综合医院HIV阳性住院病人的疾病谱分布及诊治结局分析

Analysis of disease spectrum distribution and treatment outcomes of HIV-positive inpatients in a general hospital

目的分析综合医院收治的艾滋病病毒(HIV)阳性者的主诊断疾病谱及诊治结局,为进一步提高艾滋病诊治能力积累经验。方法采用回顾性分析方法,对武汉大学中南医院2016年1月至2017年12月收治的HIV阳性住院病人的临床资料进行分析。结果 1 782例住院HIV阳性者的平均年龄(45±13)岁,其中40~60岁占56.4%。入院时CD4^+T淋巴细胞(简称CD4细胞)计数均数为(233±300)个/μL,其中CD4细胞计数<200个/μL的HIV感染者占57.1%,未接受抗HIV治疗的病人占20.2%。住院HIV阳性病人涉及全院所有临床科室,平均住院(12.0±9.7)天。艾滋病相关机会性感染988例(55.4%),其中结核病占30.3%,HIV多发性感染占20.3%,肺孢子菌肺炎占14.5%。HIV合并其他疾病794例(44.6%),其中肝病、皮肤性病及恶性肿瘤分别占8.7%、10.1%、7.8%。共完成3级及以上手术139例(7.8%),其中腹部外科、眼科、泌尿外科及妇科完成60.4%的手术。死亡25例,其中84.0%死于艾滋病相关机会感染,无手术后死亡病例。结论艾滋病相关机会感染发病率相应降低,其他慢性疾病发病率升高,需要接受手术治疗的疾病增多。

Objective To analyze the main diagnostic disease spectrum and treatment outcomes of HIV-positive patients in general hospitals, and accumulate the experience for improving the ability of AIDS diagnosis and treatment. Methods The clinical data of HIV-positive inpatients in Zhongnan hospital affiliated to Wuhan University from Jan 2016 to Dec 2017 were retrospectively analyzed. Results The average age of 1 782 HIV-positive patients was 45±13 years old, of which 56.4% were 40-60 years old. The mean CD4 cells at admission were 233±300/μL, with 57.1% less than 200/μL, and 20.2% without anti-HIV treatment. The inpatients involved all clinical departments in the hospital, had an average hospitalization of 12.0 ± 9.7 days. AIDS-related opportunistic diseases were 988 cases(55.4%), with tuberculosis of 30.3%, HIV multiple infection of 20.3% and pneumocystis pneumonia 14.5%. 794 cases(44.6%) had other diseases, with 8.7% liver disease, 10.1% skin venereal diseases and 7.8% malignant tumors. 139 cases(7.8%) received grade 3 and above surgery, with 60.4% in abdominal surgery, ophthalmology, urology and gynecology. Of the 25 deaths, 84% died of AIDS-related opportunistic infections and no postoperative deaths. Conclusion The incidence of HIV-related opportunistic infections is correspondingly reducing, while the incidence of other chronic diseases is increasing, and the number of diseases requiring surgery is increasing.