68例非HIV免疫抑制巨细胞病毒肺炎患者临床特点及预后分析

目的:分析非人类免疫缺陷病毒(HIV)免疫抑制患者罹患巨细胞病毒肺炎的临床特点以及对于预后的影响。方法:回顾性分析2016年1月到2018年10月期间河北医科大学第二医院呼吸内二科病房收治的68例非HIV免疫抑制巨细胞病毒肺炎患者的临床资料,根据28 d病情转归情况将患者分为存活组和死亡组,比较临床资料并进行预后分析。结果:罹患肾脏疾病、风湿性疾病、血液系统疾病并接受糖皮质激素或免疫抑制剂治疗的患者容易发生巨细胞病毒肺炎。与存活组比较,死亡组中急性生理与慢性健康Ⅱ评分、超敏C反应蛋白、白细胞计数最小值、中性粒细胞百分比较高( P值均<0.05),淋巴细胞计数、CD3 +T淋巴细胞、CD4 +T淋巴细胞较低( P值均<0.05);长疗程(≥3个月)糖皮质激素以及联合应用免疫抑制剂在死亡组更为多见( P值均<0.05);死亡组中基础疾病为皮肤疾病、合并多重耐药革兰阳性球菌感染、血流感染、需要接受机械通气治疗患者较多( P值均<0.05)。 结论:长疗程糖皮质激素以及联合应用免疫抑制剂、合并多重耐药革兰阳性球菌感染、血流感染、需要接受机械通气治疗的患者死亡率较高。

Analysis of clinical features and related risks of prognosis in 68 non-human immunodeficiency virus immunosuppressed patients with cytomegalovirus pneumonia

Objective To analyze the clinical characteristics of 68 non-human immunodeficiency virus immunosuppressed patients with cytomegalovirus pneumonia,and the risk factors related to death,so as to provide reference for clinical diagnosis and treatment.Methods A retrospective case analysis study was used.The clinical data of 68 patients with cytomegalovirus pneumonia admitted to the Second Department of Respiratory Medicine of the Second Hospital of Hebei Medical University were collected.According to the patient′s 28d outcome,the patients were divided into the survival group and the death group.The general conditions and clinical data of the two groups were compared,and risk factors were analyzed.Results The top three underlying diseases were kidney disease,rheumatic disease,and blood system disease.In the death group,the acute physiology and chronic health evaluationⅡscores,hypersensitive C-reactive protein,the smallest absolute counts of white blood cells,neutrophil percentage were higher than those in the survival group(all P<0.05),and the absolute counts of lymphocyte,CD3+lymphocyte,CD4+lymphocyte were lower(all P<0.05).Long-term(more than three months)application of glucocorticoids or combination with immunosuppressive agents were significantly more in the death group(all P<0.05).The immunosuppressed patients who suffered from dermatological disease,had gram-positive coccal pneumonia or bloodstream infections,needed mechanical ventilation had a poor prognosis(all P<0.05).Conclusions Cytomegalovirus pneumonia patients who received long-term(more than three months)application of glucocorticoids or combination with immunosuppressive agents,had gram-positive coccal pneumonia or bloodstream infections,and needed mechanical ventilation have a poor prognosis.