艾滋病合并马尔尼菲青霉菌病患者死亡危险因素分析

目的探讨艾滋病(AIDS)合并马尔尼菲青霉菌病(PSM)的死亡危险因素。方法采用病例对照研究方法,调查2008-01～2009-12广西壮族自治区龙潭医院收治住院的307例AIDS合并PSM患者,通过单因素和多因素非条件Logistic回归分析筛选出导致患者死亡的危险因素。结果 AIDS合并PSM 307例患者中,生存组226例,死亡组81例,死亡率为26.38%。单因素Logistic回归分析显示,感染途径、治疗方案、是否接受过高效抗反转录病毒(HAART)治疗、合并细菌或其它真菌性肺炎、合并耶氏肺孢子虫肺炎(PCP)、中毒性肝炎、白细胞减少、血小板减少、白蛋白减少、血尿素氮升高、血清总胆红素升高等16个因素为死亡的影响因素。多因素分析结果显示,实施氟康唑治疗方案及两性霉素B治疗方案是预后的保护因素,合并PCP、血小板减少、血尿素氮升高、总胆红素升高是死亡的危险因素。结论通过对死亡危险因素的研究,可有针对性采取有效治疗和控制措施.对降低死亡率有重要意义。     

成人HIV/AIDS病人HAART前血小板减少的发生率及相关因素分析

目的描述成人艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人(简称HIV/AIDS病人)在高效抗病毒治疗(HAART)前,发生血小板减少的基本特征,探讨HIV合并血小板减少的发生率及相关因素。方法以2003年6月至2015年12月,在北京地坛医院门诊就诊的3452例HIV/AIDS病人为研究对象,比较HAART前不同基本情况[人口学资料、身体质量指数(BMI)、CD4+T淋巴细胞(简称CD4细胞)计数、病毒载量、是否合并机会性感染及症状体征、其他混合性感染的合并情况及是否服用复方新诺明(SMZ-TMP)情况]的血小板减少的发生率,通过Logistic回归分析HIV/AIDS病人合并血小板减少症的相关因素。结果 HAART前合并血小板减少的有137例(3.97%),其中轻度104例(3.01%),中度19例(0.55%),重度14例(0.41%)。血小板减少的发生率随CD4细胞计数的增加而降低(P0.001)。HAART前HIV RNA≥105拷贝/mL[调整OR值(AOR)=1.903,95%CI:1.125~3.218,P=0.016],CD4细胞计数≤50个/μL(AOR=8.828,95%CI:2.939~26.519,P0.001)及CD4细胞计数51~199个/μL(AOR=3.714,95%CI:1.317~10.479,P=0.013),HBsAg+(AOR=4.949,95%CI:2.372~10.323,P0.001)是发生血小板减少的危险因素。结论成人HIV/AIDS病人HAART前血小板减少发生率较低。低基线CD4细胞计数、高基线病毒载量及合并乙型肝炎是HAART前发生血小板减少的相关因素,因此对存在这些危险因素的病人及早的诊断和治疗是必须的。     

两性霉素B、氟康唑和伊曲康唑治疗AIDS合并马尔尼菲青霉病疗效的Meta分析

目的采用Meta分析评价两性霉素B、氟康唑与伊曲康唑对AIDS合并马尔尼菲青霉病(penicilliosis marneffei,PSM)的治疗效果。方法检索Cochrane图书馆、美国国立医学图书馆Pub Med数据库、美国Ovid数据库、荷兰医学文摘数据库、万方数据库、中国知网CNKI全文数据库和中国生物医学文献数据库,按照Cochrane协作网推荐的纳入标准筛选文献并进行质量评价,采用Stata 12.0进行Meta分析。结果纳入文献6篇,AIDS合并PSM共893例,其中两性霉素B治疗467例,氟康唑治疗152例,伊曲康唑治疗274例。Meta分析结果显示:两性霉素B治疗好转率高于氟康唑[OR=7.138(95%CI 1.761~28.932),P0.05],病死率低于氟康唑[OR=0.507(95%CI 0.294~0.875),P0.05],差异均具有统计学意义;两性霉素B与伊曲康唑对比,治疗好转率[OR=0.777(95%CI 0.498~1.212),P0.05]和病死率[OR=1.427(95%CI 0.890~2.287),P0.05]差异均无统计学意。结论两性霉素B治疗AIDS合并PSM效果优于氟康唑,与伊曲康唑比较疗效无明显差异。今后应积累更多前瞻性资料进一步证实。     

