagnosis of Pneumocystis Jiroveci Pneumonia. Journal of Fungi, 8, Article 1167. https://doi.org/10.3390/jof8111167 |
| [11] | Harris, J.R., Balajee, S.A. and Park, B.J. (2010) Pneumocystis jirovecii Pneumonia: Current Knowledge and Outstanding Public Health Issues. Current Fungal Infection Reports, 4, 229-237. https://doi.org/10.1007/s12281-010-0029-3 |
| [12] | Groll, A.H., Ritter, J. and Müller, F.C. (2001) Empfehlungen zur Prävention der Pneumocystis-carinii-Pneumonie bei Kindern und Jugendlichen mit neoplastischen Erkrankungen. Klinische Pädiatrie, 213, A38-A49. https://doi.org/10.1055/s-2001-17501 |
| [13] | O’Riordan, D.M., Standing, J.E. and Limper, A.H. (1995) Pneumocystis Carinii Glycoprotein A Binds Macrophage Mannose Receptors. Infection and Immunity, 63, 779-784. https://doi.org/10.1128/iai.63.3.779-784.1995 |
| [14] | Ezekowitz, R.A.B., Williams, D.J., Koziel, H., Armstrong, M.Y.K., Warner, A., Richards, F.F., et al. (1991) Uptake of Pneumocystis Carinii Mediated by the Macrophage Mannose Receptor. Nature, 351, 155-158. https://doi.org/10.1038/351155a0 |
| [15] | Steele, C., Marrero, L., Swain, S., Harmsen, A.G., Zheng, M., Brown, G.D., et al. (2003) Alveolar Macrophage-Mediated Killing of Pneumocystis carinii F. sp. Muris Involves Molecular Recognition by the Dectin-1 Β-Glucan Receptor. The Journal of Experimental Medicine, 198, 1677-1688. https://doi.org/10.1084/jem.20030932 |
| [16] | Limper, A.H., Hoyte, J.S. and Standing, J.E. (1997) The Role of Alveolar Macrophages in Pneumocystis Carinii Degradation and Clearance from the Lung. Journal of Clinical Investigation, 99, 2110-2117. https://doi.org/10.1172/jci119384 |
| [17] | Beck, J.M., Preston, A.M., Wagner, J.G., Wilcoxen, S.E., Hossler, P., Meshnick, S.R., et al. (1998) Interaction of Ratpneumocystis Cariniiand Rat Alveolar Epithelial Cells in Vitro. American Journal of Physiology-Lung Cellular and Molecular Physiology, 275, L118-L125. https://doi.org/10.1152/ajplung.1998.275.1.l118 |
| [18] | Beck, J.M., Preston, A.M., Wilcoxen, S.E., Morris, S.B., White, E.S. and Paine, R. (2003) Pneumocystis Pneumonia Increases the Susceptibility of Mice to Sublethal Hyperoxia. Infection and Immunity, 71, 5970-5978. https://doi.org/10.1128/iai.71.10.5970-5978.2003 |
| [19] | Limper, A.H., Offord, K.P., Smith, T.F. and Martin, W.J. (1989) Pneumocystis carinii Pneumonia: Differences in Lung Parasite Number and Inflammation in Patients with and without Aids. American Review of Respiratory Disease, 140, 1204-1209. https://doi.org/10.1164/ajrccm/140.5.1204 |
| [20] | Khoo, T., Lilleker, J.B., Thong, B.Y., Leclair, V., Lamb, J.A. and Chinoy, H. (2023) Epidemiology of the Idiopathic Inflammatory Myopathies. Nature Reviews Rheumatology, 19, 695-712. https://doi.org/10.1038/s41584-023-01033-0 |
| [21] | Roux, A., Canet, E., Valade, S., Gangneux-Robert, F., Hamane, S., Lafabrie, A., et al. (2014) Pneumocystis jirovecii Pneumonia in Patients with or without AIDS, France. Emerging Infectious Diseases, 20, 1490-1497. https://doi.org/10.3201/eid2009.131668 |
| [22] | Thomas, C.F. and Limper, A.H. (2004) Pneumocystis Pneumonia. New England Journal of Medicine, 350, 2487-2498. https://doi.org/10.1056/nejmra032588 |
| [23] | Liu, Y., Wang, X., Xu, J., Yang, Q., Zhu, H. and Yang, J. (2023) Diagnostic Value of Metagenomic Next-Generation Sequencing of Lower Respiratory Tract Specimen for the Diagnosis of Suspected Pneumocystis jirovecii Pneumonia. Annals of Medicine, 55, Article 2232358. https://doi.org/10.1080/07853890.2023.2232358 |
