非HIV免疫抑制患者合并重症肺炎的临床特点及预后因素

Clinical characteristics and factors affecting prognosis of non-HIV immunocompromised patient with severe pneumonia

目的了解非获得性免疫缺陷病毒(HIV)免疫抑制患者合并重症肺炎的临床特点,探讨影响预后的危险因素.方法分析2014年4月至2017年8月河北医科大学第二医院呼吸与危重症医学二科收治的101例非H IV免疫抑制合并重症肺炎患者,根据28 d病情转归情况分为存活组和死亡组.比较两组一般情况及临床资料,分析影响预后的危险因素.结果两组比较,死亡组中多重耐药细菌感染患者较高(P<0.05);急性生理与慢性健康状况Ⅱ评分、超敏C反应蛋白、中性粒细胞比例较高(P<0.05);淋巴细胞计数、CD3^+、CD4^+T淋巴细胞计数低(P<0.05);有创机械通气、呼吸机相关性肺损伤发生率高(P<0.05),且两者是影响预后危险因素,其OR值为:10.870、6.897.结论死亡组病情及免疫损伤更严重,多重耐药细菌感染人数多.有创机械通气、呼吸机相关性肺损伤是影响预后的危险因素.

Objective To understand the clinical characteristics of non-human immunodeficiency virus ( HIV) immunocompromised patients with severe pneumonia ,and evaluate the risk factors which affected the prognosis .Methods All non-HIV immunocompromised patients with severe pneumonia admitted to the Respiratory Intensive Care Unit ( RICU ) of the Second Hospital of Hebei Medical University from April 2014 to August 2017 were included .One hundred and one patients were divided into two groups:patients were survival and the rest were death .The date of clinical and laboratory were observed and compared between the two groups ,and the risk factors of mortality were analyzed . Results In two groups ,rate of multidrug-resistant bacterial infection was higher in the death group than that of in the survival group ( P <0 .05).The Acute Physiology and Chronic Health Evaluation Ⅱ score ,hypersensitive C-reactive protein ,NEUT%, theincidence rate of invasive mechanical ventilation ,and ventilator associated lung injury were higher in the death group than that of in the survival group ( P < 0 .05 ).Lymphocyte count ,CD3^+ T lymphocytes ,and CD4^+ T lymphocytes were lower in the death group than that of in the survival group ( P <0 .05).Invasive mechanical ventilation and ventilator associated lung injury were risk factors for the prognosis of patients . Their OR values were 10 .870 and 6 .897 , respectively . Conclusions The occurrences of invasive mechanical ventilation and ventilator associated lung injury arerisk of non-HIV immunocompromised patients with severe pneumonia .