艾滋病合并肺孢子菌肺炎患者近期预后的COX回归分析

Cox regression survival analysis on the short-term prognosis of AIDS patients with pneumocystis pneumonia

目的分析AIDS合并肺孢子菌肺炎(PCP)患者生存及预后的影响因素,建立近期预后的预测指数。方法回顾性分析2009年1月至2020年1月柳州市人民医院收治的409例AIDS合并PCP患者的临床资料,包括基本资料、影像学资料、实验室检查、并发症等。采用单因素及多因素COX回归分析筛选出独立预后因素,建立预后指数方程,并根据预后指数分组预测患者的生存率。结果多因素COX回归分析结果显示,白蛋白(ALB)、CD4细胞、乳酸脱氢酶(LDH)、肺泡-动脉血氧分压差[P(A-a)O_(2)]、肺纤维化(PF)是AIDS合并PCP患者的独立预后因素(P<0.05)。预后指数(PI)=1.242×ALB+1.315×CD4+1.402×LDH+3.384×P(A-a)O_(2)+1.298×PF,ROC曲线下面积(AUC)为0.925(95%CI:0.894~0.957,Sx=0.016,P=0.000)。根据预后指数将病例分为低危、中危及高危3组,3组的28天生存率分别为99.20%、83.33%、7.27%。Log-Rank检验结果提示3组患者的生存率组间比较差异有统计学意义(χ^(2)=319.670,ν=2,P=0.000)。结论ALB、CD4细胞、LDH、P(A-a)O_(2)以及PF是影响AIDS合并PCP患者近期预后的独立因素,这些因素可用于预后指数方程的建立,所构建的预后指数方程提示随方程分值增加,患者病死率呈逐渐上升趋势。

Objictive To analyze the affecting factors for the survival and prognosis of acquired immune deficiency syndrome(AIDS)patients with pneumocystis pneumonia(PCP)and to establish a prognostic index(PI)for the short-term outcome.Methods The clinical data of 409 AIDS patients with PCP treated in Liuzhou people's Hospital from January 2009 to January 2020 were analyzed retrospectively,which included contents as fundamental information、imaging data、laboratory examination、complication,etc.The independent prognostic factors of AIDS with PCP were screened by single factor and multiple factor Cox regression analysis,establishing the PI equation and predicting patient survival.Results Multiple factor Cox regression analysis showed that the independent prognostic factors of AIDS with PCP were albumin(ALB)、CD4+T lymphocyte count、lactate dehydrogenase(LDH)、alveolar-arterial oxygen pressure difference〔P(A-a)O_(2)〕and pulmonary fibrosis(PF).PI=1.242×ALB+1.315×CD4+1.402×LDH+3.384×P(A-a)O_(2)+1.298×PF,The Area Under Curve(AUC)was 0.925〔95%CI(0.894~0.957),Sx=0.016,P=0.000〕.The cases were divided into PI:low risk,medium risk,and high-risk groups.The 28-day survival rates of the three groups were 99.20%、83.33%、7.27%,respectively.The log-rank test results showed that patients'survival rate in the three groups was statistically significant(χ^(2)=319.670,ν=2,P=0.000).Conclusion ALB、CD4+T lymphocyte count、LDH、P(A-a)O_(2) and PF were independent prognostic factors for the short-term outcome of AIDS patients with PCP.These factors can be used to establish the prognostic index equation,which suggested that the mortality increased along with the increase of the score of the equation.The prognostic index constructed can provide a reference for the evaluation of clinical conditions.