人类免疫缺陷病毒感染合并结核病患者死亡相关因素分析

目的 回顾性调查HIV合并结核病(TB)双重感染(HIV-TB)死亡病例的临床特征,探索导致HIV-TB双重感染病例死亡的相关危险因素.方法 收集2004年11月至2009年5月在上海市公共卫生临床中心住院期间死亡的53例HIV-TB双重感染患者(死亡组),同时选择同期住院期间存活的79例HIV-TB双重感染患者(存活组),对两组的人口学资料、临床特点、放射学特征和实验室检查进行对照研究.采用多因素Logistic逐步回归分析,探索与HIV-TB双重感染患者死亡相关的危险因素.结果 HIV-TB双重感染病例共459例,死亡53例,病死率为11.5%,入院1周内死亡25例,占47.2%,死于肺结核34例,占64.2%.死亡组患者中体质量≤50 kg者较存活组多见(χ2=7.50),痰标本抗酸杆菌涂片阳性率和结核菌培养阳性率(χ2=4.04、14.27),耐药结核病(χ2=9.00),耐多药结核病(χ2=6.39),肺外结核发生率(χ2=6.99),复治结核病(χ2=5.92),抗结核治疗不规范(χ2=12.07),肺部病灶广泛者(病灶＞50%肺野,χ2=20.21),合并真菌感染、呼吸衰竭、肺外脏器功能受损者(χ2=3.46、4.27、3.46),HIV感染＞5年(χ2=7.19)、高效抗反转录病毒疗法(HAART)不规范(χ2=5.16);CD4+T淋巴细胞计数≤200×106/L者(x=12.99)均高于存活组(均P＜0.05＝.多因素Logistic逐步回归分析显示,抗结核治疗不规范、肺部病灶广泛、耐多药结核病和CD4+T淋巴细胞计数≤200×106/L是HIV-TB主要的死亡相关危险因素.结论 HIV-TB双重感染死亡病例病情呈现复杂性、多样性,抗结核治疗不规范、肺部病灶广泛、耐多药结核病和CD4+T淋巴细胞计数≤200×106/L是导致HIV-TB双重感染患者死亡主要的相关危险因素.

Factors related to in-hospital deaths in patients co-infected with human immunodeficiency virus and tuberculosis

Objective To evaluate the risk factors associated with in-hospital death in patients co-infected with human immunodeficiency virus and Mycobacterium tuberculosis (HIV-TB). Methods A retrospective case-control study was performed in patients admitted to Shanghai Public Health Clinical Center from November 2004 to May 2009. Fifty-three HIV-TB patients who died during hospitalization were matched with 79 HIV-TB co-infected patients who survived during hospitalization.Clinical, demographic, and radiological characteristics of the two groups were compared by the retrospective case-control study method. Multivariate Logistic stepwise regression analysis was performed to explore the risk factors contributing to death in HIV-TB co-infected patients. Results Among the 459 co-infected patients, 53 (11.5%) cases died during hospitalization and 25 cases died during the first week in hospital. Sixty-four point two percent dead patients (34/53) died from tuberculosis. Several factors were associated with worse prognosis in the death group compared to the survival group, which included body weight≤50 kg (χ2 = 7.50), positive for acid-fast bacilli in sputum smear or culture exam (χ2= 4. 04, 14. 27), drug-resistant/multi-drug resistant Mycobacterium tuberculosis infection (χ2 =9.00,6.39), extra-pulmonary tuberculosis infection (χ2 =6.99), retreated tuberculosis (χ2 = 5. 92), non-standardized anti-tuberculosis treatment (χ2 = 12. 07), extensive pulmonary TB infection (lesions ≥50% of lung fields, χ2 = 20. 21), co-infection with fungi (χ2 =3.46), respiratory failure (χ2 = 4.27), non-pulmonary organ impairment (χ2 = 3.46), HIV infection longer than 5 years (χ2 = 7. 19), non-standardized highly active antiretroviral therary treatment (χ2 =5.16) and CD4+ T lymphocyte count ≤ 200 × 106/L (χ2= 12.99) (all P＜0. 05). Multivariate Logistic regression analysis showed that non-standardized anti-TB treatment, extensive pulmonary TB infection, multi-drug resistant TB infection and CD4+ T lymphocyte count ≤ 200 × 106/L were the major risk factors related to in-hospital mortality. Conclusions Non-standardized anti-TB treatment,extensive pulmonary TB infection, multi-drug resistant TB infection and CD4+ T lymphocyte count ≤200 × 106/L are the major risk factors related to in-hospital mortality in the patients co-infected with TB and HIV.