云南省2992例HIV/AIDS住院患者临床特征分析

Analysis of Clinical Features of 2992 Inpatients with HIV/AIDS in Yunnan Province

目的系统研究云南省HIV/AIDS住院患者疾病谱和临床特点,为艾滋病的诊治和防控提供依据。方法以2013年11月1日-2016年10月31日在云南省传染病医院感染科住院的HIV/AIDS患者为研究对象,采用整群抽样和回顾性研究方法采集患者相关系统资料,以病案首页中出院诊断前3位诊断统计,并进行统计分析。结果本研究入组2992例HIV/AIDS患者,男2092例(占69.92%),女900例(占30.08%),共有4362个住院诊断。38.14%的患者住院时新近被诊断HIV/AIDS、45.99%的患者尚未启动艾滋抗病毒治疗。所有患者机会性感染诊断2935例次(67.29%),肿瘤233例次(5.34%),非艾滋相关性疾病737例次(16.90%)。机会性感染中结核病(27.94%)、细菌性肺炎(13.83%)、口腔念珠菌病(10.09%)、肺孢子菌肺炎(7.32%)、马尔尼菲篮状菌病(7.29%)、隐球菌病(4.46%)最为常见。其中隐球菌病、马尔尼菲篮状菌病、结核病、肺孢子菌肺炎在未启动ART组的感染率显著高于已接受ART组(P<0.05)。本组患者病死率3.61%,死亡原因中机会性感染占86.11%。结论机会性感染仍是云南省HIV/AIDS患者住院、死亡最主要的原因,常见的机会性感染依次是结核病、细菌性肺炎、口腔念珠菌病、肺孢子菌肺炎、马尔尼菲篮状菌病、隐球菌病。及早发现HIV/AIDS和积极启动ART、及时规范开展机会性感染的诊断、治疗是临床诊疗工作的重点。

Objective To systematically study the disease spectrum and clinical characteristics of HIV/AIDS inpatients in Yunnan Province,so as to provide a basis for the prevention,diagnosis,and treatment of HIV/AIDS.Methods HIV/AIDS patients hospitalized in Infection Department,the Yunnan Provincial Hospital for Infectious Diseases from November 1,2013 to October 31,2016 were enrolled in this study.Cluster sampling and a retrospective study were conducted to collect relevant information of patients and the top 3 patients who were discharged and documented on the first page of the medical record were used for statistical analysis.Results A total of 2992 patients with HIV/AIDS were enrolled in this study,including 2092 men(69.92%),and 900 women(30.08%),with a total of 4362 diagnoses.38.14%of patients were newly diagnosed with HIV/AIDS at the time of hospitalization,and 45.99%of patients had not yet started antiretroviral therapy(ART).There were diagnoses with opportunistic infections in 2935 cases(67.29%),tumors in 233 cases(5.34%),and non-AIDS-related diseases in 737 cases(16.90%).Among opportunistic infections,tuberculosis(27.94%),bacterial pneumonia(13.83%),oral candidiasis(10.09%),pneumocystis pneumonia(7.32%),cyanobacteria marneffei(7.29%),cryptococcosis diseases(4.46%)were the most common.Among them,the infection rate of cryptococcosis,Marneffe basket disease,tuberculosis,and pneumocystis pneumonia in the non-ART group was significantly higher than that in the ART group(P<0.05).The mortality rate of patients was 3.61%,and the opportunistic infection accounted for 86.11%of the causes of death.Conclusion Opportunistic infections are still the main cause of hospitalization and death of HIV/AIDS patients in Yunnan province.The most common opportunistic infections are tuberculosis,bacterial pneumonia,oral candidiasis,PCP,and Talaromyces marneffei,and cryptococcosis.Early detection of HIV/AIDS,active initiation of ART,and standardized diagnosis and treatment of opportunistic infections are the key to diagnosis and treatment in clinical practice.