获得性免疫缺陷综合征合并肺孢子菌性肺炎患者病情影响因素

目的探讨获得性免疫缺陷综合征（AIDS）合并肺孢子菌性肺炎（PCP）患者病情的影响因素。 方法分析2009年1月至2017年9月首都医科大学附属北京地坛医院收治的1 001例AIDS合并PCP患者的临床资料,根据PaO₂将患者分为轻度PCP组（PaO₂ ≥ 70 mmHg）（543例）和中重度PCP组（PaO₂ <70 mmHg）（458例）,并采用单因素和多因素Logistic回归方法分析年龄、乳酸脱氢酶（LDH）水平增高、肺部混合感染、低蛋白血症和气胸等因素是否影响AIDS合并PCP患者的病情进展。 结果轻度PCP组和中重度PCP组患者气胸发生率分别为1.1%（6/543）和7.6%（35/458）,差异有统计学意义（χ² = 27.027、P < 0.001）;轻度PCP组和中重度PCP组患者肺部混合感染的发生率分别为86.4%（469/543）和95.0%（435/458）,差异有统计学意义（χ² = 21.027、P < 0.001）;轻度PCP组和中重度PCP组患者低蛋白血症发生率分别为29.47%（160/543）和42.58%（195/458）,差异有统计学意义（χ² = 18.658、P < 0.001）;轻度PCP组和中重度PCP组患者中LDH ≥ 350 U/L者分别为32.04%（174/543）和61.57%（282/458）,差异有统计学意义（χ² = 87.338、P < 0.001）。单因素回归分析发现年龄≥ 50岁、LDH ≥ 350 U/L、肺部混合感染、低蛋白血症和气胸等因素在轻度和中重度PCP两组患者间差异均有统计学意义（OR = 0.489、95%CI：0.354～0.676、P < 0.001,OR = 0.294、95%CI：0.227～0.382、P < 0.001,OR = 0.335、95%CI：0.206～0.545、P < 0.001,OR = 0.563、95%CI：0.434～0.732、P < 0.001,OR = 0.135、95%CI：0.056～0.324、P < 0.001）。多因素Logistic回归分析发现,引起AIDS合并PCP患者病情加重的独立风险因素为年龄≥ 50岁（OR = 0.410、95%CI：0.288～0.582,P < 0.001）、肺部混合感染（OR = 0.417、95%CI：0.251～0.692,P < 0.001）、LDH ≥ 350 U/L（OR = 0.298、95%CI：0.227～0.392,P < 0.001）、低蛋白血症（OR = 0.685、95%CI：0.516～0.908,P = 0.009）和气胸（OR = 0.172、95%CI：0.070～0.424,P < 0.001）。 结论年龄≥ 50岁、肺部混合感染、LDH水平过高（≥ 350 U/L）、低蛋白血症和气胸等风险因素均可导致AIDS合并PCP患者病情加重,对相关风险因素进行积极干预可减缓患者疾病进展。

Influencing factors on the progression of acquired immunodeficiency syndrome patients with Pneumocystis carinii pneumonia

ObjectiveTo investigate the factors influencing the exacerbation of acquired immunodeficiency syndrome (AIDS) patients complicated with carinii pneumocystis pneumonia(PCP). MethodsFrom January 2009 to September 2017, data of 1 001 AIDS patients complicated with PCP admitted to Beijing Ditan Hospital, Capital Medical University were collected and analyzed. Patients were divided into 543 patients as mild group (PaO₂ ≥ 70 mmHg) and 458 patients as moderate-to-severe group (PaO₂ < 70 mmHg) according to the level of PaO₂. Univariate and multivariate Logistic regression methods were used to analyze whether factors such as age, increased LDH level, mixed pulmonary infection, hypoproteinemia and pneumothorax affected the disease progress of AIDS patients complicated with PCP. ResultsThe incidence of pneumothorax in mild group and moderate-to-severe group were 1.1% (6/543) and 7.6% (35/458), respectively, with significant difference (χ² = 27.027, P < 0.001). The incidence of mixed pathogens in lungs of patients in mild group and moderate-to-severe group were 86.4% (469/543) and 95.0% (435/458), respectively, with significant difference (χ² = 21.027, P < 0.001). The incidence of hypoproteinemia in mild group and moderate-to-severe group were 29.47% (160/543) and 42.58% (195/458), respectively, with significant difference (χ² = 18.658, P < 0.001). In mild group, 174 patients (32.04%) had LDH ≥ 350 U/L, and 282 patients (61.57%) with LDH ≥ 350 U/L in moderate-to-severity group, with no significant difference (χ² = 87.338, P < 0.001). Univariate regression analysis showed that age ≥ 50 years old (OR = 0.489, 95%CI: 0.354-0.676, P < 0.001), LDH ≥ 350 U/L (OR = 0.294, 95%CI: 0.227-0.382, P < 0.001), mixed pulmonary infection (OR = 0.335, 95%CI: 0.206-0.545, P < 0.001), hypoproteinemia (OR = 0.563, 95%CI: 0.434-0.732, P < 0.001) and pneumothorax (OR = 0.135, 95%CI: 0.056-0.324, P < 0.001) were significantly different between the two groups. Multivariate Logistic regression analysis showed that the independent risk factors causing aggravation were age ≥ 50 years old (OR = 0.410, 95%CI: 0.288-0.582, P < 0.001), mixed pulmonary infection (OR = 0.417, 95%CI: 0.251-0.692, P < 0.001), LDH ≥ 350 U/L (OR = 0.298, 95%CI: 0.227-0.392, P < 0.001), hypoproteinemia (OR = 0.685, 95%CI: 0.516-0.908, P = 0.009), and pneumothorax (OR = 0.172, 95%CI: 0.070-0.424, P < 0.001). ConclusionsRisk factors such as age ≥ 50 years old, mixed pulmonary infection, high LDH level (≥ 350 U/L), hypoproteinemia and pneumothorax could lead to aggravation of disease of patients with AIDS complicated with PCP. The clinical intervention of relevant risk factors could slow down the progress of disease.