HIV/AIDS合并社区获得性肺炎临床预后评分系统的建立及验证  

Development and Validation of a Clinical Prognosis Scoring System for HIV/AIDS Patients with Community-acquired Pneumonia

作　　者：付凯 付永佳 汪玲琴 覃锦玉 蒙达礼[1] 蒋忠胜[1] FU Kai;FU Yongjia;WANG Lingqin;QIN Jinyu;MENG Dali;JIANG Zhongsheng(Liuzhou People's Hospital Affiliated to Guangxi Medical University,Liuzhou 545006,China)

机构地区：[1]广西医科大学附属柳州市人民医院,广西柳州市545006

出　　处：《中国全科医学》2021年第35期4492-4498,4505,共8页Chinese General Practice

基　　金：十三五国家科技重大专项子课题(2018ZX10302104-001-008);国家自然科学基金青年基金资助项目(81803295);广西卫生健康委员会计划课题(Z20180300);柳州市科学研究与技术开发计划课题(2017BH20304)。

摘　　要：背景社区获得性肺炎(CAP)是人类免疫缺陷病毒(HIV)/艾滋病(AIDS)患者最常见的机会性感染疾病。对于HIV/AIDS合并CAP患者,最重要的是评估患者的病情严重程度,制订预测短期死亡率的严重程度评分,以便在患者初步就诊时做出更客观的决策,对患者的预后至关重要。目的建立HIV/AIDS合并CAP患者临床预后评分系统,并验证其预测效能。方法回顾性分析2016—2019年在柳州市人民医院住院的615例HIV/AIDS合并CAP患者的临床资料,随机分为建模组455例和验模组160例,根据预后评估将建模组分为好转亚组和恶化亚组,收集患者入院24 h内的一般信息、合并基础疾病、生命体征、实验室检查(血常规、电解质、肝肾功能、血气分析等)及影像学检查等资料,并对建模组临床资料数据进行多因素Logistic回归分析,筛选影响患者临床预后的危险因素,根据危险因素建立HIV/AIDS合并CAP患者临床预后评分系统。使用Kaplan-Meier生存分析比较不同风险组的恶化死亡率,并利用验模组数据验证该评分系统的预测效能。结果好转亚组进入重症加强护理病房(ICU)、意识障碍、呼吸>30次/min、低血压、血小板计数(PLT)<100×10^(9)/L、红细胞比容(HCT)<35%、pH值<7.35或>7.45、血氧分压(PaO_(2))<60 mm Hg、血氧饱和度(SaO_(2))<93%、尿素氮(BUN)>7 mmol/L、乳酸脱氢酶(LDH)>230 U/L、血清白蛋白(ALB)<30 g/L、总胆红素(TBil)>34.2μmol/L、丙氨酸氨基转移酶(ALT)>40 U/L、天冬氨酸氨基转移酶(AST)>40 U/L、血钠(Na)<135 mmol/L或>145 mmol/L、CD4淋巴细胞计数<50个/mm3比例与恶化亚组比较,差异均有统计学意义(P<0.05)。多因素Logistic回归分析,结果显示,进入ICU、意识障碍、低血压、PLT<100×10^(9)/L、HCT<35%、SaO_(2)<93%、LDH>230 U/L、ALT>40 U/L、Na<135 mmol/L或>145 mmol/L及CD4淋巴细胞计数<50个/mm^(3)共10个变量是影响患者预后的独立危险因素(P<0.05)。建立评分系统包括进�Background Community-acquired pneumonia(CAP)is the most common opportunistic infection among people with human immunodeficiency virus(HIV)/acquired immune deficiency syndrome(AIDS).Evaluating disease severity and scoring short-term mortality will greatly help physicians to make objective decisions during the initial visit of HIV/AIDS patients with CAP,which is crucial to patient prognosis.Objective To develop and verify a clinical prognosis scoring system for HIV/AIDS patients with CAP.Methods Clinical data of 615 HIV/AIDS patients with CAP(455 in modeling group,and 160 in validation group)recruited from Liuzhou People's Hospital from 2016 to 2019 were retrospectively analyzed,including demographics,underlying diseases,24-hour post-admission vital signs,clinical laboratory results(routine blood test,liver and kidney function tests,blood gas analysis),imaging examination and so on.Multivariate Logistic regression analysis of the clinical data of modeling group was conducted to screen for independent risk factors of clinical prognosis to develop a clinical prognosis scoring system.Kaplan-Meier survival analysis was used to compare the worsening mortality between different risk groups rated by the scoring system.And the predictive performance of the scoring system was tested by using the data of validation group.Results Patients with improved and deteriorated conditions had significant differences in the prevalence of admission to the ICU,disturbance of consciousness,respiratory rate>30 breaths per minute,hypotension,platelet blood count(PLT)<100×10^(9)/L,hematocrit(HCT)<35%,pH<7.35 or>7.45,partial pressure of oxygen(PaO_(2))<60 mm Hg,oxygen saturation(SaO_(2))<93%,urea nitrogen(BUN)>7 mmol/L,lactate dehydrogenase(LDH)>230 U/L,seralbumin(ALB)<30 g/L,total bilirubin(TBil)>34.2μmol/L,alanine aminotransferase(ALT)>40 U/L,aspartate aminotransferase(AST)>40 U/L,serum sodium(Na)<135 mmol/L or>145 mmol/L,and CD4 lymphocyte count<50 cells/mm3(P<0.05).Multivariate Logistic regression analysis identified 10 risk factors for

关 键 词：获得性免疫缺陷综合征 HIV 肺炎 社区获得性肺炎 预后 评分系统 

分 类 号：R512.91[医药卫生—内科学] R563.1[医药卫生—临床医学]