159例艾滋病死亡病例的临床分析

Clinical analysis of causes of death of 159 AIDS patients

目的探讨艾滋病(Acquired immunodeficiency syndrome,AIDS)病人的主要死亡原因,以改进防治措施,降低病人的病死率。方法收集2006年9月-2011年9月间159例AIDS死亡住院病人的临床资料,并进行回顾性分析。结果 AIDS死亡病人中,男性121例,女性38例。静脉吸毒感染占57.3%,性接触感染占39.6%,母婴传播感染占3.1%。17例接受了高效抗反转录病毒治疗(Highly active anti-retroviral therapy,HAART),平均生存时间(448.37±236.29)d;未接受HAART治疗的142例,平均生存时间(97.38±197.65)d,两组比较差异有统计学意义(P<0.05)。病人中86%就诊时已为晚期,其中87.4%出现机会性感染,12.6%为非机会性感染(包括机会性肿瘤),近90%病人CD4+T淋巴细胞计数<200个/μL,临床表现复杂多样,主要死亡原因依次为呼吸功能衰竭(54.7%)、循环功能衰竭(14.5%)、多脏器功能衰竭(12.6%)和感染性休克(12.6%)。结论 AIDS晚期病死率极高,肺部感染是造成病人死亡的最主要原因,早期诊断和及时HAART是降低AIDS病人机会性感染或机会性肿瘤的发生率和死亡率的关键。

Objective To explore the main cause of death of acquired immunodeficiency syndrome （AIDS） patients in order to improve the prevention and control measures to reduce the AIDS mortality. Methods Clinical data of 159 AIDS cases who died during their hospitalization between September 2006 and September 2011 were analyzed retrospectively. Results The data of 121 male patients and 38 female patients who died with AIDS were collected. Of them the rate of transmission via intravenous drug use accounted for 57.3 %, that of via sexual contact accounted for 39.6 %, and that of via mother-to-child route accounted for 3.1%. Seventeen cases had received highly active antiretroviral therapy （HAART）, and their average survival was （448.37± 236.29） days; among the 142 cases without having HAART, the average survival was （97.38±197.65） days. The comparison was statistically significant （P〈0.05）. Of these patients 86~started HAART in their late stage; opportunistic infections occurred in 87.4% of them, and 12.6% of them were complicated with non-opportunistic infections （including opportunistic tumors）. Nearly 90% of the patients had the CD4＋ T lymphocyte count less than 200/uL. Their clinical manifestations were complex and diverse, and the main causes of death were respiratory failure （54. 7%）, circulatory failure （14.5%） , multiple organs failure （12.6%） and septic shock （12.6%）. Conclusion The mortality in advanced AIDS patients is high, and lung infection is the main cause of AIDS death. Therefore, early diagnosis and HAART are the key approach to reduce the incidence and mortality of the opportunistic infections or opportunistic tumors of AIDS patients.