HIV/AIDS合并血小板减少患者HAART后血小板复常的特征及影响因素分析

目的分析HIV/AIDS合并血小板减少患者在高效抗逆转录病毒治疗(highly active antiretroviral therapy,HAART)后血小板的复常特征,探讨影响复常的相关因素。方法采用回顾性分析,以2003年6月—2015年12月在北京地坛医院进行抗病毒治疗的132例HIV/AIDS合并血小板减少的患者为研究对象,分析患者HAART 4周和24周后血小板的复常率及基本特征。结果 1 132例患者中血小板轻度减少99例(75.00%),中度减少19例(14.39%),重度减少14例(10.61%)。患者HAART 4周、24周后血小板的复常率分别为63.9%、80.8%,差异具有统计学意义(P=0.003)。2单因素Logistic分析提示通过血液传播(OR=4.632,P=0.024),合并HBs Ag阳性(OR=3.829,P=0.024)及合并抗HCV阳性(OR=6.476,P=0.020)是影响血小板复常的因素,多因素Logistic分析提示合并HBs Ag阳性(OR=4.345,P=0.027)是影响血小板复常的因素。结论 HAART为HIV/AIDS合并血小板减少最有效的方法,尽早HAART可避免血小板持续降低。HBs Ag阳性是影响血小板复常的主要因素。对于存在危险因素的患者应该给予重视,尽早做出干预措施。     

阜新市高效抗反转录病毒治疗的HIV/AIDS病人基因型耐药情况及影响因素

目的调查接受高效抗反转录病毒治疗(HAART)的艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人(简称HIV/AIDS病人)基因型耐药的发生情况及其影响因素。方法收集HIV/AIDS病人血液样本和基本资料,并进行基因型耐药检测。采用Logistic回归模型分析病人发生基因型耐药的影响因素。结果获得可供分析序列的121例病人中,29例(23.97%)发生基因型耐药。Logistic回归分析表明,离婚或丧偶、治疗时间≥6年、病毒载量水平≥10 000拷贝/mL [比值比(OR)=6.22,95%可信区间(CI):1.85～22.29]、(OR=9.92,95%CI:1.35～26.77)、(OR=14.85,95%CI:6.34～36.18)是HIV/AIDS病人发生基因型耐药的危险因素。而CD4~+T淋巴细胞(简称CD4细胞)≥600个/μL和服药依从性≥95%(OR=0.18,95%CI:0.05～0.981;OR=0.39,95%CI:0.267～0.68)是发生基因型耐药的保护因素。结论 HAART后HIV/AIDS病人发生基因型耐药受多种因素影响,HAART过程中应加强患者CD4细胞数及病毒载量水平的监测,加强服药依从性教育,降低HIV/AIDS病人体内HIV耐药毒株的发生风险。     

