156例HIV/TB患者治疗转归及死亡危险因素分析  

Analysis of risk factors for treatment outcome and death in 156 HIV/TB patients

作　　者：马瑶 吴桂辉 MA Yao;WU Gui-hui(Department of Tuberculosis District,Chengdu Public Health Clinical Medical Center,Chengdu,Sichuan610041,China)

机构地区：[1]成都市公共卫生临床医疗中心结核病区

出　　处：《临床肺科杂志》2019年第10期1878-1882,共5页Journal of Clinical Pulmonary Medicine

摘　　要：目的分析156例HIV/TB患者的治疗转归情况及死亡危险因素。方法选取本院2015年1月―2017年11月收治的156例HIV/TB患者,入组时已接受抗病毒治疗者继续维持抗病毒治疗并联合抗结核治疗,未接受抗病毒治疗者先抗结核治疗2周以后启动抗病毒治疗。抗病毒治疗方案:替诺福韦+拉米夫定+依非韦伦;抗结核治疗方案根据患者情况确定,其中单纯肺结核患者采用2HRZE/4HR方案,总疗程6个月;合并肺外结核者采用2HRZE/10HRE方案,总疗程12个月,记录治疗转归。进行追踪随访,根据死亡情况将患者分为死亡组与存活组,比较2组年龄、性别、体质量指数、抗病毒治疗情况、药敏试验、CT表现、HIV病程、HIV感染途径、肺结核类型、合并肺外结核、服药情况、CD4^+T淋巴细胞计数。采用多因素Logistic回归分析明确肺结核合并艾滋病患者抗结核治疗后死亡的危险因素。结果156例患者中治愈79例、完成疗程38例、治疗失败10例、死亡29例,治疗成功率75.00%、死亡率18.59%。最终死亡组29例、存活组127例。死亡组抗结核治疗开始前的CD4^+T淋巴细胞计数<150个/μL、静脉吸毒感染HIV、涂阳肺结核、有过中断服药患者的占比(79.31%,58.62%,65.52%,24.14%)明显高于存活组(48.03%,35.43%,37.01%,8.66%),接受抗病毒治疗患者的占比(34.48%)低于存活组(57.48%),差异有统计学意义(P<0.05)。多因素Logistic回归分析证实,CD+4T淋巴细胞计数<150个/μL、静脉吸毒感染HIV、涂阳肺结核、中断服药是肺结核合并艾滋病患者抗结核治疗后死亡的危险因素,接受抗病毒治疗则是保护因素(P<0.05)。结论CD4^+T淋巴细胞计数<150个/μL、静脉吸毒感染HIV、涂阳肺结核、中断服药是肺结核合并艾滋病患者抗结核治疗后死亡的危险因素,接受抗病毒治疗则是保护因素,应重视双重感染患者的抗病毒治疗,并加强服药的追踪管理,尽最大可能提高患者用药依从性,�Objective To analyze the treatment outcomes and risk factors for death in 156 HIV/TB patients.Methods The total of 156 patients with pulmonary tuberculosis and AIDS admitted to our hospital from January 2015 to November 2017 were enrolled.Those patients who had received antiviral therapy at the time of enrollment continued to maintain antiviral therapy and combined with anti-tuberculosis treatment.Those who did not receive antiviral therapy started antiviral therapy after anti-tuberculosis treatment for 2 weeks.Antiviral treatment regimen was tenofovir+lamivudine+efavirenz,and anti-tuberculosis treatment plan was determined according to the patient's condition,in which simple tuberculosis patients adopt 2HRZE/4HR regimen.The total course of treatment was 6 months.Combined with extrapulmonary conjugate,the 2HRZE/10HRE program was used for a total of 12 months and the treatment outcomes were recorded.The follow-up was performed,and the patients were divided into the death group and the survival group according to prognosis.Their age,gender,body mass index,antiviral treatment,drug susceptibility test,CT manifestation,HIV course,HIV infection route,type of tuberculosis,combined extrapulmonary tuberculosis,medication,and CD+4 T lymphocyte count were compared between the two groups.Multivariate logistic regression analysis was used to identify risk factors for death from tuberculosis patients with AIDS after anti-tuberculosis treatment.Results Of the 156 patients,79 cases were cured,38 cases were completed,10 cases were failed,and 29 cases were dead.The success rate was 75.00%,and the mortality was 18.59%.There were 29 patients in the final death group and 127 patients in the survival group.The CD4^+T lymphocyte count<150/μL before the start of anti-tuberculosis treatment,the proportion of patients with intravenous drug-infected HIV,smear-positive tuberculosis,and discontinued medication were significantly higher in the death group[79.31%,58.62%,65.52%,24.14%]than in the survival group[48.03%,35.43%,37.01%,8.66%].The

关 键 词：肺结核 艾滋病 抗结核治疗 预后 死亡 危险因素 

分 类 号：R512.91[医药卫生—内科学] R52[医药卫生—临床医学]