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目的了解Mtb与HIV双重感染患者抗结核治疗期间死亡相关影响因素。方法对2007—2008年期间,广西、四川、湖南三省(自治区)共6个县诊治Mtb与HIV双重感染患者抗结核治疗期间死亡情况进行分析。共观察330例患者,抗结核治疗期间死亡33例。使用SAS 9.2软件,分析患者体质量、CD4+T淋巴细胞水平、接受抗病毒治疗时间、HIV感染途径、HIV感染年限、结核病类型、机会感染等因素对Mtb与HIV双重感染患者抗结核治疗期间死亡状况的影响,P<0.05为差异有统计学意义。结果 Mtb与HIV双重感染患者抗结核治疗期间病死率为10.0%(33/330)。对死亡相关影响因素分析发现:运用logistic回归进行统计学分析,CD4+T淋巴细胞水平未对患者的病死率产生影响(Waldχ2=0.5774,P=0.4473,OR值0.858,95%CI值0.578～1.274);未接受抗病毒治疗的患者的病死率是接受抗病毒治疗的患者的病死率的7.612倍(Waldχ2=14.8539,P<0.001,OR值7.612,95%CI值2.712～21.369),是否接受抗病毒治疗是患者病死率的影响因素;性传播组病死率(6.7%,14/210)与静脉吸毒组病死率(16.1%,19/118)比较,静脉吸毒组病死率较高,采用Fisher确切概率法进行统计学分析,P<0.05;涂阳肺结核组、涂阴肺结核组、肺结核组、肺结核合并肺外结核组、单纯肺外结核组病死率(分别为:20.9%,18/86;8.0%,14/174;11.7%,27/230;16.7%,5/30;1.4%,1/70)比较,涂阳肺结核及肺结核合并肺外结核组病死率较高,χ2值分别为17.8685和7.9687,P值均<0.05。结论结核病变程度、患者机能状况是影响Mtb与HIV双重感染患者病死状况的主要因素。
Objective To understand the influencing factors of death during anti-TB treatment in patients with dual infection of Mtb and HIV. Methods During the period of 2007-2008, the deaths of patients with dual infection of Mtb and HIV from 6 counties in Guangxi, Sichuan and Hunan Provinces during anti-TB treatment were analyzed. A total of 330 patients were observed and 33 died during anti-TB treatment. Using SAS 9.2 software to analyze the patient’s body mass, CD4 + T lymphocyte levels, time to antiviral therapy, route of HIV infection, age of HIV infection, type of tuberculosis, opportunistic infections and other factors in the death of patients with dual infection with Mtb and HIV during anti-TB treatment The impact of the situation, P <0.05 for the difference was statistically significant. Results The case-fatality rate of patients with dual infection of Mtb and HIV was 10.0% (33/330) during anti-TB treatment. Analysis of the factors influencing death revealed that the logistic regression analysis showed that the CD4 + T lymphocyte level did not affect the patients’ mortality (Wald2 = 0.5774, P = 0.4473, OR = 0.858, 95% CI 0.578-1.274 ). The mortality of patients without antiviral therapy was 7.612 times of that of patients receiving antiviral therapy (Wald 2 = 14.8539, P <0.001, OR 7.612, 95% CI 2.712-21.369) Viral treatment was the influencing factor of patient mortality. The mortality rate of sex transmission group (6.7%, 14/210) was higher than that of intravenous drug use group (16.1%, 19/118) (P <0.05). The case fatality rates of smear positive pulmonary tuberculosis, smear negative pulmonary tuberculosis, pulmonary tuberculosis, pulmonary tuberculosis combined with extrapulmonary tuberculosis and simple extrapulmonary tuberculosis were 20.9%, 18/86, 8.0 The cases with smear positive pulmonary tuberculosis and pulmonary tuberculosis combined with extrapulmonary tuberculosis had higher mortality rates, withχ2 values of 17.8685 and 17.8685, respectively 7.9687, all P <0.05. Conclusion The degree of tuberculosis and the functional status of patients are the main factors affecting the morbidity of patients with dual infection of Mtb and HIV.