播散性马尔尼菲篮状菌病并发消化道出血患者近期预后的Cox回归生存分析  

Cox regression survival analysis of short-term outcome in patients with disseminated Talaromyces marneffei infection complicated with gastrointestinal bleeding

作　　者：陈涛[1] 兰慧慧 蒋忠胜[1] 莫胜林[1] 李旭 李敏基[1] 张鹏[1] 胡家光[1] 唐贵 CHEN Tao;LAN Huihui;JIANG Zhongsheng;MO Shenglin;LI Xu;LI Minji;ZHANG Peng;HU Jiaguang;TANG Gui(Department of Infectious Diseases,Liuzhou General Hospital,Liuzhou Guangxi 545006,China)

机构地区：[1]柳州市人民医院感染病科,广西柳州545006 [2]广西壮族自治区胸科医院呼吸内科

出　　处：《中国感染与化疗杂志》2022年第5期538-544,共7页Chinese Journal of Infection and Chemotherapy

基　　金：“十三五”国家科技重大专项课题(2018ZX10302104-001-008);柳州市科技计划项目资助课题(2021CBC0107);广西卫生厅课题(Z20200297、Z20200476)。

摘　　要：目的分析播散性马尔尼菲篮状菌病(DTSM)并发消化道出血(GIB)患者的临床资料,建立近期预后的预后指数方程。方法收集2009年1月—2021年3月广西壮族自治区胸科医院(62例)及柳州市人民医院(43例)收治的DTSM并发GIB患者共105例,分为好转组(58例)和死亡组(47例),通过单因素及多因素Cox回归分析逐步筛选出独立预后因素。建立预后指数方程,并根据预后指数方程分组预测患者的生存率。结果多因素Cox回归分析结果显示,白蛋白(ALB)、尿素氮(BUN)、血小板(PLT)、CD4/CD8是DTSM并发GIB患者的独立预后因素(P<0.05)。预后指数方程(PI)=1.124×PLT+1.179×BUN+1.104×ALB+0.910×(CD4/CD8),受试者工作特征曲线的曲线下面积(AUC)为0.947(95%CI 0.904~0.990,S_(x)=0.022,P<0.001)。根据预后指数方程将患者分为低危、中危和高危3组,3组的14 d生存率分别为92.59%、38.89%和3.03%。Log-Rank检验结果提示3组患者的生存率组间比较差异有统计学意义(χ^(2)=91.257,ν=2,P<0.001)。结论ALB、BUN、PLT及CD4/CD8是影响DTSM并发GIB患者近期预后的独立因素,所构建的预后指数方程可为此类患者临床预后的评估提供一定参考依据。Objective To analyze the clinical data of disseminated Talaromyces marneffei infection(DTSM)complicated with gastrointestinal bleeding(GIB)and establish a prognostic index(PI)equation for predicting short-term outcome.Methods The 105 cases of TSM patients with GIB who were treated in Chest Hospital of Guangxi Zhuang Autonomous Region(62 cases)and Liuzhou People’s Hospital(43 cases)from January 2009 to March 2021 were assigned to improvement group(58 cases)and death group(47 cases).Univariate and multivariate Cox regression analyses were performed to identify the independent prognostic factors of DTSM complicated with GIB.PI equation was established to predict the survival rate of patients.Results Multivariate Cox regression analysis showed that albumin(ALB),blood urea nitrogen(BUN),platelet(PLT),and CD4/CD8 were independent prognostic factors of DTSM complicated with GIB.PI=1.124×PLT+1.179×BUN+1.104×ALB+0.910×(CD4/CD8).The area under the receiver operating characteristic curve was 0.947(95%CI 0.904-0.990;S_(x)=0.022,P<0.001).The patients were stratified into three risk group by PI:low,medium,and high risk groups.The corresponding 14-day survival rate of these 3 risk groups was 92.59%,38.89%and 3.03%,respectively.Log-rank test showed that the survival rate was significantly different between the three risk groups of patients(χ^(2)=91.257,ν=2,P<0.001).Conclusions ALB,BUN,PLT,and CD4/CD8 were independent prognostic factors for the short-term outcome of DTSM patients with GIB.The proposed prognostic index is useful for evaluation of clinical outcome in such patients.

关 键 词：播散性马尔尼菲篮状菌病 消化道出血 预后 COX回归分析 

分 类 号：R519[医药卫生—内科学]