获得性免疫缺陷综合征并发自发性气胸患者的临床特点及预后影响因素分析

Clinical Characteristics and Prognostic Factors of AIDS Patients Complicated with Spontaneous Pneumothorax

目的分析获得性免疫缺陷综合征并发自发性气胸患者的临床特点及预后的影响因素。方法选取2010年6月-2018年12月首都医科大学附属北京地坛医院收治的获得性免疫缺陷综合征并发自发性气胸患者30例,根据预后情况将其分为好转组(n=12)和恶化组(n=18)。观察患者临床资料,包括性别、年龄、血清白蛋白、SMART-COP评分、CD4+T淋巴细胞计数、发生气胸前开始高效抗逆转录病毒治疗(HAART)情况、吸氧治疗情况、胸腔闭式引流治疗情况、气胸位置、气胸面积、是否合并纵隔气肿、肺部影像学结果、肺部感染类型(包括肺孢子菌肺炎、肺结核、细菌性肺炎、混合感染)及预后情况。结果30例患者中男29例,女1例;平均年龄为(36.5±12.2)岁;平均血清白蛋白(30±5)g/L;平均SMART-COP评分(4.1±2.2)分;CD4+T淋巴细胞计数<200个/μl 28例(93.3%);发生气胸前未开始HAART 23例(76.7%);吸氧治疗15例(50.0%),吸氧+胸腔闭式引流治疗15例(50.0%);气胸位置主要为右肺16例(53.3%);气胸面积>20%者16例(53.3%);合并纵隔气肿10例(33.3%);肺部影像学存在胸膜下气囊样病变9例(30.0%);肺部感染主要为肺孢子菌肺炎18例(60.0%);治疗好转12例(40.0%),死亡11例(36.7%),病情恶化放弃治疗自动出院7例(23.3%)。好转组患者血清白蛋白高于恶化组,SMART-COP评分低于恶化组(P<0.05);两组患者性别、年龄、CD4+T淋巴细胞计数、发生气胸前未开始HAART情况、气胸治疗方式、气胸位置、气胸面积、合并纵隔气肿、肺部感染类型比较,差异无统计学意义(P>0.05)。结论多数获得性免疫缺陷综合征并发自发性气胸患者CD4+T淋巴细胞计数<200个/μl,多合并肺孢子菌肺炎,且预后较差;肺部感染严重程度及营养状况与患者预后有关。

Objective To analyze the clinical characteristics and prognostic factors of AIDS patients complicated with spontaneous pneumothorax.Methods A total of 30 AIDS patients complicated with spontaneous pneumothorax were selected from Beijing Ditan Hospital Capital Medical University from June 2010 to December 2018,they were divided into improvement group(n=12)and deterioration group(n=18)according to the prognosis.General information of all patients were observed,including gender,age,serum albumin,SMART-COP score,CD4+T lymphocyte count,highly active antiretroviral therapy(HAART)before pneumothorax,oxygen inhalation,closed pleural drainage,pneumothorax location,pneumothorax area,whether complicated with mediastinal emphysema or not,pulmonary imaging,types of pulmonary infection(including pneumocystis pneumonia,tuberculosis,bacterial pneumonia,mixed infection)and prognosis.Results Among the 30 patients,29 were male and 1 was female,the average age was(36.5±12.2)years old;the average serum albumin was(30±5)g/L;the average SMART-COP score was(4.1±2.2);28 cases’s(accounting for 93.3%)CD4+T lymphocyte count was<200 cells/μl;23 cases(accounting for 76.7%)didn’t start HAART before pneumothorax;15 cases(accounting for 50.0%)received single oxygen inhalation;15 cases(accounting for 50.0%)received oxygen inhalation+closed pleural drainage;pneumothorax was mainly located in the right lung in 16 cases(accounting for 53.3%);16 cases’(accounting for 53.3%)pneumothorax area>20%;10 cases(accounting for 33.3%)complicated with mediastinal emphysema;there were 9 cases(accounting for 30.0%)of subpleural balloon-like lesions in pulmonary imaging;pulmonary infection was mainly pneumocystis pneumonia in 18 cases(accounting for 60.0%);12 cases(accounting for 40.0%)were improved;11 cases(accounting for 36.7%)died,7 cases(accounting for 23.3%)discharged from the hospital due to worsening condition.Serum albumin level in improvement group was statistically significantly higher than that in deterioration group,while SMARTCOP score in improvement group was statistically significantly lower than that in deterioration group(P<0.05).There was no statistically significant difference in gender,age,CD4+T lymphocyte count,HAART before pneumothorax,oxygen inhalation,pneumothorax location,pneumothorax area,complicated with mediastinal emphysema and mediastinal emphysema between the two groups(P>0.05).Conclusion AIDS patients complicated with spontaneous pneumothorax mostly have CD4+T lymphocyte count<200/μl,have pneumocystis pneumonia,and have poor prognosis.The severity of pulmonary infection and nutritional status in AIDS patients complicated with spontaneous pneumothorax are related to the prognosis.