| [24] | Bateman, M., Oladele, R. and Kolls, J.K. (2020) Diagnosing Pneumocystis jirovecii Pneumonia: A Review of Current Methods and Novel Approaches. Medical Mycology, 58, 1015-1028. https://doi.org/10.1093/mmy/myaa024 |
| [25] | Mehta, P., Aggarwal, R., Porter, J.C. and Gunawardena, H. (2022) Management of Interstitial Lung Disease (ILD) in Myositis Syndromes: A Practical Guide for Clinicians. Best Practice & Research Clinical Rheumatology, 36, Article 101769. https://doi.org/10.1016/j.berh.2022.101769 |
| [26] | Szvalb, A.D., Malek, A.E., Jiang, Y., Bhatti, M.M., Wurster, S. and Kontoyiannis, D.P. (2020) Serum (1,3)-Beta-D-Glucan Has Suboptimal Performance for the Diagnosis of Pneumocystis jirovecii Pneumonia in Cancer Patients and Correlates Poorly with Respiratory Burden as Measured by Quantitative PCR. Journal of Infection, 81, 443-451. https://doi.org/10.1016/j.jinf.2020.07.003 |
| [27] | Taniguchi, J., Nakashima, K., Matsui, H., Watari, T., Otsuki, A., Ito, H., et al. (2021) Low Cut-Off Value of Serum (1,3)-Beta-D-Glucan for the Diagnosis of Pneumocystis Pneumonia in Non-HIV Patients: A Retrospective Cohort Study. BMC Infectious Diseases, 21, Article No. 1200. https://doi.org/10.1186/s12879-021-06895-x |
| [28] | Hammarström, H., Grankvist, A., Broman, I., Kondori, N., Wennerås, C., Gisslen, M., et al. (2019) Serum-Based Diagnosis of Pneumocystis Pneumonia by Detection of Pneumocystis jirovecii DNA and 1,3-Β-D-Glucan in HIV-Infected Patients: A Retrospective Case Control Study. BMC Infectious Diseases, 19, Article No. 658. https://doi.org/10.1186/s12879-019-4289-4 |
| [29] | Liu, L., Yuan, M., Shi, Y. and Su, X. (2021) Clinical Performance of BAL Metagenomic Next-Generation Sequence and Serum (1,3)-Β-D-Glucan for Differential Diagnosis of Pneumocystis jirovecii Pneumonia and Colonisation. Frontiers in Cellular and Infection Microbiology, 11, Article 784236. https://doi.org/10.3389/fc Pneumocystis jirovecii imb.2021.784236 |
| [30] | Karageorgopoulos, D.E., Qu, J.-M., Korbila, I.P., Zhu, Y.-G., Vasileiou, V.A. and Falagas, M.E. (2013) Accuracy of Β-D-Glucan for the Diagnosis of Pneumocystis jirovecii Pneumonia: A Meta-Analysis. Clinical Microbiology and Infection, 19, 39-49. https://doi.org/10.1111/j.1469-0691.2011.03760.x |
| [31] | Lagrou, K., Chen, S., Masur, H., Viscoli, C., Decker, C.F., Pagano, L., et al. (2021) Pneumocystis jirovecii Disease: Basis for the Revised EORTC/MSGERC Invasive Fungal Disease Definitions in Individuals without Human Immunodeficiency Virus. Clinical Infectious Diseases, 72, S114-S120. https://doi.org/10.1093/cid/ciaa1805 |
| [32] | Tasaka, S. (2020) Recent Advances in the Diagnosis and Management of Pneumocystis Pneumonia. Tuberculosis and Respiratory Diseases, 83, Article 132. https://doi.org/10.4046/trd.2020.0015 |
| [33] | Hsu, C., Ko, C., Wang, J., Hsu, T. and Lin, C. (2019) Comparing the Burdens of Opportunistic Infections among Patients with Systemic Rheumatic Diseases: A Nationally Representative Cohort Study. Arthritis Research & Therapy, 21, Article No. 211. https://doi.org/10.1186/s13075-019-1997-5 |
| [34] | Sabbagh, S.E., Neely, J., Chow, A., DeGuzman, M., Lai, J., Lvovich, S., et al. (2020) Risk Factors Associated with Pneumocystis jirovecii Pneumonia in Juvenile Myositis in North America. Rheumatology, 60, 829-836. https://doi.org/10.1093/rheumatology/keaa436 |