基于倾向性评分匹配分析门静脉血栓对肝硬化患者预后的影响

目的分析门静脉血栓(PVT)对肝硬化患者短期预后的影响并探讨肝硬化患者预后的危险因素。方法回顾性分析西南医科大学附属医院2018年9月—2020年3月的肝硬化住院患者临床资料,其中合并PVT患者58例为PVT组,随机选取同期无PVT患者116例为非PVT组,通过1∶1倾向性评分匹配(PSM)均衡组间协变量获取PVT组及非PVT组各44例。满足正态性计量资料2组间比较采用t检验,非正态性计量资料2组间比较采用Mann-Whitney U秩和检验;计数资料2组间比较采用χ~2检验和Fisher确切概率法。利用Kaplan-Meier法及log-rank法分析PSM前后2组患者的生存情况及出血情况,并使用Cox风险模型分析PSM前后影响肝硬化患者预后的危险因素。结果 PSM前非PVT组患者总体生存率明显高于PVT组(P=0.008),而PSM后2组患者总体生存率无明显差异(P=0.076)。PSM前非PVT组上消化道出血或再出血率明显低于PVT组(P 0.001),PSM后结果与PSM前一致(P=0.028)。PSM前肝硬化患者预后多因素分析显示,PVT(HR=2.944, 95%CI:1.364～6.441,P=0.007)和MELD评分≥15(HR=3.531,95%CI:1.630～7.650,P=0.001)是肝硬化患者短期死亡的危险因素。PSM后肝硬化患者预后多因素分析显示,MELD评分≥15是肝硬化患者短期死亡的危险因素(HR=3.312, 95%CI:1.049～10.457,P=0.041)。结论肝硬化合并PVT增加上消化道出血或再出血风险,但其不是肝硬化患者短期死亡的独立危险因素,MELD评分≥15是肝硬化患者短期死亡的独立危险因素。     

慢性心力衰竭患者性别差异对预后的影响因素研究

目的对慢性心力衰竭(心衰)患者进行随访,评估其病因、合并疾病、临床特征与心衰预后指标的相关性,分析性别差异对患者预后影响的相关危险因素。方法连续纳入慢性心衰患者228例,每3个月门诊随访,收集临床资料、心脏超声参数等。记录患者心衰再入院、心源性死亡以及全因死亡终点发生情况。分析在不同性别中不良预后的相关危险因素。结果与男性比较,女性年龄偏大,合并高血压、心房颤动、慢性肾脏病和舒张功能不全明显升高(P<0.01)。对影响预后因素分析显示,女性心房颤动是心衰复发的独立危险因素(OR=6.874,95%CI:1.932²4.459,P=0.003),急性期LVEF降低和肺动脉压力升高是心源性死亡的独立危险因素(OR=0.917,95%CI:0.85124.459,P=0.003),急性期LVEF降低和肺动脉压力升高是心源性死亡的独立危险因素(OR=0.917,95%CI:0.851⁰.989,P=0.024;OR=1.107,95%CI:1.0210.989,P=0.024;OR=1.107,95%CI:1.021¹.200,P=0.013),稳定期心功能分级是全因死亡的独立危险因素(OR=12.484,95%CI:1.1171.200,P=0.013),稳定期心功能分级是全因死亡的独立危险因素(OR=12.484,95%CI:1.117¹39.495,P=0.040)。结论慢性心衰预后的危险因素存在性别差异。对女性患者控制心房颤动、优化舒张性心衰治疗对减少心衰复发,降低心源性死亡可能较男性更有意义。     

老年急性冠状动脉综合征患者预后危险因素分析

目的 探讨急性冠状动脉综合征(ACS)患者的近期预后与影响临床预后的危险因素,为ACS患者的预后风险评估提供依据.方法 入选ACS患者156例.采用无序多分类Logistic回归分析ACS患者的基线特征因素与30 d好转、死亡、心绞痛、心力衰竭的相关性.结果 将全部变量进行多因素Logistic回归分析,显示年龄(OR=1.20,95%CI:1.07～1.34)、糖尿病(OR=19.41,95%CI:3.02～124.70)、白细胞升高(OR=11.36,95%CI:1.87～69.11)及血小板升高(OR=7.72,95%CI:1.29～46.15)是30 d死亡的独立危险因素;白细胞升高(OR=2.35,95%CI:0.89～6.17)及血脂异常(OR=6.25,95%CI:2.11～18.48)是30 d心绞痛发作的独立危险因素;年龄(OR=1.10,95%CI:1.03～1.17)、男性(OR=4.18,95%CI:0.81～21.51)、白细胞升高(OR=2.97,95%CI:1.09～8.14)及血脂异常(OR=7.69,95%CI:2.39～24.76)是30 d发生心力衰竭的独立危险因素.结论 年龄、糖尿病史、血小板升高及白细胞升高是影响ACS患者30 d死亡的独立危险因素;白细胞升高及血脂异常是影响ACS患者30 d心绞痛发作的独立危险因素;年龄、男性、白细胞升高及血脂异常是影响ACS患者30 d心力衰竭的独立危险因素.

