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目的 分析人类免疫缺陷病毒（human immunodeficiency virus, HIV）感染/获得性免疫缺陷综合征（acquired immunodeficiencysyndrome, AIDS）患者合并脓毒症的临床特征，为HIV/AIDS合并脓毒症早期诊断和治疗提供参考依据。方法 选取南宁市第四人民医院2021年1月至2022年12月收治的HIV/AIDS合并脓毒症患者为研究对象，根据发病30 d临床结局分为存活组和死亡组，对2组患者一般资料、感染分布情况、实验室检查结果进行比较，分析病原菌分布情况。结果 共纳入431例患者，存活组269例（62.4%），死亡组162例（37.6%）；其中383例（88.9%）患者为多重感染，呼吸系统为最常见的感染系统。死亡组年龄、出血比例、休克比例、器官功能衰竭比例、序贯器官衰竭评分、合并恶性肿瘤比例、合并隐球菌抗原血症比例、中枢神经系统感染率及多器官感染率均高于存活组，而体质量指数、合并梅毒感染比例、住院天数均低于存活组（均P<0.05）。死亡组白细胞计数、降钙素原、C反应蛋白、中性粒细胞绝对值、乳酸、乳酸脱氢酶水平以及凝血酶原时间均高于存活组，而血红蛋白、白蛋白水平以及CD4+T细胞计数均低于存活组（均P<0.05）。在病原学方面，351例（81.4%）患者病原菌培养阳性，199例（56.7%）患者培养出2种或2种以上病原菌；病原菌以真菌为主，最常见病原菌依次为白色念珠菌180例（25.8%）、马尔尼篮状菌119例（17.1%）、肺炎克雷伯菌54例（7.7%）、分枝杆菌45例（6.5%）及大肠埃希菌36例（5.2%）。结论 HIV/AIDS合并脓毒症以多重感染为主，呼吸系统是最常见感染系统，病原菌以真菌为主，且培养呈多样性，针对病原菌的治疗应使用广谱抗菌药物及联合应用抗菌药物。
Abstract：Objective To analyze the clinical characteristics of HIV/AIDS patients with sepsis, and to provide reference for the early diagnosis and treatment of HIV/AIDS patients with sepsis. Methods HIV/AIDS patients with sepsis admitted to Nanning Fourth People's Hospital from January 2021 to December 2022 were selected as the study subjects. Based on 30-day clinical outcomes, they were divided into a survival group and a death group. General data, infection distribution,and laboratory test results were compared between the two groups, and pathogen distribution was analyzed. Results A total of 431 patients were included, with 269(62.4%) in the survival group and 162(37.6%) in the death group. Among them, 383(88.9%) patients had multiple infections, with the respiratory system being the most common site of infection. The death group had significantly higher age, bleeding rate, shock rate, organ failure rate, sequential organ failure assessment(SOFA) score,proportion of comorbid malignancies, and proportion of cryptococcal antigenemia compared to the survival group(P<0.05).The survival group had higher body mass index, proportion of comorbid syphilis infection, and hospitalization duration than the death group(P<0.05). The death group also had higher rates of central nervous system infections and multi-organ infections(P<0.05). Laboratory results showed that the death group had significantly higher white blood cell count, procalcitonin, C-reactive protein, absolute neutrophil count, lactate, lactate dehydrogenase, and prothrombin time compared to the survival group(P<0.05).Conversely, hemoglobin, albumin, and CD4+ T-cell counts were lower in the death group(P<0.05). In terms of pathogens,351(81.4%) patients had positive pathogen cultures, with 199(56.7%) showing two or more pathogens. Fungal infections predominated, with the most common pathogens being Candida albicans(180 cases, 25.8%), Talaromyces marneffei(119 cases,17.1%), Klebsiella pneumoniae(54 cases, 7.7%), Mycobacterium(45 cases, 6.5%), and Escherichia coli(36 cases, 5.2%).Conclusion HIV/AIDS patients with sepsis primarily present with multiple infections, most commonly in the respiratory system. Fungal infections are predominant, with diverse pathogen profiles. Treatment should involve broad-spectrum and combined antimicrobial therapy.
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基本信息:
中图分类号:R459.7;R512.91
引用信息:
[1]肖秋叶,郑艳青,黄田,等.431例人类免疫缺陷病毒感染/获得性免疫缺陷综合征合并脓毒症患者的临床特征分析[J].传染病信息,2025,38(06):534-539.
基金信息:
广西自治区卫生健康委自筹经费科研课题（Z-A20231216）
2025-12-25
2025-12-25