本文選題：河南省 + 艾滋病　； 參考：《鄭州大學(xué)》2014年碩士論文

【摘要】：目的：通過了解2009-2013年5年期間河南省HIV/AIDS患者機(jī)會性感染的種類、發(fā)生率,總結(jié)HAART時代艾滋病患者機(jī)會性感染的特點及規(guī)律,為我省艾滋病防治工作提供一定的科學(xué)依據(jù)。方法：統(tǒng)計2009年1月-2013年12月在河南省傳染病醫(yī)院住院的HIV/AIDS合并機(jī)會性感染患者的臨床資料,統(tǒng)計患者的一般資料、機(jī)會性感染的名稱、類型、HAART治療情況、患者發(fā)生機(jī)會性感染時CD4+T淋巴細(xì)胞計數(shù)、預(yù)后。結(jié)果：符合標(biāo)準(zhǔn)進(jìn)入本次研究有1314例患者,平均年齡42.47±12.5歲。未接受HAART治療的患者456例,經(jīng)HAART后治療的患者858例。1、兩組患者的人口學(xué)特征：HAART組男女比為1.28：1,41-60歲人群占56.88%。感染途徑以采供血和輸血感染為主,分別占38.69%和27.04%。未HAART組男性占69.3%,男女比為2.26：1,年齡41-60歲人群占49.34%,其次是18-40歲人群(37.94%)。感染途徑中男男同性感染占首位(29.61%),第二位是采供血途徑(25.88%)。兩組患者以駐馬店、周口、南陽等南部地區(qū)為主,農(nóng)民和農(nóng)民工占大多數(shù)。2、機(jī)會性感染疾病譜和病原菌的分布與種類(1)1314例患者發(fā)生機(jī)會性感染2645例(部分患者一人合并多種感染)。細(xì)菌性肺炎占24.31%,真菌口炎12.78%,肺結(jié)核9.26%,肺孢子菌肺炎7.71%,感染性腹瀉4.69%,CMV肺炎4.01%,淋巴結(jié)核3.97%。各機(jī)會性感染常見于呼吸系統(tǒng)、消化系統(tǒng)、中樞神經(jīng)系統(tǒng),分別為47%、20%、10%。(2)1314例患者共培養(yǎng)分離266株致病菌。以細(xì)菌(53.38%)、真菌(28.95%)為主。病原菌的來源部位以下呼吸道最多,其次為腦脊液。細(xì)菌譜以大腸埃希菌、肺炎克雷伯菌、銅綠假單胞菌為主。真菌以新型隱球菌為主。3、未HAART和HAART兩組患者機(jī)會性感染發(fā)病率的差異結(jié)核性胸膜炎發(fā)病率兩組間無顯著性差異(P=0.163),細(xì)菌性肺炎、真菌性口炎、肺孢子菌肺炎、CMV肺炎、真菌性肺炎、隱球菌腦膜炎發(fā)病率兩組均有顯著性差異。HAART組中細(xì)菌性肺炎、PCP、真菌性口炎、CMV肺炎、真菌性肺炎、隱球菌腦膜炎的發(fā)病率較未HAART組明顯下降。4、兩組患者機(jī)會性感染與CD4+T淋巴細(xì)胞的關(guān)系(1)肺結(jié)核在未HAART組的CD4+T淋巴細(xì)胞中位數(shù)是59個/ul,HAART組為127個/ul；PCP.在未HAART組的CD4+T淋巴細(xì)胞中位數(shù)是33個/u1,HAART組為71.5個/u1；細(xì)菌性肺炎未HAART組的CD4+T淋巴細(xì)胞中位數(shù)是45個/u1,HAART組為124個/u1。HAART組中各機(jī)會性感染發(fā)病時CD4+T淋巴細(xì)胞中位數(shù)高于未HAART組。(2)1203例患者按合并機(jī)會性感染的數(shù)量分為5個層面,HAART組合并1種機(jī)會性感染病例最多(40.32%),CD4+T淋巴細(xì)胞計數(shù)中位數(shù)為304個/μL。未HAART組合并2-3種機(jī)會性感染病例最多(49.67%)。合并2種以上機(jī)會性感染的CD4+T淋巴細(xì)胞計數(shù)中位數(shù)低于100個/μL,合并5種及5種以上機(jī)會性感染的低于50個/μL。5、惡化和死亡病例共有70例。男性49例,女性13例。死亡前接受HAART治療者占31.43%。直接死于艾滋病機(jī)會性感染的患者62例(88.57%),死于一種病原菌感染的28例,死于多種病原菌共同感染的34例。結(jié)論：1、HAART時代,機(jī)會性感染仍以呼吸和消化系統(tǒng)感染為主�？共《竞髾C(jī)會性感染疾病譜有一些變化,重癥難治、致死性強(qiáng)的機(jī)會性感染的發(fā)生率和多重感染的發(fā)生率下降。2、機(jī)會性感染的病原菌以細(xì)菌和真菌為主,病原學(xué)檢出率低,是困擾著臨床對機(jī)會性感染診治的難題。3、CD4+T淋巴細(xì)胞計數(shù)與機(jī)會性感染發(fā)生率、病原體的種類存在相關(guān)性。抗病毒后發(fā)生機(jī)會性感染原因多種,根據(jù)不同的原因和患者免疫水平,采取不同治療措施。4、HAART后患者機(jī)會性感染的發(fā)生率仍然較高,機(jī)會性感染仍然是目前我省艾滋病患者是其主要就診、住院,甚至是致死原因,因此提高患者免疫水平,降低機(jī)會性感染的發(fā)生率是治療的首要任務(wù)。
[Abstract]:Objective: through understanding the types of opportunistic infection of HIV/AIDS patients in Henan Province during 5 years, the incidence of the incidence of opportunistic infection in the HAART era, the characteristics and laws of opportunistic infection of AIDS patients in the age of Henan were summarized, and the scientific basis for AIDS prevention and control work in our province was provided. Methods: in December January 2009, the hospital in infectious disease hospital was hospitalized in the province of -2013. The clinical data of HIV/AIDS patients with opportunistic infection, the general data of the patients, the name of the opportunistic infection, the type, the HAART treatment, the CD4+T lymphocyte count and the prognosis in the opportunistic infection of the patients, and the prognosis. Results: 1314 patients were enrolled in this study, the average age was 42.47 + 12.5 years old. No HAART treatment was accepted. 456 cases of patients, 858 cases of.1 and two groups of patients treated after HAART, the demographic characteristics of the two groups were: group HAART and 1.28:1,41-60 years old people accounted for the main 56.88%. infection route, accounting for blood supply and blood transfusion infection, accounting for 38.69% and 27.04%. not HAART group 69.3%, male and female ratio of 2.26:1, age 41-60 age 49.34%, followed by 18-40 years. Population (37.94%). Male and male sex infection accounted for the first (29.61%), second was the way of blood supply (25.88%). Two groups were Zhumadian, Zhoukou, Nanyang and other southern regions, farmers and migrant workers accounted for most of the.2, opportunistic