AIDS患者感染侵袭性真菌的临床特征和危险因素研究

Clinical features and risk factors of invasive fungal infection in AIDS patients

目的探讨艾滋病(AIDS)患者合并侵袭性真菌感染(IFI)的临床特征和危险因素。方法回顾性分析2021年1月至2023年4月在该院就诊的194例AIDS患者,根据是否合并IFI分为IFI组107例,非IFI组87例。分析IFI组的菌种分布,比较两组临床资料,采用Logistic回归分析AIDS患者合并IFI的危险因素,并绘制受试者工作特征(ROC)曲线,探讨各项指标对AIDS合并IFI的临床预测价值。结果IFI组感染最多的是白念珠菌,占71.05%。IFI组CD4^(+)T淋巴细胞计数和血清清蛋白(ALB)水平明显低于非IFI组(P<0.001)。Logistic回归分析显示,CD4^(+)T淋巴细胞计数降低和血清ALB水平降低是AIDS患者合并IFI的独立危险因素(P<0.001)。ROC曲线分析结果显示,CD4^(+)T淋巴细胞计数和血清ALB单独和联合预测AIDS患者合并IFI的曲线下面积(AUC)分别为0.954(95%CI:0.925~0.984)、0.890(95%CI:0.844~0.935)和0.960(95%CI:0.935~0.986)。结论CD4^(+)T淋巴细胞计数降低和血清ALB水平降低是AIDS患者合并IFI的独立危险因素,临床应该关注高危患者,并及时进行干预治疗。

Objective To investigate the clinical features and risk factors of invasive fungal infection(IFI)in the patients with acquired immune deficiency syndrome(AIDS).Methods A total of 194 patients with AIDS visiting in this hospital from January 2021 to April 2023 were retrospectively analyzed.The patients were divided into the IFI group(107 cases)and non-IFI group(87 cases)according to whether complicating IFI.The distribution of funguses types in the IFI group was analyzed.The Logistic regression analysis was adopted to analyze the risk factors for AIDS complicating IFI.The receiver operating characteristic(ROC)curve was drawn to investigate the predictive value of those indexes for AIDS complicating IFI.Results The most infected fungus in the IFI group was Candida albicans,which accounted for 71.05%.The levels of CD4^(+)T lymphocytes counts and serum albumin(ALB)in the IFI group were significantly lower than those in the non-IFI group(P<0.001).The Logistic regression analysis showed that the CD4^(+)T lymphocytes count decrease and serum ALB level decrease were the independent risks for the patients with AID complicating IFI(P<0.001).The ROC curve analysis results showed that the area under the curve of CD4^(+)T lymphocytes count and serum ALB alone and combined for predicting AIDS complicating IFI were 0.954(95%CI:0.925-0.984),0.890(95%CI:0.844-0.935)and 0.960(95%CI:0.935-0.986)respectively.Conclusion The decreases of CD4^(+)T lymphocytes count and serum ALB level are the independent risk factors for the patients with AIDS complicating IFI.It is necessary for the clinic to pay attention to the high risk patients and take the intervention treatment in time.