| [35] | Vassallo, R., Standing, J.E. and Limper, A.H. (2000) Isolated Pneumocystis Carinii Cell Wall Glucan Provokes Lower Respiratory Tract Inflammatory Responses. The Journal of Immunology, 164, 3755-3763. https://doi.org/10.4049/jimmunol.164.7.3755 |
| [36] | Prévost, M. (1998) XV. Pneumocystosis Pathophysiology. FEMS Immunology and Medical Microbiology, 22, 123-128. https://doi.org/10.1016/s0928-8244(98)00069-8 |
| [37] | Li, J., Wang, S., Zheng, J., Li, Q., Li, J. and Lu, L. (2022) Clinical Characteristics of and Risk Factors for Pneumocystis jirovecii Pneumonia in Anti-Melanoma Differentiation-Associated Gene 5 (Anti-Mda5) Antibody-Positive Dermatomyositis Patients: A Single-Center Retrospective Study. Clinical Rheumatology, 42, 453-462. https://doi.org/10.1007/s10067-022-06403-9 |
| [38] | Mecoli, C.A. and Danoff, S.K. (2020) Pneumocystis jirovecii Pneumonia and Other Infections in Idiopathic Inflammatory Myositis. Current Rheumatology Reports, 22, Article No. 7. https://doi.org/10.1007/s11926-020-0883-0 |
| [39] | Jin, F., Liu, X., Chen, W., Fan, Z. and Wang, H. (2019) High Initial (1, 3) Beta-D-Glucan Concentration May Be a Predictor of Satisfactory Response of C Aspofungin Combined with TMP/SMZ for HIV-Negative Patients with Moderate to Severe Pneumocystis jirovecii Pneumonia. International Journal of Infectious Diseases, 88, 141-148. https://doi.org/10.1016/j.ijid.2019.08.015 |
| [40] | Quist, J. and Hill, A.R. (1995) Serum Lactate Dehydrogenase (LDH) in Pneumocystis Carinii Pneumonia, Tuberculosis, and Bacterial Pneumonia. Chest, 108, 415-418. https://doi.org/10.1378/chest.108.2.415 |
| [41] | 孟淑艳. 血清铁蛋白、CYFRA21-1及ESR在肺癌诊断和病情评估中的应用价值[J]. 中国卫生工程学, 2024, 23(4): 546-548. |
| [42] | 刘昕, 张晓萌, 马楠, 等. 甲功、ESR、WBC、NLR在SAT急性炎症期和恢复期的比较分析[J]. 标记免疫分析与临床, 2022, 29(8): 1280-1284. |
| [43] | Kaplan, J.E., Benson, C., Holmes, K.K., Brooks, J.T., Pau, A., Masur, H. and HIV Medicine Association of the Infectious Diseases Society of America (2009) Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents. MMWR Recommendations and Reports, 58, 1-207. |
| [44] | Maschmeyer, G., Helweg-Larsen, J., Pagano, L., Robin, C., Cordonnier, C. and Schellongowski, P. (2016) ECIL Guidelines for Treatment of Pneumocystis jirovecii Pneumonia in Non-HIV-Infected Haematology Patients. Journal of Antimicrobial Chemotherapy, 71, 2405-2413. https://doi.org/10.1093/jac/dkw158 |
| [45] | Park, J.W., Curtis, J.R., Kim, M.J., Lee, H., Song, Y.W. and Lee, E.B. (2019) Pneumocystis Pneumonia in Patients with Rheumatic Diseases Receiving Prolonged, Non-High-Dose Steroids—Clinical Implication of Primary Prophylaxis Using Trimethoprim-Sulfamethoxazole. Arthritis Research & Therapy, 21, Article No. 207. https://doi.org/10.1186/s13075-019-1996-6 |
| [46] | Yale, S.H. and Limper, A.H. (1996) Pneumocystis Carinii Pneumonia in Patients without Acquired Immunodeficiency Syndrome: Associated Illnesses and Prior Corticosteroid Therapy. Mayo Clinic Proceedings, 71, 5-13. https://doi.org/10.4065/71.1.5 |
| [47] | Winthrop, K.L. and Baddley, J.W. (2018) Pneumocystis and Glucocorticoid Use: To Prophylax or Not to Prophylax (and When). That Is the Question. Annals of the Rheumatic Diseases, 77, 631-633. https://doi.org/10.1136/annrheumdis-2017-212588 |
| [48] | Sowden, E. and Carmichael, A.J. (2004) Autoimmune Inflammatory Disorders, Systemic Corticosteroids and Pneumocystis Pneumonia: A Strategy for Prevention. BMC Infectious Diseases, 4, Article No. 42. https://doi.org/10.1186/1471-2334-4-42 |
