云南省245例AIDS患者死亡原因分析

Analysis of death causes of 245 AIDS patients in Yunnan Province

目的分析云南省245例AIDS患者的死亡原因及特点,为预防及干预策略提供参考。方法收集云南省传染病医院2015年1月-2019年12月收治的245例AIDS死亡患者的病例资料,并进行回顾性分析。结果245例AIDS死亡患者中CD4^+T淋巴细胞计数≤50个/μl 129例(52.65%),86例行HIV RNA检测,病毒载量为(3.90±0.75)lg拷贝/ml;74例(30.20%)行高效抗反转录病毒治疗(highly active antiretroviral therapy,HAART),平均生存时间为(1106.0±72.5)d;171例(69.80%)未行HAART,平均生存时间为(710.0±25.5)d,行HAART组生存时间长于未行HAART组,差异具有统计学意义(t=9.338,P=0.002)。245例AIDS患者中183例合并机会性感染(opportunistic infections,OIs)。死于HIV相关性原因192例(78.36%),死于非HIV相关原因53例(21.64%)。在行HAART组与未行HAART组中死于HIV相关原因患者分别为70.27%、81.87%,两者相比,差异具有统计学意义(χ^2=4.100,P=0.043);HIV相关死亡原因中,感染性休克在行HAART组与未行HAART组中的占比分别为24.31%、41.52%,未行HAART组死于感染性休克发生率高于行HAART组,差异具有统计学意义(χ^2=6.603,P=0.010)。结论AIDS死亡患者普遍合并OIs,且确诊时间晚、HAART率低、CD4^+T淋巴细胞计数低、病毒载量高。OIs仍然是导致AIDS患者死亡的主要原因,早期有效的HAART可以延长AIDS患者的生存期,降低病死率。

Objective To analyze the death causes and characteristics of 245 AIDS patients in Yunnan Province and provide reference for prevention and intervention strategies.Methods A total of 245 AIDS dead patients who were admitted to and treated in Yunnan Province Infectious Disease Hospital from January 2015 to December 2019 were collected and analyzed retrospectively.Results Among 245 AIDS dead patients,129 cases(52.65%)had CD4^+T lymphocyte count≤50 cells/μl,86 cases had HIV RNA test,the viral load was(3.90±0.75)lg copies/ml;74 cases(30.20%)received highly active antiretroviral therapy(HAART),the average survival time was(1106.0±72.5)days;171 cases(69.80%)did not receive HAART,the average survival time was(710.0±25.5)days,the survival time of HAART group was longer than that of non-HAART group and the difference was statistically significant(t=9.338,P=0.002);183 cases of them were complicated with opportunistic infections(OIs);192 cases(78.36%)died of HIV-related causes,53 cases(21.64%)died of non-HIV-related causes.70.27%and 81.87%of patients died of HIV-related causes in HAART group and non-HAART group,respectively.The proportion of patients who died of HIV-related causes in non-HAART group was higher than that in HAART group(χ^2=4.100,P=0.043).Among the causes of HIV-related death,septic shock accounted for 24.31%and 41.52%in HAART patients and non-HAART patients,respectively.The incidence of septic shock in non-HAART group was significantly higher than that in HAART group(χ^2=6.603,P=0.010).Conclusions OIs is commonly complicated in AIDS dead patients with late diagnosis,low HAART rate,low CD4^+T lymphocyte count and high viral load.OIs is still the main cause of death in AIDS patients.Early effective HAART can prolong the survival time of AIDS patients and reduce the mortality.