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目的了解艾滋病患儿死亡前的流行病学特点及临床特征,为有针对性降低艾滋病患儿死亡率提供有价值的参考依据。方法收集南宁市第四人民医院2007—2009年收治的13例5岁以下艾滋病患儿的人口学特征、传播途径、临床特征、并发症、实验室检查、治疗、死因等资料,并采用描述性流行病学方法进行分析。结果 13例患儿中女童10例,男童3例;年龄最小3月龄,最大4岁,平均2岁;有11例患儿为足月顺产,9例为母乳喂养;11例病例为母婴传播,2例传播途径不详,10例患儿母亲分娩时未采取母婴阻断措施,仅5例患儿母亲孕前开始采取抗病毒治疗。发病至死亡时间(中位数)为0.58年,平均入院至死亡时间(中位数)为5 d;13例病例均有多种并发症,其中以肺部感染(12例)、口腔真菌感染(11例)为多。检测5例患儿的病毒载量,平均值为1.6×105cop ies/mL;检测7例患儿的CD4+水平,平均值为263个/μL(17.00%)。13例病例均采取对症、支持、抗逆转录病毒治疗等,抗病毒治疗一般采用AZT(d4T)+3TC+NVP(EFV)方案;艾滋病儿童死亡直接死亡原因分别为多器官功能衰竭(7例)、呼吸衰竭(4例)、脑水肿(2例)。结论受调查的艾滋病患儿主要为母婴传播,具有起病急、进展快、免疫功能水平低下、合并多种机会性感染、以多器官功能衰竭为主要死因等特点。
Objective To understand the epidemiological features and clinical features of children with AIDS before death and provide valuable reference for targeted reduction of mortality in children with AIDS. Methods The demographic, transmission, clinical characteristics, complications, laboratory tests, treatment, and cause of death of 13 children under 5 years of age admitted from 2007 to 2009 in Nanning Fourth People’s Hospital were collected. Descriptive Epidemiological methods were analyzed. Results Of the 13 children, 10 were girls and 3 were boys. The youngest was 3 months of age and the oldest was 4 years old, with an average of 2 years of age. Eleven children were fully term and 9 were breastfed. 11 Infant transmission, 2 cases of transmission is unknown, 10 cases of mothers did not take maternal and childbirth childbirth blocking measures, only 5 cases of mothers before pregnancy to start taking antiviral therapy. The median time between onset and death was 0.58 years and the median time between admission and death was 5 days. There were various complications in 13 cases, including pulmonary infection (12 cases), oral fungal infection (11 cases) as much. Five patients were tested for viral load, with an average of 1.6 × 10 5 cops / mL. Seven of the 7 children were tested for CD4 + levels with an average of 263 / μL (17.00%). All 13 cases were treated with symptomatic, supportive and antiretroviral therapy, and AZT (d4T) + 3TC + NVP (EFV) was generally used in antiviral therapy. The direct causes of death from AIDS were multiorgan failure (7 cases) , Respiratory failure (4 cases), cerebral edema (2 cases). Conclusion The children with AIDS are mainly maternal-to-infant transmission, with the characteristics of acute onset, rapid progression, low level of immune function, multiple opportunistic infections combined with multiple organ failure as the main cause of death.