艾滋病合并马尔尼菲篮状菌病82例临床和预后分析
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摘要
目的探讨艾滋病合并马尔尼菲篮状菌病的临床特征、治疗方法和预后。方法采用前瞻性队列研究,观察和分析云南省传染病医院确诊的82例艾滋病合并马尔尼菲篮状菌病病人的临床情况。结果 82例艾滋病合并马尔尼菲篮状菌病常见症状为发热(95.1%)、特征性中央坏死性皮疹(62.2%)、口腔黏膜损害(40.2%)、呼吸道症状(64.6%)、消化道症状(61.0%)。抗真菌治疗至启动抗病毒治疗(ART)时间中位数为15(11～21)天。病死率为14.6%(12/82),艾滋病合并马尔尼菲篮状菌病死亡影响单因素分析中年龄、特征性皮疹、肝脏肿大、颈部淋巴结肿大、谷丙转氨酶、抗真菌治疗、ART差异有统计学意义(P均<0.05);其中抗真菌治疗、ART差异有显著的统计学意义(P均<0.001)。Logistic回归多因素分析显示,年龄为艾滋病合并马尔尼菲篮状菌病死亡危险因素,特征性皮疹为保护因素(P均>0.05),但差异无统计学意义。结论特征性皮疹和口腔黏膜损害可为艾滋病合并马尔尼菲篮状菌病早期诊断提供依据。及时合理抗真菌治疗和ART能显著降低病死率。
Objective To explore the clinical feature, therapy and prognoses of AIDS complicated with talaromycosis. Methods A prospective cohort study was conducted on 82 AIDS cases complicated with talaromycosis in Yunnan provincial infectious diseases hospital, by observation and analysis. Results The common symptoms of 82 AIDS patients were fever(95.1%), characteristic central necrotizing rash(62.2%), oral mucosal lesion(40.2%), respiratory symptoms(64.6%) and digestive tract symptoms(61.0%). The median time from antifungal therapy to ART initiation was 15(11, 21)days. The mortality was 14.6%(12/82). The univariate analysis showed that there were significant differences in age, characteristic rash, hepatauxe, cervical lymphadenectasis, glutamic-pyruvic transaminase, antifungal therapy and ART in mortality of AIDS complicated with talaromycosis(P<0.05), among which there was highly significant difference between antifungal therapy and ART(P<0.001). Logistic regression multivariate analysis showed that age was a risk factor for the mortality, and characteristic rash was a protective factor, but there was no significant difference between the two factors(P>0.05). Conclusion Characteristic rash and oral mucosal lesion can provide a basis for early diagnosis of AIDS complicated with talaromycosis. Timely and rational antifungal therapy and ART can reduce mortality significantly in AIDS complicated with talaromycosis.
Objective To explore the clinical feature, therapy and prognoses of AIDS complicated with talaromycosis. Methods A prospective cohort study was conducted on 82 AIDS cases complicated with talaromycosis in Yunnan provincial infectious diseases hospital, by observation and analysis. Results The common symptoms of 82 AIDS patients were fever(95.1%), characteristic central necrotizing rash(62.2%), oral mucosal lesion(40.2%), respiratory symptoms(64.6%) and digestive tract symptoms(61.0%). The median time from antifungal therapy to ART initiation was 15(11, 21)days. The mortality was 14.6%(12/82). The univariate analysis showed that there were significant differences in age, characteristic rash, hepatauxe, cervical lymphadenectasis, glutamic-pyruvic transaminase, antifungal therapy and ART in mortality of AIDS complicated with talaromycosis(P<0.05), among which there was highly significant difference between antifungal therapy and ART(P<0.001). Logistic regression multivariate analysis showed that age was a risk factor for the mortality, and characteristic rash was a protective factor, but there was no significant difference between the two factors(P>0.05). Conclusion Characteristic rash and oral mucosal lesion can provide a basis for early diagnosis of AIDS complicated with talaromycosis. Timely and rational antifungal therapy and ART can reduce mortality significantly in AIDS complicated with talaromycosis.
引文
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[8] 吴碧君,汤庆,周爱群,等.艾滋病合并播散性马尔尼菲青霉菌病腹部超声表现分析[J].中国超声医学杂志,2011,27(3):246-248.
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[10] 陈涛,蒋忠胜,李敏基,等.马尔尼菲篮状菌病预后危险因素Logistic回归分析及预后模型的建立[J].中国皮肤性病学杂志,2018,32(5):518-522.
[11] Son VT,Khue PM,Strobel M,et al.Penicilliosis and AIDS in Haiphong,Vietnam:evolution and predictive factors of death[J].Med Mal Infect,2014(44):495-501.
