获得性免疫缺陷综合征合并慢性阻塞性肺疾病影响因素分析

doi:10.3877/cma.j.issn.1674-6902.2025.04.024

目的

分析获得性免疫缺陷综合征(acquired immunodeficiency syndrome, AIDS)患者合并慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)的影响因素。

方法

选择2020年1月至2023年12月我院收治的AIDS患者398例，根据弥散障碍程度分为弥散功能正常组48例、轻度下降组40例、中度下降组92例、重度下降组218例。收集临床资料，采用t检验、方差分析、χ²检验、Logistic回归方法分析AIDS患者合并COPD的影响因素。

结果

每组体质量、CD4^＋及CD8^＋细胞计数，有吸烟史、咳嗽、咳痰症状，白细胞介素-6(interleukin-6, IL-6)、右心室测值，支气管扩张、肺孢子菌肺炎(pneumocystis pneumonia, PCP)、肺结核、肺真菌病差异有统计学意义(P<0.05)。多因素分析显示，体质量(OR＝0.944, 95%CI：0.909~0.979)、吸烟(OR＝2.798, 95%CI：1.452~5.392)、CD4^＋细胞计数(OR＝0.996, 95%CI：0.994~0.998)是AIDS患者弥散功能障碍的影响因素。每组用力肺活量(forced vital capacity, FVC)、第1秒用力呼气容积(forced expiratory volume in 1 second, FEV₁)、最大呼气中期流量(maximal mid-expiratory flow 75/25, MMEF75/25)、呼气峰值流量(peak expiratory flow, PEF)、肺总量(total lung capacity, TLC)、残气量(residual volume, RV)、最大肺活量(maximal vital capacity，VC MAX)差异有统计学意义(P<0.05)。随访结束，未合并COPD 251例，合并COPD 99例，其中轻度组2例(5.00%)、中度组19例(20.65%)、重度组78例(35.78%)(P<0.001)。AIDS合并COPD者较未合并COPD者体质量、吸烟、住院频次、CD4^＋及CD8^＋淋巴细胞、合并PCP、肺结核、肺真菌病、马尔尼菲蓝状菌、FEV₁、FVC、FEV₁/FVC差异有统计学意义(P<0.05)。重度且持续弥散障碍是AIDS患者合并COPD的危险因素(OR＝2.699, 95%CI：1.571~4.637)。

结论

吸烟是AIDS弥散功能障碍危险因素；体质量、CD4^＋细胞计数是AIDS弥散功能障碍的预测因素。吸烟、重度弥散障碍、住院史是AIDS合并COPD的危险因素；CD4^＋细胞计数、体质量是AIDS合并COPD的预测因素。维持CD4^＋细胞正常状态、规范抗病毒治疗、戒烟、增强营养、控制肺部感染可改善弥散功能，降低AIDS患者合并COPD的发病率。

关键词: 获得性免疫缺陷综合征, 弥散功能, CD4^＋细胞, 慢性阻塞性肺疾病

Objective

To analyze the influencing factors of chronic obstructive pulmonary disease (COPD) in patients with acquired immunodeficiency syndrome (AIDS).

Methods

A total of 398 AIDS patients admitted to our hospital from January 2020 to December 2023 were enrolled and divided into groups based on the degree of diffusion impairment: normal diffusion function group 48 cases, mild decline group 40 cases, moderate decline group 92 cases, and severe decline group 218 cases. Clinical data were collected, and statistical methods including t-test, analysis of variance (ANOVA), χ² test, and Logistic regression were used to analyze the factors influencing COPD in AIDS patients.

Results

Statistically significant differences (P<0.05) were observed among the groups in terms of body weight, CD4⁺ and CD8⁺ cell counts, smoking history, cough, expectoration, IL-6 levels, right ventricular measurements, bronchiectasis, Pneumocystis pneumonia(PCP), pulmonary tuberculosis, and pulmonary fungal infections. Multivariate analysis revealed that body weight (OR=0.944, 95%CI: 0.909~0.979), smoking (OR=2.798, 95%CI: 1.452~5.392), and CD4⁺ cell count (OR=0.996, 95%CI: 0.994~0.998) were influencing factors for diffusion dysfunction in AIDS patients. Significant differences (P<0.05) were also found in forced vital capacity (FVC), forced expiratory volume in 1 second (FEV₁), maximal mid-expiratory flow (MMEF75/25), peak expiratory flow (PEF), total lung capacity (TLC), residual volume (RV), and maximal vital capacity (VC MAX) among the groups. At the end of the 3-year follow-up, 251 patients had not developed COPD, while 99 had, with the distribution as follows: 0 cases in normal group, 2 cases(5.00%) in mild group, 19 cases (20.65%) in moderate group, and 78 cases(35.78%) in severe group (P<0.001). Compared to non-COPD patients, AIDS patients with COPD exhibited statistically significant differences (P<0.05) in body weight, smoking, hospitalization frequency, CD4⁺ and CD8⁺ lymphocyte counts, concurrent PCP, pulmonary tuberculosis, pulmonary fungal infections, Talaromyces marneffei infection, FEV₁, FVC, and FEV₁/FVC ratio. Severe and persistent diffusion impairment was identified as a risk factor for COPD in AIDS patients (OR=2.699, 95%CI: 1.571~4.637).

