温州地区51例AIDS合并播散性马尔尼菲篮状菌病患者临床特征及死亡危险因素分析

吴联朋; 何贵清; 胡型忠; 潘勇; 唐少华

doi:10.16766/j.cnki.issn.1674-4152.002070

温州地区51例AIDS合并播散性马尔尼菲篮状菌病患者临床特征及死亡危险因素分析

doi: 10.16766/j.cnki.issn.1674-4152.002070

吴联朋^{1, 2},
何贵清^{1, 2},
胡型忠^{1, 2},
潘勇^{1, 2},
唐少华^{1, 2, ,}

1.
温州医科大学定理临床学院，浙江温州 325000
2.
温州市中心医院检验科，浙江温州 325000

基金项目:

浙江省科技厅公益项目 2017C33215

详细信息

通讯作者:
唐少华, E-mail: tsh006@163.com

中图分类号: R512.91 R379
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- 被引次数: 0
出版历程
- 收稿日期: 2020-10-10
- 网络出版日期: 2022-02-16

Analysis of clinical characteristics and risk factors of death in 51 AIDS patients with disseminated Talaromycosis marneffei in Wenzhou

WU Lian-peng^{1, 2},
HE Gui-qing^{1, 2},
HU Xing-zhong^{1, 2},
PAN Yong^{1, 2},
TANG Shao-hua^{1, 2
, ,}

1.
The Dingli Clinical Institute of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China

摘要

摘要: 目的了解温州地区艾滋病(acquired immunodeficiency syndrome，AIDS)合并播散性马尔尼菲篮状菌病患者临床特征，并统计分析患者的死亡危险因素，为该地区该类疾病患者的临床诊治和降低其死亡率提供依据。方法收集2016年1月—2020年5月温州市中心医院收治的51例AIDS合并马尔尼菲篮状菌病患者病历资料，分析患者的流行病学特点、临床表现、实验室和影像学检查结果、治疗转归等情况，根据治疗结局将其分为好转组42例和死亡组9例，比较分析其死亡的危险因素。结果 2016—2020年温州地区AIDS合并播散性马尔尼菲篮状菌病患者逐年增多；以青壮年为主(64.71%，33/51)；最常见临床表现为发热及淋巴结肿大；患者CD4⁺T淋巴细胞为9(5, 19)个/μL，其中＜50个/μL的有47例，占92.16%；G试验和GM试验阳性率为分别为70.00%(28/40)和75.00%(30/40)；50例患者胸部CT检查异常；病死率为17.65%(9/51)；患者死亡影响因素分析结果显示，死亡组患者入院至接受抗真菌治疗的时间大于好转组，死亡组患者进行抗逆转录病毒治疗的比率明显低于好转组，差异均有统计学意义(均P＜0.05)。结论温州地区AIDS合并播散性马尔尼菲篮状菌患者发病率逐年升高，患者CD4⁺T淋巴细胞计数常 < 50个/μL，临床表现多样化，及时抗真菌治疗和进行抗逆转录病毒治疗可明显降低患者病死率。
- 艾滋病 /
- /
- 马尔尼菲篮状菌病 /
- 临床特征 /
- 死亡危险因素
Abstract: Objective To understand the clinical characteristics of AIDS patients with disseminated Talaromycosis marneffei in Wenzhou, and to statistically analyze the risk factors of death, so as to provide a basis for clinical diagnosis, treatment and reduction of mortality of patients with these diseases in this area. Methods The medical records of 51 AIDS patients with Talaromycosis marneffei treated in Wenzhou Central Hospital from January 2016 to May 2020 were collected. The epidemiological characteristics, clinical manifestations, laboratory and imaging examination results and treatment outcome of the patients were analyzed. According to the treatment outcome, the patients were divided into improvement group (42 cases) and death group (9 cases), and the risk factors of death were compared and analyzed. Results From 2016 to 2020, the number of AIDS patients with disseminated Talaromycosis marneffei in Wenzhou area increased year by year, mainly in young adults (64.71%, 33/51). The most common clinical manifestations were fever and lymph node enlargement. The average number of CD4⁺ T lymphocytes in patients was 9(5, 19) cells/μL, of which 47 cases were less than 50 cells/μL (92.16%). The positive rates of G test and GM test were 70.00% (28/40) and 75.00% (30/40). 50 patients performed by chest CT examination were abnormal, the fatality rate was 17.65% (9/51). The analysis of influencing factors of death showed that the time from hospitalization to antifungal therapy in the death group was longer than that in the improvement group, and the rate of ART in the death group was significantly lower than that in the improvement group, the difference was statistically significant (P < 0.05). Conclusion The incidence of AIDS patients with disseminated Talaromycosis marneffei in Wenzhou is increasing year by year. The CD4⁺ T lymphocyte count of the patients is often less than 50 cells/μL, and the clinical manifestations are diversified. Timely antifungal therapy and antiretroviral therapy can significantly reduce the mortality of the patients.
- AIDS /
- Acquired immunodeficiency syndrome /
- Talaromycosis marneffei /
- Clinical features /
- Death risk factors

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表 1 51例AIDS合并播散性马尔尼菲篮状菌病患者临床表现

