Purpose. With immunosuppressants being widely used, Pneumocystis jirovecii pneumonia (PCP) has been increasing and could be life-threatening among HIV-negative patients. This study aimed at identifying prognostic factors of PCP in patients with nephrotic syndrome. Methods. We retrospectively investigated patients with nephrotic syndrome who were diagnosed with PCP. The diagnosis of PCP was based on clinical manifestations, radiological findings, and microbiological confirmatory tests. Predictors of outcome were determined with multivariate logistic regression analysis. Results. A total of 57 patients were included in this study. The PCP mortality was 33.3%, which increased to 48.6% if ICU admission was required and to 60% when mechanical ventilation was needed. The T lymphocyte count and CD4/CD8 ratio independently predicted the outcome of PCP, so did the CD4⁺ T lymphocyte count (OR, 0.981; 95% CI, 0.967–0.996; ). The cut-off value of 71 cells/μl for the CD4⁺ T lymphocyte count was determined to identify patients with poor prognosis. No association was found between PCP mortality and the type of immunosuppressant used. Conclusions. PCP is a fatal complication among nephrotic syndrome patients receiving immunosuppressive therapy. The CD4⁺ T lymphocyte count is suggested as an independent predictor of prognosis, which can be used clinically to identify patients with high risk of unfavorable outcomes.

中文翻译：

---

Pneumocystis jirovecii 肺炎在肾病综合征患者中的应用：淋巴细胞亚群分析在预测临床结果中的应用

目的。随着免疫抑制剂的广泛使用，耶氏​​肺孢子菌肺炎 (PCP) 一直在增加，并可能危及 HIV 阴性患者的生命。本研究旨在确定肾病综合征患者 PCP 的预后因素。方法。我们回顾性调查了被诊断为 PCP 的肾病综合征患者。PCP 的诊断基于临床表现、放射学发现和微生物学确认试验。结果的预测因子通过多变量逻辑回归分析确定。结果. 本研究共纳入 57 名患者。PCP 死亡率为 33.3%，如果需要入住 ICU，死亡率会增加到 48.6%，如果需要机械通气，死亡率会增加到 60%。T 淋巴细胞计数和 CD4/CD8 比率独立预测 PCP 的结果，CD4 ⁺ T 淋巴细胞计数也是如此（OR，0.981；95% CI，0.967-0.996；）。确定CD4 ^{+ T 淋巴细胞计数的 71 个细胞/} μl的临界值以识别预后不良的患者。未发现 PCP 死亡率与使用的免疫抑制剂类型之间存在关联。结论。PCP 是接受免疫抑制治疗的肾病综合征患者的致命并发症。CD4 ⁺T 淋巴细胞计数被认为是预后的独立预测因子，可用于临床识别不良预后的高风险患者。