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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。
Objective To understand the epidemiology and etiological distribution of HIV / AIDS-severe pneumonia in Guangxi area, the status of clinical diagnosis and treatment, the prognosis and the improvement of diagnosis and treatment. Methods A retrospective analysis was conducted on the underlying or concurrent diseases and related major clinical features of AIDS patients with severe pneumonia admitted to Guangxi AIDS Center during 2010-2015. Results The type of respiratory failure in 153 HIV / AIDS patients with severe pneumonia was mainly type Ⅰ respiratory failure. The imaging findings varied from exudation, consolidation to emphysema, centrilobular nodules and fibrosis, and the lesions lacked the typical Imaging features; the most common pathogenic infection is a variety of bacteria, fungi and viruses mixed infection, the most common bacterial infections, the most common fungal infection Penicillium marneffei; death group laboratory indicators white blood cell count, C-reactive protein, lactic acid (P <0.05). The age and hypoproteinemia were the risk factors influencing the prognosis of severe pneumonia. The serum levels of CD8 + T lymphocytes and serum albumin were significantly lower than those in control group Rapid identification of pathogens and enhanced anti-infective treatment are the key to the treatment of severe pneumonia in HIV / AIDS. Conclusions Patients with severe pneumonia in Guangxi province are mainly characterized by type Ⅰ respiratory failure. Radiographic imaging shows consolidation and ground glass-like changes. The opportunistic pathogens may include bacteria, fungi, tuberculosis and viruses, and most of them are many kinds of bacteria , Mixed fungal and tuberculosis infection; HIV / AIDS complicated with severe pneumonia should be diagnosed early, full coverage of antimicrobial treatment as soon as possible, primary hospital should be referred to conditional hospital treatment as soon as possible, in order to effectively reduce mortality.