作者：刘刚，王宇，汤艳芬，任爱民，赵雯，陈奇

单位：

100015 北京市，首都医科大学附属北京地坛医院呼吸科　感染病科国家临床重点专科　北京市中西医结合感染性疾病研究所；通信作者：王宇，E-mail：ruixin20001@139.com

关键词：

获得性免疫缺陷综合征；气胸；疾病特征；预后；影响因素分析

Keywords：

Acquired immunodeficiency syndrome；Pneumothorax；Disease attributes；Prognosis；Root causeanalysis

CLC：

R 512.91　R 561.4

DOI：

DOI：10.3969/j.issn.1008-5971.2020.05.020

Funds：

摘要：

目的　分析获得性免疫缺陷综合征并发自发性气胸患者的临床特点及预后的影响因素。方法　选取2010 年 6 月—2018 年 12 月首都医科大学附属北京地坛医院收治的获得性免疫缺陷综合征并发自发性气胸患者 30 例，根据预后情况将其分为好转组（n=12）和恶化组（n=18）。观察患者临床资料，包括性别、年龄、血清白蛋白、SMART-COP 评分、CD 4 + T 淋巴细胞计数、发生气胸前开始高效抗逆转录病毒治疗（HAART）情况、吸氧治疗情况、胸腔闭式引流治疗情况、气胸位置、气胸面积、是否合并纵隔气肿、肺部影像学结果、肺部感染类型（包括肺孢子菌肺炎、肺结核、细菌性肺炎、混合感染）及预后情况。结果　30 例患者中男 29 例，女 1 例；平均年龄为（36.5±12.2）岁；平均血清白蛋白（30±5）g/L；平均SMART-COP评分（4.1±2.2）分；CD 4 + T淋巴细胞计数<200个/μl 28例（93.3%）；发生气胸前未开始 HAART 23 例（76.7%）；吸氧治疗 15 例（50.0%），吸氧 + 胸腔闭式引流治疗 15 例（50.0%）；气胸位置主要为右肺 16 例（53.3%）；气胸面积 >20% 者 16 例（53.3%）；合并纵隔气肿 10 例（33.3%）；肺部影像学存在胸膜下气囊样病变 9 例（30.0%）；肺部感染主要为肺孢子菌肺炎 18 例（60.0%）；治疗好转 12 例（40.0%），死亡 11 例（36.7%），病情恶化放弃治疗自动出院 7 例（23.3%）。好转组患者血清白蛋白高于恶化组，SMART-COP评分低于恶化组（P<0.05）；两组患者性别、年龄、CD 4 + T 淋巴细胞计数、发生气胸前未开始 HAART 情况、气胸治疗方式、气胸位置、气胸面积、合并纵隔气肿、肺部感染类型比较，差异无统计学意义（P>0.05）。结论　多数获得性免疫缺陷综合征并发自发性气胸患者 CD 4 + T 淋巴细胞计数 <200 个 /μl，多合并肺孢子菌肺炎，且预后较差；肺部感染严重程度及营养状况与患者预后有关。

Abstract：

Objective　To analyze the clinical characteristics and prognostic factors of AIDS patients complicatedwith spontaneous pneumothorax.Methods　A total of 30 AIDS patients complicated with spontaneous pneumothorax wereselected from Beijing Ditan Hospital Capital Medical University from June 2010 to December 2018，they were divided intoimprovement group （n=12） and deterioration group （n=18）according to the prognosis.General information of all patientswere observed，including gender，age，serum albumin，SMART-COP score，CD 4 + T lymphocyte count，highly activeantiretroviral therapy（HAART）before pneumothorax，oxygen inhalation，closed pleural drainage，pneumothorax location，pneumothorax area，whether complicated with mediastinal emphysema or not，pulmonary imaging，types of pulmonary infection（including pneumocystis pneumonia，tuberculosis，bacterial pneumonia，mixed infection） and prognosis.Results　Amongthe 30 patients，29 were male and 1 was female，the average age was（36.5±12.2）years old；the average serum albumin was（30±5）g/L；the average SMART-COP score was（4.1±2.2）；28 cases's（accounting for 93.3%）CD 4 + T lymphocytecount was < 200 cells/μl；23 cases（accounting for 76.7%）didn't start HAART before pneumothorax；15 cases（accountingfor 50.0%）received single oxygen inhalation；15 cases（accounting for 50.0%）received oxygen inhalation + closed pleuraldrainage；pneumothorax was mainly located in the right lung in 16 cases（accounting for 53.3%）；16 cases'（accounting for53.3%）pneumothorax area>20%；10 cases（accounting for 33.3%）complicated with mediastinal emphysema；there were9 cases（accounting for 30.0%）of subpleural balloon-like lesions in pulmonary imaging；pulmonary infection was mainlypneumocystis pneumonia in 18 cases（accounting for 60.0%）；12 cases（accounting for 40.0%）were improved；11 cases（accounting for 36.7%）died，7 cases（accounting for 23.3%）discharged from the hospital due to worsening condition.Serum albumin level in improvement group was statistically significantly higher than that in deterioration group，while SMART-COP score in improvement group was statistically significantly lower than that in deterioration group（P<0.05）.There wasno statistically significant difference in gender，age，CD 4 + T lymphocyte count，HAART before pneumothorax，oxygeninhalation，pneumothorax location，pneumothorax area，complicated with mediastinal emphysema and mediastinal emphysemabetween the two groups（P>0.05）.Conclusion　AIDS patients complicated with spontaneous pneumothorax mostly have CD 4 +T lymphocyte count<200/μl，have pneumocystis pneumonia，and have poor prognosis.The severity of pulmonary infection andnutritional status in AIDS patients complicated with spontaneous pneumothorax are related to the prognosis.

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