2009-2013年河南省艾滋病机会性感染回顾性研究

发布时间：2018-05-01 10:04

本文选题：河南省 + 艾滋病　；参考：《郑州大学》2014年硕士论文

【摘要】：目的：通过了解2009-2013年5年期间河南省HIV/AIDS患者机会性感染的种类、发生率,总结HAART时代艾滋病患者机会性感染的特点及规律,为我省艾滋病防治工作提供一定的科学依据。方法：统计2009年1月-2013年12月在河南省传染病医院住院的HIV/AIDS合并机会性感染患者的临床资料,统计患者的一般资料、机会性感染的名称、类型、HAART治疗情况、患者发生机会性感染时CD4+T淋巴细胞计数、预后。结果：符合标准进入本次研究有1314例患者,平均年龄42.47±12.5岁。未接受HAART治疗的患者456例,经HAART后治疗的患者858例。1、两组患者的人口学特征：HAART组男女比为1.28：1,41-60岁人群占56.88%。感染途径以采供血和输血感染为主,分别占38.69%和27.04%。未HAART组男性占69.3%,男女比为2.26：1,年龄41-60岁人群占49.34%,其次是18-40岁人群(37.94%)。感染途径中男男同性感染占首位(29.61%),第二位是采供血途径(25.88%)。两组患者以驻马店、周口、南阳等南部地区为主,农民和农民工占大多数。2、机会性感染疾病谱和病原菌的分布与种类(1)1314例患者发生机会性感染2645例(部分患者一人合并多种感染)。细菌性肺炎占24.31%,真菌口炎12.78%,肺结核9.26%,肺孢子菌肺炎7.71%,感染性腹泻4.69%,CMV肺炎4.01%,淋巴结核3.97%。各机会性感染常见于呼吸系统、消化系统、中枢神经系统,分别为47%、20%、10%。(2)1314例患者共培养分离266株致病菌。以细菌(53.38%)、真菌(28.95%)为主。病原菌的来源部位以下呼吸道最多,其次为脑脊液。细菌谱以大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌为主。真菌以新型隐球菌为主。3、未HAART和HAART两组患者机会性感染发病率的差异结核性胸膜炎发病率两组间无显著性差异(P=0.163),细菌性肺炎、真菌性口炎、肺孢子菌肺炎、CMV肺炎、真菌性肺炎、隐球菌脑膜炎发病率两组均有显著性差异。HAART组中细菌性肺炎、PCP、真菌性口炎、CMV肺炎、真菌性肺炎、隐球菌脑膜炎的发病率较未HAART组明显下降。4、两组患者机会性感染与CD4+T淋巴细胞的关系(1)肺结核在未HAART组的CD4+T淋巴细胞中位数是59个/ul,HAART组为127个/ul；PCP.在未HAART组的CD4+T淋巴细胞中位数是33个/u1,HAART组为71.5个/u1；细菌性肺炎未HAART组的CD4+T淋巴细胞中位数是45个/u1,HAART组为124个/u1。HAART组中各机会性感染发病时CD4+T淋巴细胞中位数高于未HAART组。(2)1203例患者按合并机会性感染的数量分为5个层面,HAART组合并1种机会性感染病例最多(40.32%),CD4+T淋巴细胞计数中位数为304个/μL。未HAART组合并2-3种机会性感染病例最多(49.67%)。合并2种以上机会性感染的CD4+T淋巴细胞计数中位数低于100个/μL,合并5种及5种以上机会性感染的低于50个/μL。5、恶化和死亡病例共有70例。男性49例,女性13例。死亡前接受HAART治疗者占31.43%。直接死于艾滋病机会性感染的患者62例(88.57%),死于一种病原菌感染的28例,死于多种病原菌共同感染的34例。结论：1、HAART时代,机会性感染仍以呼吸和消化系统感染为主。抗病毒后机会性感染疾病谱有一些变化,重症难治、致死性强的机会性感染的发生率和多重感染的发生率下降。2、机会性感染的病原菌以细菌和真菌为主,病原学检出率低,是困扰着临床对机会性感染诊治的难题。3、CD4+T淋巴细胞计数与机会性感染发生率、病原体的种类存在相关性。抗病毒后发生机会性感染原因多种,根据不同的原因和患者免疫水平,采取不同治疗措施。4、HAART后患者机会性感染的发生率仍然较高,机会性感染仍然是目前我省艾滋病患者是其主要就诊、住院,甚至是致死原因,因此提高患者免疫水平,降低机会性感染的发生率是治疗的首要任务。
[Abstract]:Objective: through understanding the types of opportunistic infection of HIV/AIDS patients in Henan Province during 5 years, the incidence of the incidence of opportunistic infection in the HAART era, the characteristics and laws of opportunistic infection of AIDS patients in the age of Henan were summarized, and the scientific basis for AIDS prevention and control work in our province was provided. Methods: in December January 2009, the hospital in infectious disease hospital was hospitalized in the province of -2013. The clinical data of HIV/AIDS patients with opportunistic infection, the general data of the patients, the name of the opportunistic infection, the type, the HAART treatment, the CD4+T lymphocyte count and the prognosis in the opportunistic infection of the patients, and the prognosis. Results: 1314 patients were enrolled in this study, the average age was 42.47 + 12.5 years old. No HAART treatment was accepted. 456 cases of patients, 858 cases of.1 and two groups of patients treated after HAART, the demographic characteristics of the two groups were: group HAART and 1.28:1,41-60 years old people accounted for the main 56.88%. infection route, accounting for blood supply and blood transfusion infection, accounting for 38.69% and 27.04%. not HAART group 69.3%, male and female ratio of 2.26:1, age 41-60 age 49.34%, followed by 18-40 years. Population (37.94%). Male and male sex infection accounted for the first (29.61%), second was the way of blood supply (25.88%). Two groups were Zhumadian, Zhoukou, Nanyang and other southern regions, farmers and migrant workers accounted for most of the.2, opportunistic infection disease spectrum and pathogen distribution and species (1) 1314 patients had opportunistic infections (2645 cases). Bacterial pneumonia accounted for 24.31%, bacterial pneumonia