摘要
目的研究艾滋病合并结核分枝杆菌(MTB)和非结核分枝杆菌(NTM)血流感染患者的临床特征、合并感染及预后,分析预后不良的影响因素。方法回顾性收集2015-2020年上海市公共卫生临床中心艾滋病合并分枝杆菌血流感染患者资料。按住院结局分为正常出院组和预后不良组,用秩和检验及χ^(2)检验比较两组患者的人口学及临床特征,Logistic回归分析预后不良的影响因素。结果共纳入207例分枝杆菌血流感染的病例,其中MTB感染80例,NTM感染127例。MTB感染患者的C反应蛋白(CRP)、降钙素原(PCT)等炎症标志物均高于NTM患者;但NTM患者的免疫缺陷更严重。MTB感染者中,预后不良组22例,正常出院组58例,预后不良组CRP(P=0.011)、PCT(P<0.001)均高于正常出院组,而白蛋白(P=0.032)、血红蛋白(P=0.020)均低于正常出院组。CRP≥100 mg/L患者预后不良的风险是CRP<100 mg/L患者的6.27倍(P=0.029)。NTM感染者预后不良组39例,正常出院组88例,预后不良组白蛋白(P=0.016)和CD8细胞计数(P=0.009)较低。白蛋白<30 g/L(OR=2.66,P=0.031)和CD8细胞<200/μL(OR=3.15,P=0.008)均是不良预后危险因素。结论艾滋病合并分枝杆菌血流感染的患者炎症指标较高时MTB的风险高于NTM。对于MTB患者要积极监测CRP;对于NTM血流感染,积极处理低蛋白血症同时提升免疫功能可能有益于改善预后。
Objective To study the clinical characteristics and prognosis influencing factors of AIDS patients with mycobacterium tuberculosis(MTB)or non-tuberculous mycobacteria(NTM)bloodstream infection.Methods The data of AIDS patients with mycobacterial bloodstream infection in Shanghai Public Health Clinical Center from 2015 to 2020 were retrospectively collected.The outcome of hospitalization was divided into a normal discharge group and a poor prognosis group.The rank sum and chi-square tests were used to compare the demographic and clinical characteristics of the two groups.Logistic regression was used to analyze the risk factors for poor prognosis.Results A total of 207 cases of mycobacterial bloodstream infections were collected,including 80 MTB infections and 127 NTM infection cases.The inflammatory markers such as CRP and PCT were all higher in the patients with MTB infection than in NTM patients.However,NTM patients have a more severe immunodeficiency.Among patients with MTB bloodstream infection,22 cases were in the poor prognosis group and 58 cases in the normal discharge group.The CRP(P=0.011)and PCT(P<0.001)were higher than the normal discharge group,while albumin(P=0.032)and hemoglobin(P=0.020)were lower than the normal discharge group.The risk of poor prognosis in patients with CRP≥100 mg/L was 6.27 times higher than in patients with CRP<100 mg/L(P=0.029).Among patients with NTM bloodstream infection,39 cases were in the poor prognosis group and 88 cases in the normal discharge group.The poor prognosis group of albumin(P=0.016)and CD8 count(P=0.009)were low.Both albumin<30 g/L(OR=2.66,P=0.031)and CD8<200/μL(OR=3.15,P=0.008)were risk factors for poor prognostic.Conclusions Mycobacterial bloodstream infection patients with a higher level of inflammatory markers have a higher risk of MTB than NTM.The CRP should be actively monitored for MTB patients.For NTM bloodstream infection,active management of hypoproteinemia and enhancing immune function was important for clinical outcomes.
作者
孙建军
田波
刘莉
陈军
沈银忠
张仁芳
SUN Jianjun;TIAN Bo;LIU Li;CHEN Jun;SHEN Yinzhong;ZHANG Renfang(Department of Infection and Immunity,Shanghai Public Health Clinical Center,Shanghai 201508,China;Department of Infectious Disease NO.1,The Third People's Hospital of Kunming,Kunming 650041,Yunnan)
出处
《中国艾滋病性病》
CAS
CSCD
北大核心
2023年第3期258-262,共5页
Chinese Journal of Aids & STD
基金
上海市公共卫生临床中心临床院内课题(KY-GW-2020-30)。
关键词
艾滋病
结核分枝杆菌
非结核分枝杆菌
临床特征
结局
AIDS
mycobacterium tuberculosis
non-tuberculous mycobacteria
clinical characteristics
prognosis
