HIV感染/AIDS住院患者高效抗逆转录病毒治疗中发生骨髓抑制致死亡的影响因素

Effects of Myelosuppression in HIV/AIDS Patients on Death during HARRT Treatment

目的:探讨人类免疫缺陷病毒(HIV)感染/艾滋病(AIDS)住院患者高效抗逆转录病毒治疗(HAART)中发生骨髓抑制致死亡的影响因素。方法:采用病例对照研究的方法,调查2011年1月—2015年7月南宁市第四人民医院的735例住院HIV感染/AIDS住院患者,通过单因素和多因素非条件Logistic分析筛选出导致患者死亡的危险因素。结果:735例患者中,生存组648例,死亡组87例,病死率为11.8%。单因素Logistic分析显示:男性、老年、总胆红素升高、内生肌酐清除率降低、基线CD4+T淋巴细胞数较低、合并机会性感染较多、联合多种具有骨髓抑制的药物、血小板减少、血红蛋白减少是HAART中死亡的危险因素,而患者HIV感染途径、有齐多夫定的HAART方案、开始HAART时患者的体质量是HAART中死亡的保护性因素;多因素Logistic回归分析显示:男性、老年、总胆红素升高、内生肌酐清除率降低、基线CD4+T淋巴细胞数较低、合并机会性感染较多、联合多种具有骨髓抑制的药物、血小板减少、血红蛋白减少是死亡的危险因素。结论:临床应针对住院HIV感染者/AIDS患者HAART中发生骨髓抑制致死亡的危险因素,采取有针对性的治疗和控制措施,以降低患者病死率。

OBJECTIVE：To explore risk factors for the death in HIV/AIDS patients suffering from myelosuppression during highly active antiretroviral therapy（HAART）treatment. METHODS：The historical cohort study method was used to choose 735 inpatients from Nanning Forth People＇s Hospital during Jan. 2011 to Jul. 2015. Univariate and multivariate Logistic regression analysis were used to show the risk factors for the death. RESULTS：Of 735 cases,there were 648 survival cases and 87 dead cases,with mortality of 11.8%. Univariate Logistic analysis showed that：male,elder,higher total bilirubin,lower creatinine clearance,lower CD4＋T cell count in baseline,combined more opportunistic infection,combined more myelosuppressive drugs,thrombocytopenia,lower hemoglobin were the risk factors for the death of HIV patients with myelosuppression in HARRT treatment,while route of HIV infection,HAART treatment A including Zidovudine,weight were the protective factors. Multivariate Logistic regression analysis showed male,elder,higher total bilirubin,lower creatinine clearance,lower CD4 ＋ T cell count in baseline,combined more opportunistic infection,combined more myelosuppressive drugs,thrombocytopenia,lower hemoglobin were the risk factors for the death of HIV patients with myelosuppression in HARRT treatment too. CONCLUSIONS：Pertinence treatment and control methods for HIV/AIDS with myelosuppression in HARRT treatment should be taken to reduce the mortality in the future.