[12] Le T,Kinh NV,Cuc NTK,et al.A Trial of Intraconazole or Amphotericin B for HIV-Associated Talaromycosis[J].N Engl J Med,2017,376(24):2329-2340.
[13] Ouyang Y,Cai S,Liang H,et al.Administration of Voriconazole in Disseminated Talaromyces (Penicillium) Marneffei Infection:A Retrospective Study[J].Mycopathologia,2017,182(5-6):569-575.
[14] Lei HL,Li LH,Chen WS,et al.Susceptibility profile of echinocandins,azoles and amphotericin B against yeast phase of Talaromyces marneffei isolated from HIV-infected patients in Guangdong,China[J].Eur J Clin Microbiol Infect Dis,2018,37(6):1099-1102.
[15] 叶萍孔,晋亮,吴聪,等.不同方案治疗马尔尼菲青霉菌病对的疗效分[J].中华医院感染学杂志,2016,26(18):4128-4131.
[16] 吴念宁,邹俊,农影星,艾滋病合并播散型马尔尼菲青霉菌病危险因素分析[J].中华临床医师杂志,2012,6(15):4429-4431.
[17] 李芳,耿文奎,邓晓军,等.艾滋病合并马尔尼菲青霉菌病人死亡危险因素分析[J].中国临床新医学,2012,5(5):423-427.
[2] Bulterys PL,Le T,Quang VM,et al.Environmental Predictors and Incubation Period of AIDS-Associated Penicillium marneffei Infection in Ho Chi Minh City,Vietnam[J].Clin Infect Dis,2013,56(9):1273-1279.
[3] 丁秀荣,于艳华,陈铭,等.HIV/AIDS病人合并血流感染的病原菌分布特点[J].中国艾滋病性病,2016,22(5):317-319.
[4] 李英,卢斯汉,胡荣欣,等.861例艾滋病合并马尔尼菲篮状菌的临床分析[J].热带医学杂志,2018,18(7):939-942.
[5] Zheng J,Gui X,Cao Q,et al.A Clinical Study of Acquired Immunodeficiency Syndrome Associated Penicillium Marneffei Infection from a Non-Endemic Area in China[J].PLoS One,2015,10 (6):e0130376.
[6] M Larsson,LHT Nguyen,HF Wertheim,et al.Clinical characteristics and outcome of Penicillium marneffei infection among HIV-infected patients in northern Vietnam[J].AIDS Research and Therapy,2012,9(1):1-5.
[7] Hu Y,Zhang J,Li X,et al.Penicillium marneffei Infection:An Emerging Disease in Mainland China[J].Mycopathologia,2013(175):57-67.
[8] 吴碧君,汤庆,周爱群,等.艾滋病合并播散性马尔尼菲青霉菌病腹部超声表现分析[J].中国超声医学杂志,2011,27(3):246-248.
[9] 张云桂,赵月娟,李玉叶,等.226例艾滋病合并马尔尼菲青霉菌病病人的影像学特征[J].皮肤病与性病,2016,38(2):91-94.
[10] 陈涛,蒋忠胜,李敏基,等.马尔尼菲篮状菌病预后危险因素Logistic回归分析及预后模型的建立[J].中国皮肤性病学杂志,2018,32(5):518-522.
[11] Son VT,Khue PM,Strobel M,et al.Penicilliosis and AIDS in Haiphong,Vietnam:evolution and predictive factors of death[J].Med Mal Infect,2014(44):495-501.
[12] Le T,Kinh NV,Cuc NTK,et al.A Trial of Intraconazole or Amphotericin B for HIV-Associated Talaromycosis[J].N Engl J Med,2017,376(24):2329-2340.
[13] Ouyang Y,Cai S,Liang H,et al.Administration of Voriconazole in Disseminated Talaromyces (Penicillium) Marneffei Infection:A Retrospective Study[J].Mycopathologia,2017,182(5-6):569-575.
[14] Lei HL,Li LH,Chen WS,et al.Susceptibility profile of echinocandins,azoles and amphotericin B against yeast phase of Talaromyces marneffei isolated from HIV-infected patients in Guangdong,China[J].Eur J Clin Microbiol Infect Dis,2018,37(6):1099-1102.
[15] 叶萍孔,晋亮,吴聪,等.不同方案治疗马尔尼菲青霉菌病对的疗效分[J].中华医院感染学杂志,2016,26(18):4128-4131.
[16] 吴念宁,邹俊,农影星,艾滋病合并播散型马尔尼菲青霉菌病危险因素分析[J].中华临床医师杂志,2012,6(15):4429-4431.
[17] 李芳,耿文奎,邓晓军,等.艾滋病合并马尔尼菲青霉菌病人死亡危险因素分析[J].中国临床新医学,2012,5(5):423-427.