Abstract：

Objective To explore short-term prognosis of patients with acute coronary syndrome (ACS) and prognostic risk factors, and to provide information for prognostic risk assessment. Methods A total of 156 patients with acute coronary syndrome were enrolled. The correlations of baseline characteristics with 30-day improvement, death, angina pectoris and heart failure were analyzed using unordered multivariate logistic regression. Results Logistic regression analysis showed that the independent risk factors for 30-day death included age (OR=1.20, 95%CI: 1.07-1.34), diabetes (OR=19.41, 95%CI: 3.02-124.70), leukocytosis (OR=11.36, 95%CI: 1.87-69.11) and increased platelet (OR=7.72, 95%CI: 1.29-46.15). The independent risk factors for 30-day angina pectoris included leukocytosis (OR=2.35, 95%CI: 0.89-6.17) and dyslipidemia (OR=6.25, 95%CI: 2.11-18.48). The independent risk factors for the occurrence of heart failure during 30-day post-ACS included age (OR=1.10, 95%CI: 1.03-1.17), male (OR=4.18, 95%CI: 0.81-21.51), leukocytosis (OR=2.97, 95%CI: 1.09-8.14) and dyslipidemia (OR=7.69, 95%CI: 2.39-24.76). Conclusions Age, diabetes, leukocytosis and increased platelet are independent risk factors associated with 30-day death; Leukocytosis and dyslipidemia are independent risk factors associated with 30-day angina pectoris; Age, male, leukocytosis and dyslipidemia are the independent risk factors associated with 30-day heart failure.     

成人HIV/AIDS病人HAART前血小板减少的发生率及相关因素分析北大核心

目的描述成人艾滋病病毒（HIV）感染者/艾滋病（AIDS）病人（简称HIV/AIDS病人）在高效抗病毒治疗（HAART）前,发生血小板减少的基本特征,探讨HIV合并血小板减少的发生率及相关因素。方法以2003年6月至2015年12月,在北京地坛医院门诊就诊的3452例HIV/AIDS病人为研究对象,比较HAART前不同基本情况[人口学资料、身体质量指数（BMI）、CD4^＋T淋巴细胞（简称CD4细胞）计数、病毒载量、是否合并机会性感染及症状体征、其他混合性感染的合并情况及是否服用复方新诺明（SMZ-TMP）情况]的血小板减少的发生率,通过Logistic回归分析HIV/AIDS病人合并血小板减少症的相关因素。结果 HAART前合并血小板减少的有137例（3.97%）,其中轻度104例（3.01%）,中度19例（0.55%）,重度14例（0.41%）。血小板减少的发生率随CD4细胞计数的增加而降低（P〈0.001）。HAART前HIV RNA≥105拷贝/mL[调整OR值（AOR）=1.903,95%CI：1.125-3.218,P=0.016],CD4细胞计数≤50个/μL（AOR=8.828,95%CI：2.939-26.519,P〈0.001）及CD4细胞计数51-199个/μL（AOR=3.714,95%CI：1.317-10.479,P=0.013）,HBsAg＋（AOR=4.949,95%CI：2.372-10.323,P〈0.001）是发生血小板减少的危险因素。结论成人HIV/AIDS病人HAART前血小板减少发生率较低。低基线CD4细胞计数、高基线病毒载量及合并乙型肝炎是HAART前发生血小板减少的相关因素,因此对存在这些危险因素的病人及早的诊断和治疗是必须的。     

