【摘要】 目的 探討艾滋病患者合并機會性感染的臨床特征并評價其治療效果。 方法 回顧分析2003年-2009年53例確診為艾滋病患者的臨床資料，對患者合并機會性感染的臨床特征，包括發生機會性感染的時間、發生機會性感染時CD4+T細胞計數、起病急緩、嚴重程度等，進行觀察和分析，并給予國家推薦的標準治療方案進行治療，通過臨床癥狀、病毒載量、CD4+T細胞計數、影像學監測進行療效分析，隨訪時間為初治至出院后6年。 結果 53例艾滋病患者均為重癥感染，41例為混合感染，其中2個以上部位感染者為36例（67.9%），2種以上病原體感染者為28例（52.8%），3種以上病原體感染者13例（24.5%）。最常見的機會性感染為結核35.8%（19/53）；其次為卡氏肺孢子菌肺炎30.2%（16/53）；敗血癥20.8%（11/53），此外，尚有隱球菌感染15.1%（8/53）、弓形蟲感染3.8%（2/53）、帶狀皰疹病毒感染7.5%（4/53）、念珠菌感染17.0%（9/53）、巨細胞病毒感染7.5%（4/53）、合并乙肝11.3%（6/53）、丙肝3.8%（2/53）。機會性感染治療有效率為77.4%（41/53），病死率為22.6%（12/53），其中隱球菌腦膜炎或混合感染者病死率最高。 結論 艾滋病患者在CD4+T細胞計數lt;350/mm3時各種機會感染明顯升高，且隨著CD4+T細胞計數的下降呈增高趨勢，艾滋病合并機會性感染最常見的是結核，其次卡氏肺孢子菌肺炎；合并結核的治療效果較好，合并隱球菌腦病的病死率最高。早期啟動高效抗逆轉錄病毒治療效果好。【Abstract】 Objective To investigate the clinical characteristics of acquired immune deficiency syndrome (AIDS) combined with opportunistic infections and its treatment. Methods We retrospectively analyzed the clinical data of 53 patients diagnosed to have AIDS in our hospital between 2003 and 2009. The clinical features (such as time of the onset of opportunistic infections, CD4+ T cells value at the onset, severity of the infection, etc.) of the opportunistic infections (such as tuberculosis, Pneumocystis carinii pneumonia, toxoplasmosis, etc.) were also observed and analyzed. The patients were treated according to the national standards. The clinical outcome was analyzed based on such indicators as clinical symptoms, viral load, CD4+ T cells value at the onset, and the results of various imaging. Follow-up was done for six years. Results All 53 patients had severe AIDS infection. Forty-one of them had combined infections, among whom 36 (67.9%) had infections in two or more parts of the body, 28 (52.8%) were infected by two or more pathogens, and 13 (24.5%) were infected by three or more pathogens. The most common opportunistic infection was tuberculosis (35.8%,19/53) followed by pneumocystis carinii pneumonia (30.2%,16/53) and septicemia (20.8%,11/53). Other infections included cryptococcal infection (15.1%, 8/53), toxoplasma gondii infection (3.8%, 2/53), herpes zoster virus infection (7.5%, 4/53), candidiasis (17.0%, 9/53), cytomegalovirus infection (7.5%, 4/53), combined hepatitis B (11.3%, 6/53), and hepatitis C (3.8%, 2/53). Effective treatment rate for opportunistic infections was 77.4% (41/53) with a mortality of 22.6% (12/53). The highest fatality rate occurred to those patients with cryptococcal meningitis or mixed infections. Conclusions The occurrence of opportunistic infections rises obviously when CD4+ T cells is lower than 350/mm3, and it increases more significantly as the value of CD4+ T cells goes down. The most common opportunistic infection is tuberculosis followed by pneumocystis carinii pneumonia. The clinical outcome for the combined cases of tuberculosis is good, while combined cryptococcal encephalopathy has the highest mortality rate. High active anti-retroviral therapy should be initiated as early as possible.
