成都市某医院结核重症监护室TB/HIV感染患者死亡相关因素分析  

Analysis of factors related to the death of TB/HIV infected patients in the TB intensive care unit of a hospital in Chengdu

作　　者：程耀 陈洪德 吴桂辉 赖敏 罗海霞 李玉科 CHENG Yao;CHEN Hong-de;WU Gui-hui;LAI Min;LUO Hai-xia;LI Yu-ke(Department of Tuberculosis,Chengdu Municipal Public Health Clinical Medical Center,Chengdu 610061,China)

机构地区：[1]成都市公共卫生临床医疗中心结核科,四川成都610061

出　　处：《临床肺科杂志》2022年第11期1746-1750,共5页Journal of Clinical Pulmonary Medicine

基　　金：成都市卫生与健康委员会医学科学研究课题(No.2019089)。

摘　　要：目的探讨结核重症监护室TB/HIV感染患者的临床特征及死亡相关预测因素,以提高重症监护室诊治TB/HIV感染患者的水平。方法采用回顾性分析研究方法,搜集2017年1月到2020年12月成都市公共卫生临床医疗中心结核重症监护室收治的TB/HIV感染死亡患者及存活患者的临床特征做单因素分析,将单因素分析中差异有统计学意义(P<0.05)的因素赋值后以进一步做多因素Logistic回归分析。结果纳入的142名患者中,有102人死亡,占71.83%,其中45人在入住监护室后7天内死亡,占所有患者31.69%;单因素分析死亡患者及存活患者,在性别、婚姻、入住前是否抗结核/抗病毒治疗、白蛋白计数、CD4^(+)T淋巴细胞计数、是否机械通气治疗方面,差异有统计学意义(P<0.05),进一步多因素分析发现男性(OR=2.474,95%CI 1.072~5.707,P=0.034)、入住前未抗结核治疗(OR=3.622,95%CI 1.580~8.488,P=0.002)、低蛋白血症(OR=2.381,95%CI 1.328~5.494,P=0.042)、行机械通气治疗(OR=4.644,95%CI 1.522~13.894,P=0.006)是监护室TB/HIV感染患者的死亡独立危险因素(P<0.05)。结论结核重症监护室中TB/HIV感染患者的高死亡率,对此类患者管理及诊治有极高的难度,尤其存在入住前未抗结核治疗、低蛋白血症、机械通气治疗的患者。Objective To explore the clinical characteristics and death-related predictors of TB/HIV infected patients in the tuberculosis intensive care unit(ICU),so as to improve the diagnosis and treatment level of TB/HIV infected patients in the ICU.Methods A retrospective analysis was used to collect the clinical features of TB/HIV infected dead and surviving patients admitted to the tuberculosis ICU of Chengdu Public Health Clinical Medical Center from January 2017 to December 2020,and a univariate analysis was performed.Then,the factors with statistically significant differences(P<0.05)in the univariate analysis were assigned to further multivariate Logistic regression analysis.Results Among the 142 patients included,102 died,accounting for 71.83%,of which 45 died within 7 days of admission to the ICU,accounting for 31.69%of all patients.Univariate analysis showed that there were significant differences in gender,marriage,anti-tuberculosis/antiviral treatment before admission,albumin count,CD4^(+)T lymphocyte count,and mechanical ventilation treatment between dead patients and surviving patients(P<0.05).Further multivariate analysis found that males(OR=2.474,95%CI:1.072-5.707,P=0.034),had no anti-tuberculosis treatment before admission(OR=3.622,95%CI:1.580-8.488,P=0.002),low protein Hyperemia(OR=2.381,95%CI:1.328-5.494,P=0.042),mechanical ventilation(OR=4.644,95%CI:1.522-13.894,P=0.006)were the independent risk factors for death in patients with TB/HIV infection in ICU(P<0.05).Conclusion The high mortality rate of TB/HIV-infected patients in the tuberculosis ICU makes it extremely difficult to manage,diagnose,and treat such patients,especially those who have not received anti-tuberculosis treatment,hypoalbuminemia,and mechanical ventilation before admission.

关 键 词：结核重症监护室 结核病 艾滋病 临床特征 死亡 相关因素 

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