主动脉夹层患者住院死亡危险因素分析

目的:探讨主动脉夹层(AD)患者住院期间死亡相关危险因素。方法:回顾性分析徐州医学院附属淮安医院及东南大学附属医院2004年1月至2009年1月确诊AD120病例临床资料,按住院期间是否发生死亡进行分组,分析患者性别、体质量指数、临床症状、体征和生化指标与死亡的相关性,并用Logistic回归分析其与病死率的关系。结果:1.120例AD患者中男女性别之比为2.0:1。平均年龄(54.7±10.3)岁,急性期院内病死率17.5%;2.死亡组与存活组中:女性、舒张压、超敏C反应蛋白水平、并发意识障碍及心包填塞差异有统计学意义(P0.05);3.女性多元回归分析(OR=2.052;95%CI=1.084～4.470;P=0.010)、超敏C反应蛋白水平(OR=1.436;95%CI=1.325～1.862;P=0.008)及合并意识障碍(OR=2.370;95%CI=1.290～3.192;P=0.04)是AD死亡的独立危险因素(P0.05),舒张压水平(OR=0.532;95%CI=0.262～0.843;P=0.030)为预后保护因素。结论:AD患者中超敏C反应蛋白水平、女性、合并意识障碍,是导致急性期院内死亡的独立危险因素,舒张压水平为保护性因素。     

中性粒细胞与淋巴细胞比值联合序贯器官功能衰竭评分对老年脓毒症患者预后的预测作用

目的探讨中性粒细胞与淋巴细胞比值(NLR)联合序贯器官功能衰竭评分(SOFA)对老年脓毒症患者预后的预测作用。方法回顾性分析解放军第305医院2017年1月至2019年8月收治的124例老年脓毒症患者的临床资料,根据预后情况,分为存活组(58例)和死亡组(66例)。比较2组患者性别、年龄、基础病、原发疾病及NLR、SOFA评分,多因素logistic回归分析影响患者预后的危险因素,绘制受试者工作特征(ROC)曲线,分析危险因素对老年脓毒症患者预后的预测作用。结果2组患者性别组成、年龄、基础病及原发疾病差异无统计学意义,但存活组NLR及SOFA评分明显低于死亡组(P<0.001),且NLR及SOFA评分均为老年脓毒症患者预后的独立危险因素(NLR:OR=1.163,95%CI 1.090~1.241,P<0.001;SOFA评分:OR=1.406,95%CI 1.199~1.649,P<0.001)。NLR预测老年脓毒症患者预后的ROC曲线下面积(AUC)为0.918(95%CI 0.872~0.964,P<0.001),最佳截断值30.68(灵敏度86.2%,特异度81.8%);SOFA预测效能的AUC为0.844(95%CI 0.771~0.916,P<0.001),最佳截断值12.5(灵敏度81.0%,特异度80.3%)。当两者联合预测时,AUC为0.964(P<0.001),优于任何一项指标单独预测的效果。结论NLR和SOFA评分是预测老年脓毒症患者死亡的独立危险因素,尤其两者联合预测死亡风险时,可明显提高对老年脓毒症预后判断的准确性,为临床工作提供一定指导。     

Improved survival with highly active antiretroviral therapy in HIV-infected patients with severe Pneumocystis carinii pneumonia

BACKGROUND: Although the incidence of pneumonia (PCP) has declined, mortality of patients who require intensive care for this disease remains high. Highly active antiretroviral therapy (HAART) might alter the course of PCP either via effects on the immune system or through anti- actions; however, HAART has not been studied in patients acutely ill with PCP. OBJECTIVE: To assess the effects of HAART on outcome of patients admitted to the intensive care unit (ICU) with PCP. DESIGN AND SETTING: Retrospective cohort study carried out at a University-affiliated county hospital. PARTICIPANTS: Fifty-eight HIV-infected adults with PCP admitted to an ICU from 1996 to 2001. MEASUREMENTS: A standardized chart review was performed to collect information on demographic variables, hospital course, and use of antiretroviral therapy. Outcome measured was death while in the ICU or hospital. RESULTS: A total of 20.7% of patients were either receiving HAART or were started on therapy while hospitalized. Mortality in this group was 25%, whereas mortality in those not receiving therapy was 63% (P = 0.03). Multiple logistic regression analyses adjusting for potential confounders showed that HAART started either before or during hospitalization was associated with a lower mortality [odds ratio (OR), 0.14; 95% confidence interval (95% CI), 0.02-0.84; = 0.03). The need for mechanical ventilation and/or development of a pneumothorax (OR, 20.9; 95% CI, 1.9-227.2; = 0.01) and delayed ICU admission (OR, 9.7; 95% CI, 2.2-42.1; = 0.002) were associated with increased mortality. CONCLUSIONS: Use of HAART is an independent predictor of decreased mortality in severe PCP and may represent a potential therapy to improve outcome in this disease.     

