68例艾滋病合并机会性感染者的临床特点及预后分析

发布时间：2018-03-11 00:25

本文选题：艾滋病　切入点：机会性感染　出处：《宁夏医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的通过对68例艾滋病合并机会性感染者的临床特点及对其预后的影响因素进行回顾性分析,以期为艾滋病合并机会性感染的临床预防及治疗提供一定的依据。方法选取自2008年8月至2016年10月期间于宁夏医科大学总医院相关科室住院治疗,并经宁夏疾病预防控制中心确诊核实的68例艾滋病患者。入组患者的出院诊断均为艾滋病合并相关机会性感染,收集相关资料包括患者的人口学基本特征、各类机会性感染数目、合并机会性感染的种数,患者发生机会性感染时CD4+T细胞计数,并按照患者的生存状况(存活和死亡)分组。首先对入组患者人口学基本特征、合并机会性感染情况等进行描述性分析,再用SPSS 22.0统计软件对预后影响因素分析。统计描述主要采用构成比,统计推断主要采用X2检验、fisher精确法和Logistic回归分析。结果(1)68例艾滋病合并机会性感染者中,男性52人,女性16人,男女比例为3.3:1。年龄在12岁~74岁之间,平均年龄(38.93±12.70)岁。18~39岁者占63.24%(43/68)。以汉族居多,占64.71%(44/68)。已婚或同居者占58.82%(40/68)。感染途径中性接触感染占首位,为69.12%(47/68)。所调查的患者中,初中及初中以下文化程度者共占75.00%。职业分布较分散,以农民/民工、无业待业者为主,共占72.06%(49/68)。(2)68例艾滋病合并机会性感染的发生率排在前5位的依次为(部分患者一人合并多种感染):细菌性肺炎(55.88%)、口腔白斑(50.00%)、肺孢子菌肺炎(45.59%)、带状疱疹(27.94%)、肺结核及肺外结核(22.06%)。其中艾滋病患者合并2种及2种以上机会性感染占89.71%(61/68)。(3)68例艾滋病合并机会性感染者中,CD4+T细胞计数在200个/ul以下的患者共66例,CD4+T细胞计数介于50~100个/ul时,机会性感染的发生率最高,为39.71%(27/68)。(4)68例艾滋病合并机会性感染者预后影响因素:单因素X2检验显示:男性死亡率高于女性(X2=7.297,P=0.007);年龄大于40岁以上的艾滋病患者的死亡率高(X2=8.223,P=0.028);感染途径中性接触的死亡率高(X2=8.644,P=0.015);机会性感染中肺孢子菌肺炎、肺结核及肺外结核、巨细胞病毒感染、合并3种及3种以上的机会性感染均是影响结局的因素(P0.05)。多因素Logistic回归分析发现:CD4+T细胞计数为影响艾滋病合并机会性感染者预后的独立危险因素(P=0.004)。CD4+T细胞计数越低,艾滋病患者越容易死亡(β=-0.269,OR值=0.765)。结论(1)艾滋病合并机会性感染者呼吸系统的感染机率较高,在针对艾滋病患者呼吸系统感染的防治上需进一步加强。(2)CD4+T细胞数低于200个/ul以下,可考虑作为防控机会性感染的标志。(3)CD4+T细胞计数为影响艾滋病合并机会性感染者预后的独立危险因素,CD4+T数目越少,AIDS患者的预后越差。
[Abstract]:Objective to analyze retrospectively the clinical characteristics and prognostic factors of 68 cases of AIDS complicated with opportunistic infection. Methods from August 2008 to October 2016, the patients were hospitalized in the relevant departments of the General Hospital of Ningxia Medical University, from August 2008 to October 2016, in order to provide a basis for the clinical prevention and treatment of AIDS complicated with opportunistic infection. And 68 AIDS patients confirmed and verified by the Ningxia Center for Disease Control and Prevention. The discharged patients were all diagnosed as AIDS associated opportunistic infections. Relevant data were collected, including the basic demographic characteristics of the patients. The number of opportunistic infections, the number of species associated with opportunistic infection, the number of CD4 T cells in patients with opportunistic infection, and the groups according to the patient's survival status (survival and death). The incidence of opportunistic infection was analyzed by descriptive analysis, and the prognostic factors were analyzed by SPSS 22.0 statistical software. Statistical inference was performed by using X _ 2 test and Logistic regression analysis. Results among 68 patients with opportunistic AIDS infection, 52 were male, 16 were female, and the ratio of male to female was 3.3: 1.The age was between 12 and 74 years old. The average age was 38.93 卤12.70). The average age was 38.93 卤12.70). The average age was 63.2443 / 68. The Han nationality was the majority, accounting for 64.71%. The married or cohabited persons accounted for 58.82% 68% of the total. Sexual contact infection was the most common route of infection (69.12 47% 68%). Among the patients surveyed, 75.00% were from junior high school and below junior high school education. Mainly farmers / migrant workers, unemployed and unemployed, A total of 72.06 / 68 cases of AIDS with opportunistic infection ranked the top 5 in order (some patients one person with multiple infections: bacterial pneumonia 55.88am, oral leukoplakia 50.0010, Pneumocystis pneumonia 45.59cum, herpes zoster 27.94B, tuberculosis and extrapulmonary infection: 55.88g / L, Pneumocystis pneumocystis pneumoniae 45.59m, herpes zoster 27.94%, pulmonary tuberculosis and extrapulmonary infection. TB 22.060.Among them, AIDS patients with two or more kinds of opportunistic infections accounted for 89.71% of the 68 AIDS patients with opportunistic infections. In the 68 cases with AIDS and opportunistic infections, 66 patients with CD4 T cell count below 200 / ul had a CD4 T cell count ranging from 50 to 100 Rul. Opportunistic infections have the highest incidence, A total of 68 patients with HIV / AIDS associated with opportunistic infection were identified as prognostic factors: univariate X2 test showed that male mortality was higher than that of female X2 + 7.297, mortality of AIDS patients over 40 years old was higher than that of AIDS patients over 40 years old, mortality rate of AIDS patients over 40 years old was higher than that of AIDS patients with HIV / AIDS infection, mortality of sexually transmitted infections was higher than that of female patients with HIV / AIDS infection, mortality of patients with AIDS over 40 years of age was higher than that of patients with AIDS over 40 years of age. The rate of death was high: X2 + 8.644 (P = 0.015), pneumocystis pneumonia in opportunistic infection, and Pneumocystis pneumoniae in opportunistic infection. Tuberculosis and extrapulmonary tuberculosis, cytomegalovirus infection, The multivariate Logistic regression analysis showed that the percentage of CD4 T cells was an independent risk factor for the prognosis of AIDS patients with opportunistic infection. The lower the number of CD4 T cells was, the lower the number of CD4 T cells was. The more easily the AIDS patients died (尾 -0.269 OR value 0.7650.Conclusion 1) the rate of respiratory system infection in AIDS patients with opportunistic infection is higher. The prevention and treatment of respiratory system infection in AIDS patients should be further strengthened. The number of CD4 T cells in AIDS patients is less than 200 / ul. As a marker of prevention and control of opportunistic infection, the count of CD4 T cells is an independent risk factor for the prognosis of AIDS patients with opportunistic infection. The lower the number of CD4 T cells is, the worse the prognosis of AIDS patients is.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R512.91

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