温州地区51例AIDS合并播散性马尔尼菲篮状菌病患者临床特征及死亡危险因素分析

  目的  了解温州地区艾滋病(acquired immunodeficiency syndrome，AIDS)合并播散性马尔尼菲篮状菌病患者临床特征，并统计分析患者的死亡危险因素，为该地区该类疾病患者的临床诊治和降低其死亡率提供依据。  方法  收集2016年1月—2020年5月温州市中心医院收治的51例AIDS合并马尔尼菲篮状菌病患者病历资料，分析患者的流行病学特点、临床表现、实验室和影像学检查结果、治疗转归等情况，根据治疗结局将其分为好转组42例和死亡组9例，比较分析其死亡的危险因素。  结果  2016—2020年温州地区AIDS合并播散性马尔尼菲篮状菌病患者逐年增多；以青壮年为主(64.71%，33/51)；最常见临床表现为发热及淋巴结肿大；患者CD4+T淋巴细胞为9(5, 19)个/μL，其中＜50个/μL的有47例，占92.16%；G试验和GM试验阳性率为分别为70.00%(28/40)和75.00%(30/40)；50例患者胸部CT检查异常；病死率为17.65%(9/51)；患者死亡影响因素分析结果显示，死亡组患者入院至接受抗真菌治疗的时间大于好转组，死亡组患者进行抗逆转录病毒治疗的比率明显低于好转组，差异均有统计学意义(均P＜0.05)。  结论  温州地区AIDS合并播散性马尔尼菲篮状菌患者发病率逐年升高，患者CD4+T淋巴细胞计数常 < 50个/μL，临床表现多样化，及时抗真菌治疗和进行抗逆转录病毒治疗可明显降低患者病死率。 

Analysis of clinical characteristics and risk factors of death in 51 AIDS patients with disseminated Talaromycosis marneffei in Wenzhou

  Objective  To understand the clinical characteristics of AIDS patients with disseminated Talaromycosis marneffei in Wenzhou, and to statistically analyze the risk factors of death, so as to provide a basis for clinical diagnosis, treatment and reduction of mortality of patients with these diseases in this area.  Methods  The medical records of 51 AIDS patients with Talaromycosis marneffei treated in Wenzhou Central Hospital from January 2016 to May 2020 were collected. The epidemiological characteristics, clinical manifestations, laboratory and imaging examination results and treatment outcome of the patients were analyzed. According to the treatment outcome, the patients were divided into improvement group (42 cases) and death group (9 cases), and the risk factors of death were compared and analyzed.  Results  From 2016 to 2020, the number of AIDS patients with disseminated Talaromycosis marneffei in Wenzhou area increased year by year, mainly in young adults (64.71%, 33/51). The most common clinical manifestations were fever and lymph node enlargement. The average number of CD4+ T lymphocytes in patients was 9(5, 19) cells/μL, of which 47 cases were less than 50 cells/μL (92.16%). The positive rates of G test and GM test were 70.00% (28/40) and 75.00% (30/40). 50 patients performed by chest CT examination were abnormal, the fatality rate was 17.65% (9/51). The analysis of influencing factors of death showed that the time from hospitalization to antifungal therapy in the death group was longer than that in the improvement group, and the rate of ART in the death group was significantly lower than that in the improvement group, the difference was statistically significant (P < 0.05).  Conclusion  The incidence of AIDS patients with disseminated Talaromycosis marneffei in Wenzhou is increasing year by year. The CD4+ T lymphocyte count of the patients is often less than 50 cells/μL, and the clinical manifestations are diversified. Timely antifungal therapy and antiretroviral therapy can significantly reduce the mortality of the patients.