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艾滋病合并马尔尼菲青霉菌病患者预后因素分析
引用本文:李凌华,唐小平,贾卫东,蔡卫平,陈万山.艾滋病合并马尔尼菲青霉菌病患者预后因素分析[J].中华传染病杂志,2009,27(11).
作者姓名:李凌华  唐小平  贾卫东  蔡卫平  陈万山
作者单位:广州市第八人民医院感染科,510060
基金项目:广州市重大科技攻关资助项目,广州市医药卫生科技重点资助项目 
摘    要:目的 探讨影响AIDS合并马尔尼菲青霉菌病(PSM)预后的因素.方法 165例经病原学确诊的AIDS合并PSM患者.根据预后分成生存组和死亡组.应用Logistic回归,分析25个可能影响疾病预后的临床和实验室指标,筛选出独立预后因素.结果 AIDS合并PSM患者中,生存组121例,死亡组44例,病死率为26.7%.单因素分析显示,影响AIDS合并PSM预后的因素包括皮疹、细菌和(或)其他真菌性肺炎、CMV感染、败血症、肾功能损伤、PLT减少、Hb、CD4~+T淋巴细胞计数、Alb、伊曲康唑(ITR)序贯疗法及高效抗反转录病毒治疗(HAART).多因素分析显示,去除各因素之间相互混杂的影响,筛选出细菌或其他真菌性肺炎(OR=6.539;95%CI 2.312,18.498)、败血症(OR=15.307;95%CI 1.473,42.462)及PLT减少(OR=7.763;95%CI 2.658,22.675)是AIDS合并PSM死亡的危险因素,而ITR序贯疗法((OR=0.088;95%CI 0.013,0.611)与HAART(OR=0.084;95%CI 0.026,0.269)是其保护性因素.结论 合并细菌或其他真菌性肺炎、败血症与PLT减少是AIDS合并PSM预后不良的危险因素,ITR序贯疗法和HAART则可减少死亡风险,改善预后.

关 键 词:获得性免疫缺陷综合征  青霉属  真菌病  回归分析  预后

Prognostic factors of Penicilliosis Marneffei in patients with acquired immunodeficiency syndrome
Abstract:Objective To explore the prognostic factors of Penicilliosis Marneffei(PSM)in acquired immunodeficiency syndrome (AIDS) patients. Methods One hundred and sixty-five cases of AIDS complicated with PSM were divided into survival group and death group, and were studied retrospectively. Twenty-five potential variables from clinical and biochemical examinations were evaluated by Logistic regression analysis in order to determine independent prognostic factors. Results There were 121 cases in the survival group and 44 cases in the death group, with a mortality rate of 26.7%0. In the univariate analysis, variables that were significantly associated with the prognosis of PSM included rash, bacterial/fungal pneumonia(except Penicillium marneffei pneumonia and Pneumocystis pneumonia), cytomegalovirus (CMV) infection, sepsis, impaired renal function, thrombocytopenia, the hemoglobin (Hb) level in peripheral blood, CD4~+ lymphocyte count, the serum albumin level, itraconazole sequential therapy and highly active antiretroviral therapy (HAART). Multivariate Logistic regression analysis showed variables including bacterial/fungal pneumonia (OR=6.539; 95%CI 2.312, 18.498), sepsis (OR=15.307; 95%CI 1.473, 42.462) and thrombocytopenia (OR=7.763; 95 %CI 2.658, 22.675) were risk factors related to the mortality of AIDS patients with PSM, meanwhile, itraconazole sequential therapy (OR = 0.088; 95% CI 0.013, 0.611) and HAART (OR=0.084; 95%CI 0.026, 0.269) provided protective effect. Conclusions Bacterial/fungal pneumonia, sepsis, and thrombocytopenia are the primary risk factors contributing to the poor prognosis of AIDS patients with PSM, while itraconazole sequential therapy or HAART can reduce the mortality and improve the prognosis.
Keywords:Acquired immunodeficiency syndrome  Penicillium  Mycoses  Regression analysis  Prognosis
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