艾滋病合并肺孢子菌肺炎患者近期预后危险因素分析

Research on risk factors of short-term outcome in AIDS patients with pneumocystis pneumonia

目的探讨影响艾滋病（AIDS）合并肺孢子菌肺炎（PCP）患者预后的危险因素，并建立预测近期预后的风险模型。方法回顾性分析2008年1月至2016年5月首都医科大学附属北京佑安医院感染科收治的418例AIDS合并PCP患者的临床资料，根据住院期间的转归分为死亡组和存活组，收集两组患者的一般资料及实验室检测结果，采用多因素Logistic回归分析，探讨影响患者预后的危险因素，建立预后模型，并对所得模型的预测价值进行评估。结果418例AIDS合并PCP患者中男388例、女30例，年龄5～82岁，平均（40±12）岁。死亡组82例，存活组336例。死亡组患者病程、合并细菌感染以及肺泡-动脉血氧分压差[P（A-a）O2]、血乳酸脱氢酶（LDH）、白细胞计数（WBC）、中性粒细胞计数（N）、天冬氨酸氨基转移酶（AST）、尿素氮（BUN）、血清钾（K）均明显高于存活组（均P〈0.05）；动脉血氧分压（PaO2）、血氧饱和度（SpO2）、CD4＋T淋巴细胞计数、淋巴细胞计数（L）、血红蛋白（Hb）、血小板（PLT）、白蛋白（ALB）、前白蛋白（PALB）、胆碱酯酶（CHE）、胆固醇（CHO）、血清钠（Na）及血清氯（Cl）均明显低于存活组（均P〈0.05）。多因素Logistic回归分析显示P（A-a）O2、ALB、LDH、N以及CD4＋T淋巴细胞计数是AIDS合并PCP的预后影响因素，预后指数＝9.736＋0.112×P（A-a）O2-0.719×ALB＋0.006×LDH＋0.355×N-0.021×CD4。所得预测近期预后模型受试者工作特征（ROC）曲线下面积为0.985（95%CI0.977～0.994），P＝0.000，临界值0.907，敏感度92.0%，特异度98.8%，随方程分值增加，患者病死率呈逐渐上升趋势。结论P（A-a）O2、ALB、LDH、N以及CD4＋T淋巴细胞计数是预测AIDS合并PCP患者近期预后的独立危险因素，根据独立危险因素构建的近期预后预测模型对指导治疗具有较好的临床价值。

ObjectiveTo investigate the prognostic risk factors of acquired immunodeficiency syndrome （AIDS） patients with pneumocystis pneumonia （PCP）, and to establish risk models for predicting early outcome. MethodsThe clinical data of 418 AIDS patients with PCP admitted to Department of Infectious Diseases, Beijing You＇an Hospital, Capital Medical University from January 2008 to May 2016 were retrospectively analyzed.The patients were divided into death group and survival group according to clinical outcome during hospitalization.Data of the two groups were collected including general information and laboratory test results.Multivariate Logistic regression was used to analyze risk factors affecting prognosis of patients, establish prognostic models and evaluate predictive value of the model. ResultsOf the 418 AIDS patients with PCP, 388 cases were male and 30 cases were female, aged from 5 to 82 years, mean age was （40±12） years.There were 82 patients in the death group and 336 patients in the survival group.Disease course, bacterial infection and alveolar-arterial oxygen pressure difference（P（A-a）O2）, serum lactate dehydrogenase（LDH）, white blood cell （WBC）, neutrophil （N）, alanine aminotransferase （AST）, urea nitrogen （BUN） and serum potassium （K） were significantly higher in the death group than those in the survival group （all P〈0.05）, and arterial oxygen pressure （PaO2）, blood oxygen saturation （SpO2）, CD4＋ T lymphocyte count, lymphocyte （L） , hemoglobin （Hb）, platelet （PLT）, albumin （ALB）, prealbumin （PALB）, cholinesterase （CHE）, cholesterol （CHO）, serum chlorine （Cl） and serum sodium （Na） were significantly lower in the death group than those in the survival group （all P〈0.05）. Multivariate Logistic regression analysis showed that P（A-a）O2, ALB, LDH, N and CD4＋ T lymphocyte count were prognostic factors of AIDS complicated with PCP.Prognostic index=9.736＋ 0.112×P（A-a）O2-0.719×ALB＋ 0.006×LDH＋ 0.355×N-0.021×CD4.ROC curve of the short-term prognostic model was 0.985 （95%CI 0.977-0.994）, with P value 0.000, cut-off value 0.907, sensitivity 92.0% and specificity 98.8%.The mortality rate increased with the increase of equation value. ConclusionsP（A-a）O2, ALB, LDH, N and CD4＋ T lymphocyte count are independent risk factors to predict short-term prognosis in these patients.The short-term prognostic model based on independent risk factors is useful in guiding clinical treatment.