本文選題：艾滋病　切入點(diǎn)：機(jī)會(huì)性感染　出處：《寧夏醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的通過(guò)對(duì)68例艾滋病合并機(jī)會(huì)性感染者的臨床特點(diǎn)及對(duì)其預(yù)后的影響因素進(jìn)行回顧性分析,以期為艾滋病合并機(jī)會(huì)性感染的臨床預(yù)防及治療提供一定的依據(jù)。方法選取自2008年8月至2016年10月期間于寧夏醫(yī)科大學(xué)總醫(yī)院相關(guān)科室住院治療,并經(jīng)寧夏疾病預(yù)防控制中心確診核實(shí)的68例艾滋病患者。入組患者的出院診斷均為艾滋病合并相關(guān)機(jī)會(huì)性感染,收集相關(guān)資料包括患者的人口學(xué)基本特征、各類機(jī)會(huì)性感染數(shù)目、合并機(jī)會(huì)性感染的種數(shù),患者發(fā)生機(jī)會(huì)性感染時(shí)CD4+T細(xì)胞計(jì)數(shù),并按照患者的生存狀況(存活和死亡)分組。首先對(duì)入組患者人口學(xué)基本特征、合并機(jī)會(huì)性感染情況等進(jìn)行描述性分析,再用SPSS 22.0統(tǒng)計(jì)軟件對(duì)預(yù)后影響因素分析。統(tǒng)計(jì)描述主要采用構(gòu)成比,統(tǒng)計(jì)推斷主要采用X2檢驗(yàn)、fisher精確法和Logistic回歸分析。結(jié)果(1)68例艾滋病合并機(jī)會(huì)性感染者中,男性52人,女性16人,男女比例為3.3:1。年齡在12歲~74歲之間,平均年齡(38.93±12.70)歲。18~39歲者占63.24%(43/68)。以漢族居多,占64.71%(44/68)。已婚或同居者占58.82%(40/68)。感染途徑中性接觸感染占首位,為69.12%(47/68)。所調(diào)查的患者中,初中及初中以下文化程度者共占75.00%。職業(yè)分布較分散,以農(nóng)民/民工、無(wú)業(yè)待業(yè)者為主,共占72.06%(49/68)。(2)68例艾滋病合并機(jī)會(huì)性感染的發(fā)生率排在前5位的依次為(部分患者一人合并多種感染):細(xì)菌性肺炎(55.88%)、口腔白斑(50.00%)、肺孢子菌肺炎(45.59%)、帶狀皰疹(27.94%)、肺結(jié)核及肺外結(jié)核(22.06%)。其中艾滋病患者合并2種及2種以上機(jī)會(huì)性感染占89.71%(61/68)。(3)68例艾滋病合并機(jī)會(huì)性感染者中,CD4+T細(xì)胞計(jì)數(shù)在200個(gè)/ul以下的患者共66例,CD4+T細(xì)胞計(jì)數(shù)介于50~100個(gè)/ul時(shí),機(jī)會(huì)性感染的發(fā)生率最高,為39.71%(27/68)。(4)68例艾滋病合并機(jī)會(huì)性感染者預(yù)后影響因素:單因素X2檢驗(yàn)顯示:男性死亡率高于女性(X2=7.297,P=0.007);年齡大于40歲以上的艾滋病患者的死亡率高(X2=8.223,P=0.028);感染途徑中性接觸的死亡率高(X2=8.644,P=0.015);機(jī)會(huì)性感染中肺孢子菌肺炎、肺結(jié)核及肺外結(jié)核、巨細(xì)胞病毒感染、合并3種及3種以上的機(jī)會(huì)性感染均是影響結(jié)局的因素(P0.05)。多因素Logistic回歸分析發(fā)現(xiàn):CD4+T細(xì)胞計(jì)數(shù)為影響艾滋病合并機(jī)會(huì)性感染者預(yù)后的獨(dú)立危險(xiǎn)因素(P=0.004)。CD4+T細(xì)胞計(jì)數(shù)越低,艾滋病患者越容易死亡(β=-0.269,OR值=0.765)。結(jié)論(1)艾滋病合并機(jī)會(huì)性感染者呼吸系統(tǒng)的感染機(jī)率較高,在針對(duì)艾滋病患者呼吸系統(tǒng)感染的防治上需進(jìn)一步加強(qiáng)。(2)CD4+T細(xì)胞數(shù)低于200個(gè)/ul以下,可考慮作為防控機(jī)會(huì)性感染的標(biāo)志。(3)CD4+T細(xì)胞計(jì)數(shù)為影響艾滋病合并機(jī)會(huì)性感染者預(yù)后的獨(dú)立危險(xiǎn)因素,CD4+T數(shù)目越少,AIDS患者的預(yù)后越差。
[Abstract]:Objective to analyze retrospectively the clinical characteristics and prognostic factors of 68 cases of AIDS complicated with opportunistic infection. Methods from August 2008 to October 2016, the patients were hospitalized in the relevant departments of the General Hospital of Ningxia Medical University, from August 2008 to October 2016, in order to provide a basis for the clinical prevention and treatment of AIDS complicated with opportunistic infection. And 68 AIDS patients confirmed and verified by the Ningxia Center for Disease Control and Prevention. The discharged patients were all diagnosed as AIDS associated opportunistic infections. Relevant data were collected, including the basic demographic characteristics of the patients. The number of opportunistic infections, the number of species associated with opportunistic infection, the number of CD4 T cells in patients with opportunistic infection, and the groups according to the patient's survival status (survival and death). The incidence of opportunistic infection was analyzed by descriptive analysis, and the prognostic factors were analyzed by SPSS 22.0 statistical software. Statistical inference was performed by using X _ 2 test and Logistic regression analysis. Results among 68 patients with opportunistic AIDS infection, 52 were