诊断学理论与实践

诊断学理论与实践 ›› 2022, Vol. 21 ›› Issue (04): 444-449.doi: 10.16150/j.1671-2870.2022.04.005

• 论著 • 上一篇    下一篇

133例艾滋病合并马尔尼菲篮状菌病死亡病例分析

陈志敏, 刘波, 何浩岚(), 何耀祖, 冯理智, 刘新华, 张坚生, 蔡卫平, 李凌华   

  1. 广州医科大学附属市八医院感染病中心,广州 510060
  • 收稿日期:2022-05-20 出版日期:2022-08-25 发布日期:2022-11-07
  • 通讯作者: 何浩岚 E-mail:gz8hhhl@126.com
  • 基金资助:
    广东省医学科研基金(B2021006)

Analysis of 133 dead cases of AIDS patients co-infected with Talaromycosis

CHEN Zhimin, LIU Bo, He Haolan(), HE Yaozu, FENG Lizhi, LIU Xinhua, ZHANG Jiansheng, CAI Weiping, LI Linghua   

  1. Infectious Diseases Center, Guangzhou Eighth People′s Hospital, Guangzhou Medical University, Guangdong Guangzhou 510060, China
  • Received:2022-05-20 Online:2022-08-25 Published:2022-11-07
  • Contact: He Haolan E-mail:gz8hhhl@126.com

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摘要：

目的：分析艾滋病合并马尔尼菲篮状菌病的病死率、临床特征及死亡的相关因素。方法：对广州医科大学附属市八医院2013年至2021年133例AIDS合并TM病的死亡病例进行回顾性分析,将入院抗菌<14 d内死亡的93例患者计入早期死亡组,14 d后死亡的40例患者计入后期死亡组,比较组间的临床特征差异。结果：2013年至2021年,本院就诊18 722例AIDS患者,合并TM病感染率为10.4%（1 947例）,死亡133例,总死亡率为6.83%。与14 d后死亡组比较,14 d内死亡组脓毒性休克发生率明显升高（93.5%比57.5%）（P值均<0.001）,而血骨髓培养时长、凝血酶原活动度、血小板计数（<50×109/L）、白蛋白水平（20 g/L比25 g/L）、病原学转阴率则较低,合并巨细胞病毒肺炎、结核、肺孢子菌肺炎、重症肺炎发生率、院内感染率也较低（P值均<0.05）。结论：AIDS患者罹患TM病的发生率为10.4%,总死亡率为6.83%;AIDS合并TM病患者早期死亡者特征包括发生脓毒性休克、血小板计数低、白蛋白水平低等;后期死亡患者,虽然多数患者TM的病原学已转阴,但合并其他机会性感染或院内感染率高,是导致其死亡的重要原因,故不同时期应采取相应策略。

关键词: 人类免疫缺陷病毒, 艾滋病, 马尔尼菲篮状菌病, 病死率, 死亡原因

Abstract:

Objective: To investigate the mortality, clinical characteristics and related risk factors of death in the AIDS patient co-infected with Talaromycosis. Methods: A total of 133 AIDS patients co-infected with Talaromycosis who died from 2013 to 2021 in Guangzhou Eighth People′s Hospital of Guangzhou Medical University were enrolled and the information was analyzed retrospectively. The patients admitted in hospital were divided into two groups to compare the clinical data, which were 93 patients receiving antifungal therapy within 14 days after admission(Group A) and 40 patients died after 14 days (Group B). Results: From 2013 to 2021, a total of 18722 AIDS patients were admitted,and 1947 AIDS patients(10.4%) were co-infected with Talaromycosis. It revealed that 133 out of 1947 patients died, and the total mortality was 6.83%. The incidence of septic shock in Group A were significantly higher than those in Group B (93.5% vs 57.5%)(P<0.001). The blood bone marrow culture time, PTA, platelet count (<50×109/L), albumin level (20 g/L vs 25 g/L) and etiological conversion rate in Group A were lower than those in Group B (P<0.05). While the incidence of CMV, TB, PCP, severe pneumonia, and nosocomial infection rate in Group B were higher than those in Group A. Conclusions: The incidence and mortality of AIDS patients co-infected with Talaromycosis is high. The clinical symptoms of patient died early are septic shock, low platelet count and low albumin level, having a higher probability of early death and worse basic status. Most of the pathogens turne negative in the patients die later, while the other opportunistic infections or nosocomial infections could be important causes of death.

Key words: HIV, AIDS, Talaromycosis, Mortality, Cause of death

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