血小板减少症对脓毒症患者预后的影响:系统回顾和Meta分析

目的探讨血小板减少症与脓毒症患者不同时期病死率的相关性。方法截至2020年5月31日,通过检索PubMed、Cochrane Library、中国知网、万方等数据库发表的关于血小板减少症与脓毒症预后相关性的文献,主要结局指标包括不同时期病死率。使用STATA 14.0和Review manager 5.3软件进行统计分析。结果最终共纳入9项研究,共10 915例参与者。脓毒症合并血小板减少症对短期(ICU、住院、28 d和30 d)(RR 1.69,95%CI 1.48~1.92,P=0.000),90 d(RR 1.50,95%CI 1.27~1.78,P=0.000)及长期(1年)(RR 1.24,95%CI 1.14~1.35,P=0.000)病死率的影响呈现递减趋势。结论血小板减少症的发生与脓毒症不同时期病死率显著相关,且两者之间的相关性随观测时间的延长逐步减弱。     

他汀类药物对缺血性脑卒中相关性肺炎的预防作用

目的:调查他汀类药物对急性缺血性脑卒中患者并发卒中相关性肺炎(SAP)的预防作用。方法:回顾性分析3492例急性缺血性脑卒中患者的临床资料,并采用logistic回归分析预测发生SAP的危险因素。结果:97例患者死亡,489例患者发生SAP,使用他汀类药物的患者SAP发生率显著低于未使用该药物的患者(12. 0%vs 17. 2%,P 0. 01),多因素分析显示,年龄、改良Rankin量表(mRS)评分、国立卫生研究院卒中量表(NIHSS)评分、吞咽困难、合并心源性栓塞和未采用他汀类药物治疗是SAP发生的危险因素;在调整其他危险因素后,吞咽困难OR值最高(OR=3. 71,95%CI:2. 7～5. 1)。多因素logistic回归分析显示未接受他汀类药物治疗、mRS评分和不明原因的诊断会影响病死率,发生SAP的OR值最高(OR:5. 62,95%CI:3. 40～9. 29)。结论:SAP是患者死亡的主要危险因素,他汀类药物能预防急性缺血性脑卒中患者SAP的发生,并可改善患者的预后。     

Prognostic factors for the survival of patients with AIDS cholangiopathy

OBJECTIVES: AIDS cholangiopathy, once considered to have extremely poor prognosis, is now rarely fatal. This study was designed to assess the survival of patients with AIDS cholangiopathy and investigate prognostic variables, especially in the era of highly active antiretroviral therapy (HAART). METHODS: Ninety-four patients with AIDS cholangiopathy were diagnosed at the San Francisco General Hospital from 1983 to 2001. The mortality status, demographic and clinical variables, and ERCP results were collected through death certificates, chart review, and endoscopic reports. RESULTS: The median survival time from the diagnosis of AIDS and AIDS cholangiopathy was 23 and 9 months, respectively. HAART significantly improved the mortality of patients with AIDS cholangiopathy (hazard ratio [HR] = 0.08, 95% confidence interval [CI] = 0.02-0.35). The presence or history of any opportunistic infection involving the digestive tract, lung, eye, nervous system, skin, or systemic involvement at the time when AIDS cholangiopathy was diagnosed was an indicator of poor prognosis (HR = 3.24, 95% CI = 1.45-7.26); this was especially true for cryptosporidial infection (HR = 2.05, 95% CI = 1.24-3.38). Patients with high serum ALP levels, especially greater than 1000 IU/L or eight times the normal value (HR = 2.69, 95% CI = 1.10-6.60), tended to have a shorter life expectancy than those with normal or slightly elevated serum ALP levels. CD4 lymphocyte counts, type of cholangiopathy, and the performance of sphincterotomy were not correlated with the survival of patients with AIDS cholangiopathy. CONCLUSIONS: HAART administration most likely accounts for the recent dramatic improvement in survival of patients with AIDS cholangiopathy. Underlying immunosuppressive status, reflected by the presence or history of any opportunistic infections, is associated with a worse outcome. Serum ALP levels might be a good clinical indicator for the prognosis of patients with AIDS cholangiopathy.     