male, 16 were female, and the ratio of male to female was 3.3: 1.The age was between 12 and 74 years old. The average age was 38.93 鹵12.70). The average age was 38.93 鹵12.70). The average age was 63.2443 / 68. The Han nationality was the majority, accounting for 64.71%. The married or cohabited persons accounted for 58.82% 68% of the total. Sexual contact infection was the most common route of infection (69.12 47% 68%). Among the patients surveyed, 75.00% were from junior high school and below junior high school education. Mainly farmers / migrant workers, unemployed and unemployed, A total of 72.06 / 68 cases of AIDS with opportunistic infection ranked the top 5 in order (some patients one person with multiple infections: bacterial pneumonia 55.88am, oral leukoplakia 50.0010, Pneumocystis pneumonia 45.59cum, herpes zoster 27.94B, tuberculosis and extrapulmonary infection: 55.88g / L, Pneumocystis pneumocystis pneumoniae 45.59m, herpes zoster 27.94%, pulmonary tuberculosis and extrapulmonary infection. TB 22.060.Among them, AIDS patients with two or more kinds of opportunistic infections accounted for 89.71% of the 68 AIDS patients with opportunistic infections. In the 68 cases with AIDS and opportunistic infections, 66 patients with CD4 T cell count below 200 / ul had a CD4 T cell count ranging from 50 to 100 Rul. Opportunistic infections have the highest incidence, A total of 68 patients with HIV / AIDS associated with opportunistic infection were identified as prognostic factors: univariate X2 test showed that male mortality was higher than that of female X2 + 7.297, mortality of AIDS patients over 40 years old was higher than that of AIDS patients over 40 years old, mortality rate of AIDS patients over 40 years old was higher than that of AIDS patients with HIV / AIDS infection, mortality of sexually transmitted infections was higher than that of female patients with HIV / AIDS infection, mortality of patients with AIDS over 40 years of age was higher than that of patients with AIDS over 40 years of age. The rate of death was high: X2 + 8.644 (P = 0.015), pneumocystis pneumonia in opportunistic infection, and Pneumocystis pneumoniae in opportunistic infection. Tuberculosis and extrapulmonary tuberculosis, cytomegalovirus infection, The multivariate Logistic regression analysis showed that the percentage of CD4 T cells was an independent risk factor for the prognosis of AIDS patients with opportunistic infection. The lower the number of CD4 T cells was, the lower the number of CD4 T cells was. The more easily the AIDS patients died (尾 -0.269 OR value 0.7650.Conclusion 1) the rate of respiratory system infection in AIDS patients with opportunistic infection is higher. The prevention and treatment of respiratory system infection in AIDS patients should be further strengthened. The number of CD4 T cells in AIDS patients is less than 200 / ul. As a marker of prevention and control of opportunistic infection, the count of CD4 T cells is an independent risk factor for the prognosis of AIDS patients with opportunistic infection. The lower the number of CD4 T cells is, the worse the prognosis of AIDS patients is.
【學(xué)位授予單位】：寧夏醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R512.91

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本文編號(hào)：1595776