accounted for 24.31%, fungal stomatitis 12.78%, pulmonary tuberculosis 9.26%, Pneumocystis pneumoniae 7.71%, infectious diarrhea 4.69%, CMV pneumonia 4.01%, and lymphatic tuberculosis 3.97%. were often seen in respiratory system, digestive system, central nervous system, 47%, 20%, and 10%. (2) 1314 patients were separately cultured and separated 266. Bacteria (53.38%) and fungi (28.95%) were the main pathogens. The main source of the pathogenic bacteria was the most respiratory tract, followed by cerebrospinal fluid. The bacterial spectrum was mainly Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa. The fungi were mainly Cryptococcus neoformans.3, no HAART and HAART two groups had the difference of opportunistic infection rate of tuberculosis pleura. There was no significant difference between the two groups (P=0.163). Bacterial pneumonia, fungal stomatitis, Pneumocystis pneumoniae, CMV pneumonia, fungal pneumonia, and cryptococcal meningitis have significant differences in the incidence of bacterial pneumonia in group.HAART, PCP, fungal stomatitis, CMV pneumonia, fungal pneumonia, cryptococcal meningitis, and the incidence of cryptococcal meningitis in the group of non HAART group. A significant decrease in.4, two groups of patients with opportunistic infection and CD4+T lymphocyte (1) the median of CD4+T lymphocytes in the non HAART group was 59 /ul, and the HAART group was 127 /ul; the median of PCP. in the unHAART group was 33 /u1, the HAART group was 71.5. The median number of CD4+T lymphocytes in group HAART was 45 /u1, and the median of CD4+T lymphocytes in group /u1.HAART was higher than that in the unHAART group. (2) 1203 patients were divided into 5 levels according to the number of opportunistic infections, HAART combination and 1 opportunistic infections (40.32%), and the median of CD4+T lymphocyte counts were 304 / u L. unHAART combination and 2 The most opportunistic infection cases of -3 were (49.67%). The median number of CD4+T lymphocyte counts with more than 2 opportunistic infections was lower than 100 / u L, 5 and 5 more opportunistic infections were lower than 50 / L.5, 70 cases were deteriorated and death cases, 49 men and 13 women. HAART was directly killed by HAART before death and died of AIDS. Patients with opportunistic infection (62 cases (88.57%) died of a pathogen infection in 28 cases and died in 34 cases of common infection of various pathogens. Conclusion: 1, HAART era, opportunistic infection is still dominated by respiratory and digestive system infection. The spectrum of opportunistic infection after antiviral infection has some changes, severe refractory and fatal opportunistic infection. The incidence of birth rate and multiple infection is decreased by.2. The pathogenic bacteria of opportunistic infection are mainly bacteria and fungi, and the detection rate of pathogenic bacteria is low. It is a difficult problem that puzzles the diagnosis and treatment of opportunistic infection,.3, the incidence of CD4+T lymphocyte count and opportunistic infection, and the correlation of the species of pathogens. According to the different reasons and the immune level of patients, the incidence of opportunistic infection is still high after HAART, and the incidence of opportunistic infection is still high, and the opportunistic infection is still the main treatment, hospitalization and even death cause of AIDS patients in our province. Therefore, to improve the immune level and reduce the incidence of opportunistic infection is the treatment of.4. The primary task of treatment.

【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R512.91

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