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目的探讨影响艾滋病(AIDS)患者的预后因素,改进防治策略,提高患者的生活质量。方法对2004年8月至2011年12月在某市第四人民医院收治的AIDS住院患者的病历资料及山西省疾病预防控制中心定期随访提供的所有患者生存状况资料进行分析。生存率的估计采用Kaplan-Meier法;生存率的比较采用log-rank检验;多因素分析采用Cox回归分析。并计算预后指数(PI)值,然后按其分组来估计患者的期望生存率,并对其生存状况进行评价。结果 AIDS患者中位生存时间为18.00个月,其95%可信区间为(12.39,23.61)月;Cox回归分析表明:文化程度是影响AIDS患者生存的保护因素,肺部真菌感染、卡氏肺孢子虫肺炎(PCP)、艾滋病病毒(HIV)相关性脑病是影响艾滋病患者生存的危险因素。根据PI值分组,组间生存率差异有统计学意义(P﹤0.01);以PI=-0.64为基准,可估计患者个体的期望生存率。结论文化程度、肺部真菌感染、卡氏肺孢子虫肺炎及HIV相关性脑病是影响AIDS患者的独立预后因素,PI值可有效预测AIDS患者的生存情况,可作为临床个体化治疗评价的依据。
Objective To explore the prognostic factors affecting AIDS patients, to improve prevention and treatment strategies and improve the quality of life of patients. Methods The data of medical records of AIDS inpatients admitted to the Fourth People’s Hospital of a certain city from August 2004 to December 2011 and all the patients’ living conditions provided by Shanxi CDC were followed up regularly. Survival rates were estimated using Kaplan-Meier method; log-rank test was used to compare survival; Cox regression was used to analyze multivariate analysis. And calculate the prognostic index (PI) values, and then according to their group to estimate the expected survival rate of patients, and evaluate their survival status. Results The median survival time of AIDS patients was 18.00 months, with a 95% confidence interval of (12.39, 23.61) months. Cox regression analysis showed that educational level was the protective factor of AIDS patients’ survival, pulmonary fungal infection, Sporozoites pneumonia (PCP) and HIV-associated encephalopathy are risk factors affecting the survival of AIDS patients. According to PI grouping, there was significant difference in survival between groups (P <0.01). On the basis of PI = -0.64, the expected survival rate of individual patients could be estimated. Conclusion The educational level, pulmonary fungal infection, pneumocystis carinii pneumonia and HIV-related encephalopathy are independent prognostic factors in AIDS patients. The PI value can effectively predict the survival of AIDS patients and can be used as the basis for clinical individualized evaluation.