【摘要】 目的了解广西地区HIV/AIDS合并重症肺炎的流行病学、病原学分布特点、临床诊治现状及预后情况,提高诊治水平。方法回顾性分析2010—2015年广西艾滋病诊疗中心收治的AIDS合并重症肺炎患者的基础疾病或并发疾病及相关的主要临床特征。结果 153例HIV/AIDS重症肺炎患者的呼衰类型以Ⅰ型呼衰为主,影像表现可多样,从渗出、实变到空洞、小叶中心性结节、纤维化均可见,病灶缺乏典型的影像学特点;病原学感染最常见的是多种细菌、真菌及病毒的混合性感染,细菌感染最为常见,真菌感染最常见马尔尼菲青霉菌;死亡组化验指标白细胞计数、C反应蛋白、乳酸脱氢酶计数明显高于好转组,CD8+T淋巴细胞和血白蛋白降低较明显,差异有统计学意义(均P<0.05),年龄和低蛋白血症是影响重症肺炎预后的危险因素;快速识别病原体和强化抗感染治疗是治疗HIV/AIDS重症肺炎的关键。结论广西地区HIV/AIDS并发重症肺炎患者以Ⅰ型呼衰为主要表现;影像学呈实变、磨玻璃样变等改变;机会感染病原体可有细菌、真菌结核及病毒,且多为多种细菌、真菌及结核的混合性感染;HIV/AIDS合并重症肺炎应早期诊断,尽早进行全覆盖抗菌治疗,基层医院应尽早转诊到有条件医院治疗,才能有效降低死亡率。更多还原

【Abstract】 Objective To understand the clinical features of HIV/AIDS patients complicated with severe pneumonia inGuangxi, so as to improve the diagnosis and treatment level. Methods The data of AIDS patients complicated with severepneumonia were collected and analyzed retrospectively for their main clinical characteristics related to underlying diseases orcomplications from 2010 to 2015. Results The type of respiratory failure of the 153 HIV/AIDS patients complicated withsevere pneumonia was mainly type 1. he imaging findings were varied including oozing, consolidation, empty, centrilobularnodules, and fibrosis. The infection etiology was usually the mixed infections of variety of bacteria, fungi and viruses, and thepathogen culture usually showed bacterial infections, and the most common fungal infection was Penicillium; In the deathgroup, the laboratory indicators, such as leukocyte count, C- reactive protein and lactate dehydrogenase counts, weresignificantly higher than those in the improved group, and the hypoalbuminemia was much obvious and the age andhypoalbuminemia were the risk factors of prognosis; The rapid identification of pathogens and strengthening the anti-infectiontreatment were the key in the treatment of HIV/AIDS patients complicated with severe pneumonia. Conclusion In Guangxiregion, HIV/AIDS patients complicated with severe pneumonia show type 1 respiratory failure and their clinical manifestations,imaging and infectious pathogens were varied. The rapid identification of pathogens and strengthening the anti- infectiontreatment are the key to improve the prognosis.更多还原