infection disease spectrum and pathogen distribution and species (1) 1314 patients had opportunistic infections (2645 cases). Bacterial pneumonia accounted for 24.31%, bacterial pneumonia accounted for 24.31%, fungal stomatitis 12.78%, pulmonary tuberculosis 9.26%, Pneumocystis pneumoniae 7.71%, infectious diarrhea 4.69%, CMV pneumonia 4.01%, and lymphatic tuberculosis 3.97%. were often seen in respiratory system, digestive system, central nervous system, 47%, 20%, and 10%. (2) 1314 patients were separately cultured and separated 266. Bacteria (53.38%) and fungi (28.95%) were the main pathogens. The main source of the pathogenic bacteria was the most respiratory tract, followed by cerebrospinal fluid. The bacterial spectrum was mainly Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa. The fungi were mainly Cryptococcus neoformans.3, no HAART and HAART two groups had the difference of opportunistic infection rate of tuberculosis pleura. There was no significant difference between the two groups (P=0.163). Bacterial pneumonia, fungal stomatitis, Pneumocystis pneumoniae, CMV pneumonia, fungal pneumonia, and cryptococcal meningitis have significant differences in the incidence of bacterial pneumonia in group.HAART, PCP, fungal stomatitis, CMV pneumonia, fungal pneumonia, cryptococcal meningitis, and the incidence of cryptococcal meningitis in the group of non HAART group. A significant decrease in.4, two groups of patients with opportunistic infection and CD4+T lymphocyte (1) the median of CD4+T lymphocytes in the non HAART group was 59 /ul, and the HAART group was 127 /ul; the median of PCP. in the unHAART group was 33 /u1, the HAART group was 71.5. The median number of CD4+T lymphocytes in group HAART was 45 /u1, and the median of CD4+T lymphocytes in group /u1.HAART was higher than that in the unHAART group. (2) 1203 patients were divided into 5 levels according to the number of opportunistic infections, HAART combination and 1 opportunistic infections (40.32%), and the median of CD4+T lymphocyte counts were 304 / u L. unHAART combination and 2 The most opportunistic infection cases of -3 were (49.67%). The median number of CD4+T lymphocyte counts with more than 2 opportunistic infections was lower than 100 / u L, 5 and 5 more opportunistic infections were lower than 50 / L.5, 70 cases were deteriorated and death cases, 49 men and 13 women. HAART was directly killed by HAART before death and died of AIDS. Patients with opportunistic infection (62 cases (88.57%) died of a pathogen infection in 28 cases and died in 34 cases of common infection of various pathogens. Conclusion: 1, HAART era, opportunistic infection is still dominated by respiratory and digestive system infection. The spectrum of opportunistic infection after antiviral infection has some changes, severe refractory and fatal opportunistic infection. The incidence of birth rate and multiple infection is decreased by.2. The pathogenic bacteria of opportunistic infection are mainly bacteria and fungi, and the detection rate of pathogenic bacteria is low. It is a difficult problem that puzzles the diagnosis and treatment of opportunistic infection,.3, the incidence of CD4+T lymphocyte count and opportunistic infection, and the correlation of the species of pathogens. According to the different reasons and the immune level of patients, the incidence of opportunistic infection is still high after HAART, and the incidence of opportunistic infection is still high, and the opportunistic infection is still the main treatment, hospitalization and even death cause of AIDS patients in our province. Therefore, to improve the immune level and reduce the incidence of opportunistic infection is the treatment of.4. The primary task of treatment.

【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R512.91

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本文編號：1828846