摘要
目的分析影响获得性免疫缺陷综合征(AIDS)合并肺孢子菌肺炎患者预后的独立危险因素。方法采用病例对照研究,回顾性分析西南医科大学附属医院2015年9月-2018年9月收治的AIDS合并肺孢子菌肺炎患者的一般临床资料和检查结果,根据住院期间的预后情况将患者分为预后不良组和预后良好组。采用单因素分析和多因素logistic回归分析影响患者预后的独立危险因素,并绘制受试者工作特征(ROC)曲线,评估其预测预后的价值。结果共纳入127例AIDS合并肺孢子菌肺炎患者,男102例,女25例,预后不良组57例,预后良好组70例。单因素分析结果显示:两组在体重、淋巴细胞计数、血清白蛋白(ALB)、C反应蛋白(CRP)、降钙素原(PCT)间比较差异有统计学意义(P<0.05),在年龄、性别、身高、体重指数、白细胞计数、红细胞计数、血红蛋白、乳酸脱氢酶、CD4^+T细胞计数等方面差异无统计学意义。多因素logistic回归分析显示CRP水平升高、体重减轻是影响AIDS合并肺孢子菌肺炎患者预后的独立危险因素(P<0.05)。CRP区分预后的ROC曲线的曲线下面积(AUC)为0.684(95%CI:0.566~0.787),临界值、灵敏度和特异度分别为59.22 mg/L、97.22%和42.11%。体重区分预后的AUC为0.731(95%CI:0.615~0.828),临界值、灵敏度和特异度分别为49.0 kg、97.22%和57.90%。CRP联合体重区分预后的AUC为0.771(95%CI:0.659~0.861),灵敏度和特异度分别为100%和44.7%。结论CRP、体重是影响AIDS合并肺孢子菌肺炎患者预后的独立危险因素,CRP升高、体重减轻患者预后较差,故监测CRP及体重对改善患者预后可能具有一定意义。
Objective To analyze the independent prognostic factors and their value in acquired immune deficiency syndrome(AIDS)patients complicated with pneumocystis pneumonia(PCP).Methods The clinical data of AIDS patients with PCP treated in the Affiliated Hospital of Southwest Medical University from September 2015 to September 2018 were retrospectively analyzed.The patients were assigned to poor outcome group or good outcome group based on their in-hospital outcome.Multivariate logistic regression was used to identify the independent factors affecting the outcome of patients.The receiver operating characteristic(ROC)curve was plotted to assess their value in predicting patient outcome.Results A total of 127 cases of AIDS complicated with PCP were identified,including 102 males and 25 females.Overall,57 patients were assigned to poor outcome group and 70 to good outcome group.Body weight,lymphocyte,albumin,C-reactive protein(CRP),and procalcitonin were different significantly between the two groups(P<0.05).No significant difference was found between the two groups in age,sex,height,body mass index,white blood cell count,red blood cell count,hemoglobin,lactate dehydrogenase,and CD4^+T cell count.Multivariate logistic regression analysis showed that CRP and body weight were independent prognostic factors in AIDS patients complicated with PCP(P<0.05).The area under the ROC curve of CRP was 0.684(95%CI 0.566-0.787)for predicting patient outcome.If using 59.22 mg/L as cutoff value,the sensitivity was 97.22%and specificity 42.11%.The area under the ROC curve of weight was 0.731(95%CI:0.615-0.828)for predicting patient outcome.If using 49.0 kg as cutoff value,the sensitivity was 97.22%and specificity 57.90%.The area under the ROC curve of CRP combined with weight was 0.771(95%CI:0.659-0.861)for predicting patient outcome.The sensitivity was 100%and specificity 44.7%.Conclusions CRP level and body weight are independent prognostic factors for outcome of AIDS patients with PCP.Increased CRP level and weight loss will lead to poor
作者
廖芮
孙长峰
肖科
黄永茂
LIAO Rui;SUN Changfeng;XIAO Ke;HUANG Yongmao(Department of Infectious Disease,Affiliated Hospital of Southwest Medical University,Luzhou Sichuan 646000,China)
出处
《中国感染与化疗杂志》
CAS
CSCD
北大核心
2020年第5期470-475,共6页
Chinese Journal of Infection and Chemotherapy
基金
四川省卫生和计划生育委员会课题(18PJ340)
西南医科大学青年基金(2017-ZRQN-103)
泸州市人民政府-西南医科大学科技战略合作基金(2018LZXNYD-ZK29)。
关键词
获得性免疫缺陷综合征
肺孢子菌肺炎
C反应蛋白
体重
预后
acquired immune deficiency syndrome
pneumocystis pneumonia
C-reactive protein
weight
outcome
