结核分枝杆菌与艾滋病病毒双重感染患者抗结核治疗期间死亡的影响因素分析

中国防痨杂志 ›› 2011, Vol. 33 ›› Issue (11): 734-738.

结核分枝杆菌与艾滋病病毒双重感染患者抗结核治疗期间死亡的影响因素分析

周林陈磊王倪刘二勇何金戈刘飞鹰王巧智薛晓

102206 北京，中国疾病预防控制中心结核病预防控制中心［周林、陈磊、王倪、刘二勇、薛晓(研究生)］；四川省疾病预防控制中心结核病预防控制所（何金戈）；广西壮族自治区疾病预防控制中心结核病防治科（刘飞鹰）；湖南省结核病防治所（王巧智）

收稿日期:2011-06-15 出版日期:2011-11-10 发布日期:2012-01-20
通信作者: 周林 E-mail:zhoulin@chinatb.org

Analysis on the influencing factors of the mortality of Mycobacterium tuberculosis and human immunodeficiency virus co-infection patients during the anti-tuberculosis treatment period

ZHOU Lin, CHEN Lei, WANG Ni, LIU Er-yong, HE Jin-ge, LIU Fei-ying, WANG Qiao-zhi, XUE Xiao

National Center for Tuberculosis Control and Prevention,Chinese Center for Disease Control and Prevention,Beijing 102206,China

Received:2011-06-15 Online:2011-11-10 Published:2012-01-20
Contact: ZHOU Lin E-mail:zhoulin@chinatb.org

摘要/Abstract

摘要： 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（Wald χ²=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（Wald χ²=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。

关键词: 结核/治疗, HIV感染, 死亡原因

Abstract: Objective To understand the influencing factors of the mortality of Mycobacterium tuberculosis and human immunodeficiency virus (Mtb/HIV) co-infection patients during the anti-tuberculosis treatment period. Methods During 2007—2008, patients from 6 counties in Guangxi, Sichuan, Hunan three provinces (autonomous region) were analyzed. 330 patients were observed, 33 patients died during the anti-tuberculosis treatment period.SAS 9.2 software was used to do the analysis of the impact of patients’ weight, CD4⁺T lymphocyte level, antiretroviral therapy period, HIV infection route, HIV infection years, tuberculosis type, OIs on the mortality during the antituberculosis period. There is a significant statistical difference when P value is below 0.05. Results The mortality of Mtb/HIV co-infection patients during anti-tuberculosis treatment period was 10.0%（33/330）.Analysis on the influencing factors shows that: The logistic regression model is used to analyze the impact of CD4⁺T lymphocyte level and antiretroviral therapy on the mortality. The CD4 level has no impact on patients’ mortality（Wald χ²=0.5774, P=0.4473）.The mortality of patients who received antiretroviral therapy is 7.612 times higher than that of those who didn’t receive antiretroviral therapy. Statistical test shows P value is below 0.001（Wald χ²=14.8539）.Whether the patient receives antiretroviral therapy is a influencing factor of the mortality;As for the HIV infection route, the mortality of sexually transmitted group was（6.7%,14/210）,drug users group was （16.1%,19/118）,drug users group have a higher risk of death.Fisher’s exact test shows P value is below 0.05, There is a significant statistical difference; As for the tuberculosis type, the mortality of smear positive pulmonary tuberculosis group was(20.9%,18/86), smear negative pulmonary tuberculosis group was(8.0%,14/174), pulmonary tuberculosis group was(11.7%,27/230), pulmonary tuberculosis with extra-pulmonary tuberculosis group was（16.7%,5/30),extra-pulmonary tuberculosis group was(1.4%,1/70),smear positive pulmonary tuberculosis and pulmonary tuberculosis with extra-pulmonary tuberculosis has a higher risk of death, χ² test shows P value is below 0.05（χ²=17.8685, 7.9687）, There is a significant statistical difference. Conclusion TB/HIV co-infection patients’ pathological degree, health status are the major influencing factors of mortality.

Key words: Tuberculosis/therapy, HIV infections, Cause of death

周林陈磊王倪刘二勇何金戈刘飞鹰王巧智薛晓. 结核分枝杆菌与艾滋病病毒双重感染患者抗结核治疗期间死亡的影响因素分析[J]. 中国防痨杂志, 2011, 33(11): 734-738.

ZHOU Lin, CHEN Lei, WANG Ni, LIU Er-yong, HE Jin-ge, LIU Fei-ying, WANG Qiao-zhi, XUE Xiao. Analysis on the influencing factors of the mortality of Mycobacterium tuberculosis and human immunodeficiency virus co-infection patients during the anti-tuberculosis treatment period[J]. Chinese Journal of Antituberculosis, 2011, 33(11): 734-738.

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