艾滋病合并重症肺炎的特征分析

摘要

目的 探讨艾滋病(acquired immunodeficiency syndrome,AIDS)合并重症肺炎的特征及病原学特点.方法 2016年1月至2018年1月,收集在临海市第一人民医院与台州医院住院治疗的AIDS合并重症肺炎患者的病例资料,统计患者实验室检查结果、影像学表现、病原菌分布、病原菌混合感染情况、治疗与转归,预后影响因素分析采用x2或Fisher确切概率法检验,多因素分析采用Logsitic同归分析.结果 42例患者中,男性发病率较高(90.48％),集中在21 ～50岁(78.57％);均伴随CD4+T淋巴细胞计数均＜200个/mm2(100.0％),其中69.05％患者＜50个/mm2;73.81％患者白蛋白水平＜ 25 g/L;胸部CT表现为多发或弥漫性分布的密度增高影及磨玻璃样改变.29例成功分离各类菌株(69.05％),共分离各类菌株76株,病原谱前三位依次为真菌(60.53％,46/76)、革兰阴性菌(15.79％,12/76)、革兰阳性菌(10.53％,8/76),92.86％患者伴随2种及以上病原菌感染.42例患者中,17例存活(40.48％)、25例死亡(59.52％),单因素分析显示CD4+T淋巴细胞计数＜50个/mm2、白蛋白＜ 25 g/L、机械通气与疾病预后有关,多元Logsitic回归分析显示白蛋白＜25 g/L、合并机械通气是影响疾病预后的独立危险因素.结论 AIDS合并重症肺炎患者以真菌感染最为常见,92.86％伴随混合感染;另外,低白蛋白水平、合并机械通气是影响预后的重要危险因素.%Objective To investigate the characteristics and pathogenic characteristics of acquired immunodeficiency syndrome (AIDS) complicated with severe pneumonia.Methods The clinical data of patients with AIDS complicated with severe pneumonia who were hospitalized and treated in the First People's Hospital of Linhai City from January 2016 to January 2018 were collected.The laboratory test results,imaging findings,distribution of pathogens,mixed infections of pathogens,treatment and outcomes were statistically analyzed.The influencing factors of the prognosis were tested by Fisher's exact test,and Logsitic regression analysis was used for multivariate analysis.Results Among the 42 patients,the majority were male patients (90.48％),and most of them were 21 to 50 years old (78.57％),and the onset involved multiple systems.The CD4 + T lymphocyte count was less than 200/mm2 (100.0％) in the 42 patients,including 69.05％ less than 50/mm2 and 73.81％ of patients had albumin levels lower than 25 g/L.Chest CT showed multiple or diffuse distribution of increased density and ground glass opacity.Various strains of microorganisms were successfully isolated from 29 cases (69.05％),a total of 76 strains.The top three of pathogen spectrum were fungi (60.53％,46/76),Gram negative bacteria (15.79％,12/76) and Gram positive bacteria (10.53％,8/76);92.86％ of the patients were infected with 2 or more kinds of pathogenic bacteria.In the 42 patients,17 cases (40.48％) survived and 25 cases (59.52％) died.Univariate analysis showed that CD4 + T lymphocyte count ＜ 50 /mm2,the albumin level ＜ 25 g/L and mechanical ventilation were related to the prognosis of the disease.Multivariate Logstic regression analysis showed that the albumin level ＜ 25 g/L and mechanical ventilation were independent risk factors affecting the prognosis of the disease.Conclusions Fungal infection is the most common infection in patients with AIDS complicated with severe pneumonia,and 92.86％ of them are accompanied by mixed infections.Low albumin level and mechanical ventilation are important risk factors influencing the prognosis.