HIV/AIDS合并肺结核患者抗结核干预疗效的影响因素分析

Influencing factors of the curative effect of anti-tuberculosis intervention in HIV/AIDS patients with tuberculosis

摘要:

目的 探讨影响人类免疫缺陷病毒（HIV）感染/获得性免疫缺陷综合征（AIDS）合并肺结核患者抗结核干预疗效的危险因素。方法 回顾性分析2014年1月—2023年7月汉中市中心医院收治的110例HIV/AIDS合并肺结核患者的临床资料。给予所有患者H-Rfb-Z-E组合抗结核治疗，治疗9个月后，死亡组31例，存活组79例。比较两组患者的临床资料、白细胞分化抗原4（CD4⁺）水平；采用多因素一般Logistic回归分析HIV/AIDS合并肺结核患者抗结核干预后死亡的影响因素；绘制受试者工作特征（ROC）曲线分析HIV感染时间、CD4⁺水平对HIV/AIDS合并肺结核患者抗结核干预后死亡的预测价值。结果 死亡组与存活组的性别构成、年龄、肺结核类型构成、合并肺外结核病占比、其他感染疾病占比及不良反应率比较，差异均无统计学意义（P >0.05）。死亡组静脉注射吸毒占比、无抗HIV治疗占比均高于存活组，HIV感染时间长于存活组，CD4⁺水平低于存活组（P <0.05）。多因素一般Logistic回归分析结果显示：未接受抗HIV治疗［O^R =1.542（95% CI：1.127，2.110）］、HIV感染时间长［O^R =3.198（95% CI：1.243，8.228）］、静脉注射吸毒［O^R =1.757（95% CI：1.093，2.824）］、CD4⁺水平高［O^R =2.483（95% CI：1.305，4.724）］均为HIV/AIDS合并肺结核患者抗结核干预后死亡的危险因素（P <0.05）。ROC曲线结果显示，HIV感染时间预测HIV/AIDS合并肺结核患者抗结核干预后死亡的曲线下面积为0.794（95% CI：0.703，0.918）、敏感性为83.5%（95% CI：0.753，0.896）、特异性为89.8%（95% CI：0.811，0.906）；CD4⁺水平预测HIV/AIDS合并肺结核患者抗结核干预后死亡的曲线下面积为0.813（95% CI：0.724，0.926）、敏感性为87.4%（95% CI：0.767，0.912）、特异性为86.5%（95% CI：0.802，0.910）。结论 未接受抗HIV治疗、HIV感染时间长、静脉注射吸毒、CD4⁺水平高均为HIV/AIDS合并肺结核患者抗结核干预后死亡的危险因素，临床治疗时可结合以上指标针对性制订治疗方案，提高治疗效果。

Abstract:

Objective To analyze the factors influencing the efficacy of anti-tuberculosis intervention in human immunodeficiency virus (HIV) infection/acquired immunodeficiency syndrome (AIDS) patients with pulmonary tuberculosis.Method A total of 110 patients with HIV/AIDS combined with tuberculosis who received treatment in Hanzhong Central Hospital from January 2014 to July 2023 were selected and treated with the same anti-tuberculosis regimen (H-Rfb-Z-E). According to the efficacy after 9 months of treatment, they were divided into a death group (n = 31) and a survival group (n = 79). The baseline data and CD4⁺ levels were compared between the two groups. Multivariate Logistic regression was used to analyze the influencing factors of death. The value of HIV infection duration and CD4⁺ level in predicting death was analyzed using ROC curves.Result The comparisons of anti-HIV treatment rate, intravenous drug use rate, HIV infection duration, and CD4⁺ level between the death group and the survival group showed statistically significant differences (P < 0.05). Multivariate Logistic regression analysis showed that: no anti-HIV treatment [O^R = 1.542 (95% CI: 1.127, 2.110) ], long duration of HIV infection [O^R = 3.198 (95% CI: 1.243, 8.228) ], intravenous drug use [O^R = 1.757 (95% CI: 1.093, 2.824) ], and high CD4⁺ level [O^R = 2.483 (95% CI: 1.305, 4.724) ] were all risk factors for death after anti-tuberculosis intervention in patients with HIV/AIDS complicated with pulmonary tuberculosis (P < 0.05). ROC analysis confirmed that HIV infection time [AUC 0.794 (95% CI: 0.703, 0.918), sensitivity 0.835, specificity 0.898] and CD4⁺ level [AUC 0.813 (95% CI: 0.724, 0.926), sensitivity 0.874, specificity 0.865] could be used to predict the efficacy (P < 0.05).Conclusion Not receiving anti-HIV treatment, long duration of HIV infection, intravenous drug use, and high CD4⁺ level are all influencing factors for the efficacy of anti-tuberculosis intervention. Targeted treatment plans can be formulated based on these indicators to improve the therapeutic effect.