重症腺病毒肺炎患儿生化指标表达水平及近期预后危险因素研究

目的分析儿童重症腺病毒肺炎生化特征及影响预后的相关因素。方法选取2017年1月至2020年3月本院儿科诊治的重症腺病毒肺炎患儿55例为研究组,同期健康儿童55例为对照组。收集临床资料,比较两组生化指标水平(HGB、ALB、AST、ALT、LDH);观察重症腺病毒肺炎患儿预后,采用Logistic回归分析影响预后的因素。结果研究组HGB、ALB水平低于对照组,AST、ALT、LDH水平高于对照组,差异有统计学意义(P<0.05)。55例重症腺病毒肺炎患儿经住院治疗,出院时临床治愈24例(43.64%),好转14例(25.45%),未愈、无明显好转14例(25.45%),死亡3例(5.45%)。Logistic回归分析显示:PCT>10 ng/mL(OR=15.256,95%CI=1.264~184.144)、有循环系统并发症(OR=25.993,95%CI=1.469~459.974)、HGB<90g/L(OR=18.319,95%CI=1.156~290.239)、CRP>30 mg/L(OR=18.628,95%CI=1.152~301.203)、ALB<30g/L(OR=25.873,95%CI=1.583~422.826)、AST>100 U/L(OR=30.014,95%CI=1.097~820.848)是重症腺病毒肺炎患儿预后不良的危险因素(P<0.05)。[HTH]结论[HTSS]重症腺病毒肺炎患儿生化因子HGB、ALB水平相对低,AST、ALT、LDH水平相对高;且PCT>10 ng/mL、有循环系统并发症、HGB<90 g/L、CRP>30 mg/L、ALB<30 g/L、AST>100 U/L的重症腺病毒肺炎患儿更易发生不良预后,临床应予以重视。     

Whole brain radiation alone produces favourable outcomes for AIDS‐related primary central nervous system lymphoma in the HAART era

Primary central nervous system lymphoma (PCNSL) related to acquired immunodeficiency syndrome (AIDS) is a lethal disorder, but the recent application of highly active antiretroviral therapy (HAART) has significantly improved prognosis. This retrospective cohort study of AIDS‐related PCNSL examined the actual clinical outcomes and prognostic variables affecting overall survival (OS) in the HAART era. Twenty‐three newly diagnosed AIDS‐related PCNSL at 12 regional centre hospitals for HIV/AIDS in Japan between 2002 and 2008 were consecutively enrolled. The estimated 3‐yr OS rate of the entire cohort was 64% (95%CI, 41.0–80.3%). Whole brain radiation therapy (WBRT) had an independent positive impact on survival (WBRT ≥30 Gy vs. others, P = 0.02). Nine of 10 patients with a good performance status (PS) (0–2) remained alive with complete response, whereas 10 (77%) of 13 of those with a poor PS (3–4) died mostly after a short period. The estimated 3‐yr OS rate of the groups with a good and poor PS was 100% and 38% (95%CI, 14–63%), respectively (P = 0.01). Leukoencephalopathy (grade ≥ 2) developed in 21% of those that survived more than 12 months after radiation. The patients receiving a curative intent radiation dose (≥30 Gy) of WBRT achieved prolonged survival while maintaining a good quality of life in the HAART era, especially among patients with a favourable PS.