艾滋病合并急性间质性肺炎预后影响因素分析  

Analysis of Risk Factors of Prognosis and Protective Factors of Treatment in AIDS Patients with Acute Interstitial Pneumonia

作　　者：陆鹏 LU Peng(The Third People’s Hospital of Wuzhou City,Wuzhou 543001,China)

机构地区：[1]梧州市第三人民医院,广西梧州543001

出　　处：《中华灾害救援医学》2024年第2期134-137,152,共5页Chinese Journal of Disaster Medicine

基　　金：广西壮族自治区卫生健康委员会自筹经费科研课题(Z20190993)。

摘　　要：目的探讨影响艾滋病合并急性间质性肺炎患者预后的危险因素和治疗过程中对患者预后有益的治疗方法。方法收集89例艾滋病合并急性间质性肺炎接受住院治疗患者的临床资料,以治疗预后“恶化/好转”为最终定义事件,根据临床经验选择患者年龄、性别、血压、体温、呼吸频率、脉搏、血红蛋白、血小板计数、CD4^(+)T淋巴细胞计数、谷草转氨酶、乳酸脱氢酶、血清白蛋白、C反应蛋白、氧合指数、血清巨细胞病毒DNA检查结果、肺结核筛查结果、(1,3)-β-D葡聚糖检测结果17项治疗前对患者预后恶化可能有影响的因素和早期绝对卧床休息、早期给予足够呼吸支持、早期积极纠正低蛋白血症、早期使用两性霉素B、早期使用糖皮质激素这5个对患者预后好转可能有益的治疗方法进行单因素分析,筛选具有统计学差异者纳入Logistic回归分析,探讨治疗早期影响患者预后的危险因素和对患者有益的治疗方法。结果89例经过积极治疗的患者,预后为好转的71例(79.8%),恶化的18例(20.2%)。多元Logistic回归分析结果显示患者在治疗前的血压、乳酸脱氢酶、氧合指数、血液巨细胞病毒DNA、(1,3)-β-D葡聚糖检测结果5项均为影响患者预后的危险因素(P<0.05);而在治疗早期能够给予足够呼吸支持、纠正低蛋白血症、使用两性霉素B抗真菌治疗3项是对患者预后有益的治疗方法(P<0.05)。结论治疗前患者低血压、乳酸脱氢酶异常升高、氧合指数下降、血液巨细胞病毒DNA阳性、(1,3)-β-D葡聚糖检测阳性是患者治疗效果差,预后不良的危险因素;而在治疗早期给予患者足够的呼吸支持、积极纠正低蛋白血症、积极抗真菌治疗可以取得更好的疗效。Objective To explore the risk factors that affect the prognosis of AIDS patients with acute interstitial pneumonia and the treatment methods that are beneficial to the prognosis of patients in the course of treatment.Methods The clinical data of 89 hospitalized patients with AIDS complicated with acute interstitial pneumonia were collected.The final definition of the event was"deterioration/improvement"of the treatment outcome.A univariate analysis was conducted on the 17 factors that may have an impact on the deterioration of patient prognosis before treatment,including the patient's age,gender,blood pressure,temperature,respirator y rate,pulse,hemoglobin,blood plate count,CD4^(+)T lymphocyte count,glutamic oxaloacetic transaminase,lactate dehydrogenase,serum albumin,C-reactive protein,oxygenation index,serum cytomegalovirus DNA test results,pulmonary tuberculosis screening results,and fungal(1,3)-β-D-glucan test results,as well as the 5 treatment methods that may be beneficial for improving patient prognosis,including early absolute bed rest,early adequate respiratory support,early active correction of hypoalbuminemia,early use of amphotericin B,and early use of glucocorticoids.Individuals with statistical differences for inclusion in logistic regression analysis were screened to explore risk factors that affect patient prognosis in the early stages of treatment and treatment methods that are beneficial for patients.Results Among the 89 patients who underwent active treatment,71(79.8%)had improved prognosis and 18(20.2%)had worsened prognosis.The results of multiple logistic regression analysis showed that pre-treatment blood pressure,lactate dehydrogenase(LDH),oxygenation index,blood cytomegalovirus DNA,and fungal(1,3)-β-D�glucan test results were all risk factors affecting the patient's prognosis(P<0.05);Whether sufficient respiratory support can be provided in the early stage of treatment,correcting hypoproteinemia,and using amphotericin B(AMB)antifungal therapy are protective factors that affect patient

关 键 词：获得性免疫缺陷综合征 肺炎 预后 

分 类 号：R512.91[医药卫生—内科学]