中华皮肤科杂志 ›› 2025, Vol. 58 ›› Issue (4): 315-321.doi: 10.35541/cjd.20240516

• 论著·急危重皮肤病 • 上一篇    下一篇

【开放获取】 药物超敏反应综合征继发肺孢子菌肺炎的临床特征和影响因素探索

王思凡    何春霞    晋红中   

  1. 中国医学科学院  北京协和医院皮肤科  疑难重症及罕见病国家重点实验室  国家皮肤与免疫疾病临床医学研究中心，北京  100730
  • 收稿日期:2024-09-27 修回日期:2025-02-07 发布日期:2025-04-03
  • 通讯作者: 晋红中 E-mail:jinhongzhong@263.net
  • 基金资助:
    国家重点研发计划（2022YFC3601800）；中央高水平医院临床科研业务费（2022-PUMCH-B-092）；国家临床重点专科建设项目；北京市临床重点专科项目

Clinical characteristics of and factors influencing Pneumocystis pneumonia secondary to drug-induced hypersensitivity syndrome

Wang Sifan, He Chunxia, Jin Hongzhong   

  1. Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing 100730, China
  • Received:2024-09-27 Revised:2025-02-07 Published:2025-04-03
  • Contact: Jin Hongzhong E-mail:jinhongzhong@263.net
  • Supported by:
    National Key R&D Program of China （2022YFC3601800）; National High Level Hospital Clinical Research Funding （2022-PUMCH-B-092）; National Key Clinical Specialty Project of China; Beijing Key Clinical Specialty Construction Project

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摘要： 【摘要】 目的 探究药物超敏反应综合征（DIHS）继发肺孢子菌肺炎（PCP）的临床特征和影响因素。方法 回顾性分析2019年1月至2024年8月于北京协和医院皮肤科诊治的DIHS继发PCP患者的人口学特征、临床表现、实验室检查及治疗资料。按1∶2配对，选取性别相同、年龄 ± 3岁、病情严重程度相同、同期诊治但未继发PCP的DIHS患者作为对照组。组间比较采用独立样本t检验、Mann-Whitney U检验和Fisher精确概率检验。结果 共纳入8例DIHS继发PCP患者，男性5例，女性3例，年龄（62.38 ± 20.74）岁，DIHS严重程度均为重度，治疗DIHS均应用了大剂量糖皮质激素（简称激素），7例联合免疫球蛋白、免疫抑制剂、生物制剂或Janus激酶抑制剂。后续激素减量过程中8例患者均出现DIHS复发，6例出现病毒再激活，最常见为巨细胞病毒（CMV）。8例患者发生PCP时均表现为咳嗽、呼吸困难，确诊均依靠痰或支气管肺泡灌洗液中肺孢子菌DNA阳性。8例患者中7例抗PCP治疗后好转，1例病情恶化后死亡。单因素分析显示，相较于未继发PCP的DIHS患者，DIHS继发PCP患者泼尼松当量超过20 mg/d应用时间更长，外周血淋巴细胞计数、CD4+ T淋巴细胞计数、白蛋白水平更低，病程中常出现DIHS复发、CMV再激活（均P < 0.05）。结论 DIHS患者继发PCP时常见咳嗽、呼吸困难。长时间应用大剂量激素、外周血淋巴细胞减少、CD4+ T淋巴细胞减少、DIHS复发、CMV再激活、白蛋白减低可能是DIHS继发PCP的影响因素。

关键词: 药物高敏综合征, 药疹, 肺炎, 肺囊虫性, 糖皮质激素类, 恶唑类

Abstract: 【Abstract】 Objective To analyze the clinical characteristics of Pneumocystis pneumonia （PCP） in patients with drug-induced hypersensitivity syndrome （DIHS）, and to identify factors influencing the development of PCP in patients with DIHS. Methods Patients with DIHS accompanied by PCP who were hospitalized at Department of Dermatology, Peking Union Medical College Hospital from January 2019 to August 2024 were collected, and their demographic characteristics, clinical manifestations, laboratory tests, and treatment data were retrospectively analyzed. A matched control group of DIHS patients without PCP was selected based on sex, age （± 3 years）, and disease severity at a ratio of 2∶1. Comparisons between groups were made using the independent samples t-test, Mann-Whitney U test, and Fisher's exact test. Results Eight patients with DIHS accompanied by PCP were enrolled, aged 62.38 ± 20.74 years, including 5 males and 3 females. All DIHS cases were categorized as severe, and high-dose corticosteroids were applied in the treatment of DIHS, with 7 cases additionally receiving intravenous immunoglobulins, immunosuppressants, biologic agents, or Janus kinase inhibitors. During the corticosteroid tapering, 8 patients experienced recurrences of DIHS, and 6 patients exhibited reactivation of viruses, with cytomegalovirus （CMV） as the most common virus. All the patients presented with cough and dyspnea when PCP occurred, and the diagnosis of PCP was confirmed by the presence of Pneumocystis jirovecii DNA in sputum or bronchoalveolar lavage fluid. Seven patients improved with anti-PCP treatment, while one succumbed due to disease progression. Univariate analysis indicated that, compared to DIHS patients without PCP, DIHS patients with PCP received longer treatment with prednisone equivalent > 20 mg/d, had lower peripheral lymphocyte counts, CD4+ T lymphocyte counts, and albumin levels, and had a higher frequency of DIHS recurrence and CMV reactivation during the disease course （all P < 0.05）. Conclusions Cough and dyspnea are common manufestations of PCP in patients with DIHS. Prolonged use of high-dose corticosteroids, decreased peripheral lymphocytes, decreased CD4+ T lymphocytes, DIHS recurrence, CMV reactivation, and decreased albumin levels may be the influencing factors for concurrent PCP in DIHS patients.

Key words: Drug hypersensitivity syndrome, Drug eruptions, Pneumonia, Pneumocystis, Glucocorticoids, Oxazoles

引用本文

王思凡 何春霞 晋红中. 【开放获取】 药物超敏反应综合征继发肺孢子菌肺炎的临床特征和影响因素探索[J]. 中华皮肤科杂志, 2025,58(4):315-321. doi:10.35541/cjd.20240516

Wang Sifan, He Chunxia, Jin Hongzhong. Clinical characteristics of and factors influencing Pneumocystis pneumonia secondary to drug-induced hypersensitivity syndrome [J]. Chinese Journal of Dermatology, 2025, 58(4): 315-321.doi:10.35541/cjd.20240516