临床表现	例数	占比(%)	临床表现	例数	占比(%)
发热	43	83.31	乏力纳差	33	64.71
畏寒寒战	26	50.98	消瘦	40	78.43
咳嗽咳痰	36	70.59	贫血	39	76.47
胸闷气促	10	19.61	皮疹	22	43.14
腹痛腹泻	8	15.69	淋巴结肿大	51	100.00
头晕头痛	8	15.69	肝脾肿大	21	41.18
恶心呕吐	9	17.65	浆膜腔积液	34	66.67

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表 2 51例AIDS合并马尔尼菲篮状菌病患者的实验室检查结果

检测项目	结果	例数	占比(%)
白细胞(×10⁹/L)	＜4	30	58.82
	4~10	19	37.25
	＞10	2	3.93
血红蛋白(g/L)	＜60	0	0.00
	60~90	19	37.25
	91~110	20	39.22
	＞110	12	23.53
血小板(×10⁹/L)	＜50	11	21.57
	50~100	12	23.53
	＞100	28	54.90
CD4⁺T淋巴细胞(个/μL)	＜50	47	92.16
	50~100	2	3.92
	101~200	1	1.96
	＞200	1	1.96
谷丙转氨酶(U/L)	≤40	25	49.02
	＞40	26	50.98
谷草转氨酶(U/L)	≤40	10	19.61
	＞40	41	80.39
白蛋白(g/L)	＜40	51	100.00
	40~55	0	0.00
	＞55	0	0.00
总胆红素(μmol/L)	≤17.1	44	86.27
	17.2~34.2	3	5.88
	＞34.2	4	7.85
乳酸脱氢酶(U/L)	＜120	0	0.00
	120~250	8	15.69
	＞250	43	84.31
C反应蛋白(mg/L)	≤8	2	3.92
	＞8	49	96.08
G试验(40例)	阳性	28	70.00
	阴性	12	30.00
GM试验(40例)	阳性	30	75.00
	阴性	10	25.00

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表 3 AIDS合并播散性马尔尼菲篮状菌病死亡影响因素分析

临床表现/指标	好转组(42例)	死亡组(9例)	统计量	P值
年龄(x±s，岁)	37.24±11.08	39.33±14.17	-0.479^a	0.634
血红蛋白(x±s，g/L)	95.38±18.54	100.44±15.00	-0.752^a	0.456
血小板(x±s，×10⁹/L)	126.40±77.92	98.88±59.61	0.979^a	0.332
白蛋白(x±s，g/L)	29.48±5.16	29.20±4.30	0.149^a	0.882
C反应蛋白(x±s，mg/L)	60.94±42.63	65.30±34.05	-0.282^a	0.779
男性[例(%)]	39(92.86)	8(88.89)	<0.001^b	0.999
发热[例(%)]	36(85.71)	7(77.78)	0.008^b	0.929
畏寒寒战[例(%)]	22(52.38)	4(44.44)	0.004^b	0.948
咳嗽咳痰[例(%)]	28(66.67)	8(88.89)	0.855^b	0.355
胸闷气促[例(%)]	8(19.05)	2(22.22)	<0.001^b	0.999
腹痛腹泻[例(%)]	6(14.29)	2(22.22)	0.008^b	0.929
头晕头痛[例(%)]	5(11.90)	3(33.33)	1.208^b	0.272
恶心呕吐[例(%)]	6(14.29)	3(33.33)	0.772^b	0.380
乏力纳差[例(%)]	27(64.29)	6(66.67)	<0.001^b	0.999
消瘦[例(%)]	35(83.33)	5(55.56)	1.938^b	0.164
贫血[例(%)]	32(76.19)	7(77.78)	<0.001^b	0.999
皮疹[例(%)]	19(45.24)	3(33.33)	0.080^b	0.777
肝脾肿大[例(%)]	20(47.62)	1(11.11)	2.710^b	0.100
浆膜腔积液[例(%)]	29(69.05)	5(55.56)	0.152^b	0.697
抗真菌治疗[例(%)]	42(100.00)	8(88.89)	0.735^b	0.391
进行ART[例(%)]	40(95.24)	4(44.44)	12.144^b	<0.001
合并1种其他机会性感染疾病[例(%)]	14(33.33)	3(33.33)	0.000^b	0.999
合并2种其他机会性感染疾病[例(%)]	10(23.81)	3(33.33)	0.030^b	0.862
合并3种及以其他上机会性感染疾病[例(%)]	8(19.05)	1(11.11)	0.007^b	0.932
白细胞[M(P₂₅, P₇₅)，×10⁹/L]	3.35(2.25, 4.75)	3.80(2.80，6.40)	-0.766^c	0.444
谷丙转氨酶[M(P₂₅, P₇₅)，U/L]	45.50(22.00，75.25)	36.00(32.00，95.00)	-0.803^c	0.422
谷草转氨酶[M(P₂₅, P₇₅)，U/L]	75.50(41.75，113.25)	115.00(74.00，230.00)	-1.594^c	0.111
总胆红素[M(P₂₅, P₇₅)，μmol/L]	9.65(7.45，11.75)	10.80(9.00，16.40)	-0.853^c	0.394
乳酸脱氢酶[M(P₂₅, P₇₅)，U/L]	474.00(264.75，590.75)	569.00(414.00，808.00)	-0.519^c	0.604
入院至接受抗真菌治疗时间[M(P₂₅, P₇₅)，d]	2.00(1.00，4.75)	7.50(4.75，10.00)	-3.115^c	0.002
注：^a为t值，^b为χ²值，^c为U值。

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