艾滋病合并腹泻91例临床分析

Analysis of 91 cases of diarrhea in patients with HIV/AIDS

目的分析住院艾滋病患者腹泻患病、诊断及预后情况,探讨该疾病的优化诊治策略。方法在2009年7月—2011年6月入住上海市公共卫生临床中心的艾滋病患者中,筛选出91例合并腹泻患者,收集人口学、临床及实验室检查资料。采用SPSS17.0统计软件进行分析。结果总计22例(24.2%)患者取得明确的病原学或病理学诊断。出现电解质紊乱与预后不良有关(OR=9.185,95%CI=2.205～38.263,P=0.001)。10例患者在使用克林霉素平均2.1(1.3～2.9)d后出现腹泻;12例在使用碳青霉烯类抗生素或β内酰胺类/酶抑制剂后平均3.4(1.6～5.2)d内出现腹泻。结论需要进一步完善艾滋病合并腹泻诊断策略;出现电解质紊乱是艾滋病合并腹泻患者预后不良的危险因素;规范使用抗生素有助于艾滋病合并腹泻的防治。

Objective To analyze the prevalence, diagnosis and prognosis of diarrhea in the patients with HIV/AIDS and ex plore the optimal diagnostic and therapeutic strategy for this situation. Methods Ninety-one patients with HIV/AIDS admitted to Shanghai Public Health Clinical Center between July 2009 and June 2011 were included in this analysis if she/he had diarrhea. Demographic, clinical and laboratory data were collected for analysis with SPSS 17. 0 software. Results Twenty-two （24.2%） patients had a definite etiological or pathological diagnosis. Electrolyte disturbance was closely correlated with poor prognosis （OR = 9. 185, 95%CI = 2. 205-38. 263, P= 0. 001）. Ten patients experienced diarrhea 2.1 （1.3-2.9） days after initiating clindamycin therapy, while 12 developed diarrhea 3.4 （1.6-5.2） days after using carbapenems or β-lactam/lactamase inhibitor. Conclusions It is necessary to further improve the diagnostic strategy for the diarrheal disease in HIV/AIDS patients. Electrolyte disturbance is a risk factor of poor prognosis in patients with diarrhea and HIV/AIDS. Rational use of antibiotics is important in the prevention and treatment of diarrhea in HIV/AIDS patients.