艾滋病合并重症卡氏肺孢子菌肺炎患者的生存分析  

Survive of AIDS patients complicated with Pneumocystis carinii pneumonia

作　　者：曾传莉[1] 袁刚[1] 向华[1] 

机构地区：[1]宁波市第二医院北郊院区感染病科,浙江宁波315016

出　　处：《疾病监测》2013年第1期28-30,共3页Disease Surveillance

摘　　要：目的探讨医院住院艾滋病患者合并重症卡氏肺孢子菌肺炎(pneumocystis carinii pneumonia,PCP)的生存时间,为临床治疗时机及选用药物提供参考依据。方法对宁波市第二医院2007年3月至2012年6月收治的30例艾滋病合并重症PCP病例进行回顾性分析。将患者CD4+细胞计数及治疗方法采取分层的方法进行生存时间分析,绘制Kaplan-meier曲线,治疗随访时间为30 d。结果 30例艾滋病合并重症PCP患者共死亡25例,存活5例,其中复方磺胺甲恶唑(TMP-SMZ)治疗16例,患者死亡14例,病死率为87.5%;TMP-SMZ联合强的松治疗14例,患者死亡11例,病死率为78.57%。按CD4+细胞计数分层,TMP-SMZ联合强的松治疗患者累计生存率明显高于单纯TMP-SMZ治疗组;按抗PCP治疗方法分层,CD4+细胞计数<50个/μl的患者累计生存率低于CD4+细胞>50个/μl患者。结论艾滋病合并重症PCP患者病死率高,应早发现、早诊断、早治疗。TMP-SMZ联合强的松治疗方案较单纯TMP-SMZ治疗效果更好。Objective To evaluate the survive of hospitalized AIDS patients complicated with severe pneumocystis carinii pneumonia（PCP） and provide evidence for the development of treatment schedule and clinical drug use. Methods A retrospective analysis was conducted on the AIDS cases complicated with severe PCP hospitalized in our hospital from March 2007 to June 2012 to know their survival time according to their CD4 ＋ cell count and under different treatments received. Results Totally 30 AIDS cases complicated with severe PCP were analyzed, in which 25 died, 5 survived. Sixteen cases were treated with simple Trimethoprim ＋ Sulfamethoxazole （ TMP-SMZ）, 14 died, the case fatality was 87.5%. Fourteen cases were treated with TMP-SMZ plus prednisone, 11 died, the case fatality was 78.57%. According to the CD4 ＋ cell counts, the survival rate of the patients treated with TMP-SMZ plus prednisone were higher than that of those received only TMP-SMZ; According to the treatment received, the survival rate of the patients with CD4 ＋ cell count 〈 50μl was lower than that of those with CD4＋ cell count 〉 50μl. Conclusion The case fatality of AIDS patients complicated with severe PCP is high, it is critical to give them early discovery, diagnosis and treatment. The efficiency of TMP-SMZ plus prednisone is better than simple TMP-SMZ.

关 键 词：艾滋病 卡氏肺孢子菌肺炎 生存分析 CD4+细胞 复方磺胺甲恶唑 

分 类 号：R512.91[医药卫生—内科学]