炎症性肠病患者患吉氏肺孢子虫肺炎的危险因素:一项基于全国人群的研究。

IF 3.4 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Gut and Liver Pub Date : 2024-05-15 Epub Date: 2023-10-23 DOI:10.5009/gnl230152
Jiyoung Yoon, Seung Wook Hong, Kyung-Do Han, Seung-Woo Lee, Cheol Min Shin, Young Soo Park, Nayoung Kim, Dong Ho Lee, Joo Sung Kim, Hyuk Yoon
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引用次数: 0

摘要

背景/目的:吉氏肺孢子虫肺炎(PJP)是一种罕见但可能致命的感染。本研究旨在探讨炎症性肠病(IBD)患者发生PJP的危险因素。方法:这项全国性的基于人群的研究在韩国进行,使用索赔数据。在2010年至2017年间,在被诊断为溃疡性结肠炎(UC)或克罗恩病(CD)的患者中发现了PJP病例,并分析了每位患者的临床数据。双重和三重治疗被定义为同时处方两种或三种以下药物:类固醇、钙调神经磷酸酶抑制剂、免疫调节剂和生物制品。结果:在平均随访期(4.6±2.3年)内,39462名IBD患者(31名CD和53名UC)中发现了84例PJP。对于CD患者,只有诊断年龄>40岁(危险比[HR],6.12;95%置信区间[CI],1.58至23.80)与PJP风险显著相关,而在UC患者中,糖尿病(HR,2.51;95%CI,1.19至5.31)和慢性阻塞性肺病(HR,3.41;95%可信区间,1.78至6.52)的诊断与PJP的风险显著相关。三重治疗增加了UC(HR,3.90;95%CI,1.54至9.88)和CD患者(HR,5.69;95%CI为2.32至14.48)的PJP风险。然而,双重治疗仅增加了UC患者的PJP危险(HR,2.53;95%CI 1.36至4.70)。此外,23名患者(27%)接受了重症监护治疗,10名患者(12%)在30天内死亡。结论:CD和UC患者PJP的危险因素不同。考虑到PJP的潜在致死性,应考虑对高危IBD患者进行预防。
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Risk Factors of Pneumocystis jirovecii Pneumonia in Patients with Inflammatory Bowel Disease: A Nationwide Population-Based Study.

Background/aims: : Pneumocystis jirovecii pneumonia (PJP) is a rare but potentially fatal infection. This study was conducted to investigate the risk factors for PJP in inflammatory bowel disease (IBD) patients.

Methods: : This nationwide, population-based study was conducted in Korea using claims data. Cases of PJP were identified in patients diagnosed with ulcerative colitis (UC) or Crohn's disease (CD) between 2010 and 2017, and the clinical data of each patient was analyzed. Dual and triple therapy was defined as the simultaneous prescription of two or three of the following drugs: steroids, calcineurin inhibitors, immunomodulators, and biologics.

Results: : During the mean follow-up period (4.6±2.3 years), 84 cases of PJP were identified in 39,462 IBD patients (31 CD and 53 UC). For CD patients, only age at diagnosis >40 years (hazard ratio [HR], 6.12; 95% confidence interval [CI], 1.58 to 23.80) was significantly associated with the risk of PJP, whereas in UC patients, diagnoses of diabetes (HR, 2.51; 95% CI, 1.19 to 5.31) and chronic obstructive pulmonary disease (HR, 3.41; 95% CI, 1.78 to 6.52) showed significant associations with PJP risk. Triple therapy increased PJP risk in both UC (HR, 3.90; 95% CI, 1.54 to 9.88) and CD patients (HR, 5.69; 95% CI, 2.32 to 14.48). However, dual therapy increased PJP risk only in UC patients (HR, 2.53; 95% CI, 1.36 to 4.70). Additionally, 23 patients (27%) received intensive care treatment, and 10 (12%) died within 30 days.

Conclusions: : PJP risk factors differ in CD and UC patients. Considering the potential fatality of PJP, prophylaxis should be considered for at-risk IBD patients.

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来源期刊
Gut and Liver
Gut and Liver 医学-胃肠肝病学
CiteScore
7.50
自引率
8.80%
发文量
119
审稿时长
6-12 weeks
期刊介绍: Gut and Liver is an international journal of gastroenterology, focusing on the gastrointestinal tract, liver, biliary tree, pancreas, motility, and neurogastroenterology. Gut and Liver delivers up-to-date, authoritative papers on both clinical and research-based topics in gastroenterology. The Journal publishes original articles, case reports, brief communications, letters to the editor and invited review articles in the field of gastroenterology. The Journal is operated by internationally renowned editorial boards and designed to provide a global opportunity to promote academic developments in the field of gastroenterology and hepatology. Gut and Liver is jointly owned and operated by 8 affiliated societies in the field of gastroenterology, namely: the Korean Society of Gastroenterology, the Korean Society of Gastrointestinal Endoscopy, the Korean Society of Neurogastroenterology and Motility, the Korean College of Helicobacter and Upper Gastrointestinal Research, the Korean Association for the Study of Intestinal Diseases, the Korean Association for the Study of the Liver, the Korean Pancreatobiliary Association, and the Korean Society of Gastrointestinal Cancer.
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