艾滋病合并重症肺孢子菌肺炎289例预后危险因素的回顾性分析

Retrospective analysis of prognostic factors in 289 AIDS patients complicated with severe Pneumocystis pneumonia

目的探究影响艾滋病合并重症肺孢子菌肺炎(PCP)患者预后(死亡)的主要危险因素,以期提高该类患者的生存率.方法收集2017年1月-2018年12月重庆市公共卫生医疗救治中心感染病科收治的艾滋病合并重症PCP住院病例的临床资料,统计其死亡率,分别以单因素及多因素分析方法分析影响患者死亡的危险因素.结果共289例艾滋病合并重症PCP患者纳入分析.男性占74.0%(214/289),平均年龄(48.4±13.4)岁.住院病死率为37.0%(107/289);单因素分析显示患者入院时动脉血氧分压、外周血白细胞计数、血小板计数、CD4+T细胞计数、乳酸脱氢酶、低白蛋白、肺部磨玻璃影是否伴有纤维索条状及网状影改变及是否使用呼吸机对患者的死亡率有显著影响(P<0.05).多因素分析显示患者入院时肺部磨玻璃影且伴有纤维索条状及网状影改变、外周血白细胞数升高、血小板计数低、CD4+T细胞计数低、低白蛋白及无创机械通气使用时间较晚对该类患者的死亡率有明显影响(P<0.05).结论艾滋病合并重症PCP患者病死率较高,低CD4+T细胞计数、低白蛋白、肺部磨玻璃影伴有纤维索条状及网状影改变、外周血白细胞计数偏高及血小板计数偏低是死亡的独立危险因素.但早期使用无创机械通气可提高该类患者的生存率.

Objective To investigate the risk factors for outcome(mortality)of AIDS patients complicated with severe Pneumocystis pneumonia for improving survival of the patients.Methods The clinical data were collected from the AIDS patients complicated with severe Pneumocystis pneumonia who were hospitalized in the Department of Infectious Diseases,Chongqing Public Health Medical Center from January 2017 to December 2018.The mortality rate was calculated.Univariate and multivariate analyses were conducted to examine the risk factors for mortality of these patients.Results A total of 289 AIDS patients with complicated with severe Pneumocystis pneumonia were analyzed.Most patients(74.0%,214/289)were males.The mean age was(48.4±13.4)years.The overall mortality of this series was 37.0%(107/289).Univariate regression analysis showed that arterial oxygen pressure,white blood cell count,platelet count,CD4 cell count,lactate dehydrogenase,hypoalbuminemia,pulmonary ground-glass opacity with cord or reticular fibrosis,and mechanical ventilation on admission were associated with significantly higher mortality(P<0.05).Multivariate regression analysis indicated that pulmonary ground-glass opacity with cord or reticular fibrosis,increased white blood cell count,decreased platelet count and CD4 cell count,hypoalbuminemia,and delayed non-invasive mechanical ventilation on admission were significant prognostic factors of mortality(P<0.05).Conclusions AIDS patients have a high mortality when complicated with severe Pneumocystis pneumonia.Low CD4 cell count,hypoalbuminemia,pulmonary ground-glass opacity with cord or reticular fibrosis,increased white blood cell count and decreased platelet count at baseline are independent prognostic factors of mortality in these patients.Early use of non-invasive mechanical ventilation may improve patient survival.