Conclusion

Smoking is a risk factor for diffusion dysfunction in AIDS patients, while body weight and CD4⁺ cell count are predictive factors. Smoking, severe diffusion impairment, and hospitalization history are risk factors for COPD in AIDS patients, whereas CD4⁺ cell count and body weight serve as predictive factors. Maintaining normal CD4⁺ cell levels, adhering to standardized antiviral therapy, smoking cessation, improving nutrition, and controlling pulmonary infections may help enhance diffusion function and reduce COPD incidence in this population.

Key words: Acquired immunodeficiency syndrome, Diffusion function, CD4⁺ T cells, Chronic obstructive pulmonary disease

表1 每组AIDS患者临床资料结果比较

临床资料	弥散正常组(n＝48)	轻度障碍组(n＝40)	中度障碍组(n＝92)	重度障碍组(n＝218)	χ²/F	P值
吸烟史	16	16	53	124^ab	12.218	0.007
临床症状
咳嗽	35	30	69	190^abc	10.626	0.014
咳痰	24	25	55	158^ac	14.541	0.010
CD4^＋[n/μl，(±s)]	267.28±195.07	216.73±182.51	158.12±136.81^ab	96.38±112.65^abc	24.621	0.000
CD8^＋[n/μl，(±s)]	551.61±470.82	558.56±431.48	612.58±642.27	431.51±374.49^c	5.356	0.002
IL-6[pg/ml，(±s)]	7.24±6.59	45.99±136.80	70.76±237.81^a	39.84±84.09^ac	11.604	0.000
支气管扩张	4	2^a	9	8	8.210	0.042
肺孢子菌肺炎	0	2	10	28^b	16.112	0.001
肺结核	9	18^a	40^a	83^a	9.568	0.023
肺真菌病	3	16^a	27^a	65^a	14.593	0.002
心脏超声右心室	19.71±1.45	25.48±12.63	22.88±14.57	20.90±3.13	3.680	0.015

表1 每组AIDS患者临床资料结果比较

临床资料	弥散正常组(n＝48)	轻度障碍组(n＝40)	中度障碍组(n＝92)	重度障碍组(n＝218)	χ²/F	P值
吸烟史	16	16	53	124^ab	12.218	0.007
临床症状
咳嗽	35	30	69	190^abc	10.626	0.014
咳痰	24	25	55	158^ac	14.541	0.010
CD4^＋[n/μl，(±s)]	267.28±195.07	216.73±182.51	158.12±136.81^ab	96.38±112.65^abc	24.621	0.000
CD8^＋[n/μl，(±s)]	551.61±470.82	558.56±431.48	612.58±642.27	431.51±374.49^c	5.356	0.002
IL-6[pg/ml，(±s)]	7.24±6.59	45.99±136.80	70.76±237.81^a	39.84±84.09^ac	11.604	0.000
支气管扩张	4	2^a	9	8	8.210	0.042
肺孢子菌肺炎	0	2	10	28^b	16.112	0.001
肺结核	9	18^a	40^a	83^a	9.568	0.023
肺真菌病	3	16^a	27^a	65^a	14.593	0.002
心脏超声右心室	19.71±1.45	25.48±12.63	22.88±14.57	20.90±3.13	3.680	0.015

表2 AIDS合并COPD单因素分析

临床指标	合并COPD(n＝99)	未合并COPD(n＝251)	χ²/t/F值	P值
体重	48.42±19.73	57.31±12.62	－2.56	0.030
吸烟史	67	32	7.72	0.000
CD4^＋	99.61±96.76	174.59±148.67	－4.11	0.000
CD8^＋	448.18±154.08	560.14±229.89	－2.16	0.040
IL-6	41.25±93.73	47.11±96.10	0.36	0.720
肺孢子菌肺炎	48	61	4.28	0.040
肺真菌病	37	35	9.16	0.000
肺结核	39	44	5.50	0.020
马尔尼菲蓝状菌	6	2	5.22	0.030
弓形虫感染	3	1	2.57	0.110
年均住院≥2次	37	28	15.13	0.000
FEV₁	1.28±0.50	1.66±0.53	5.32	0.000
FVC	1.30±0.53	1.71±0.59	23.57	0.000
FEV₁/FVC	42.62±9.13	72.01±8.01	19.57	0.000
弥散正常	0	48	21.94	0.000
轻度弥散障碍	2	38	12.07	0.000
中度弥散障碍	19	73	3.59	0.060
重度弥散障碍	78	140	16.00	0.000

表2 AIDS合并COPD单因素分析

临床指标	合并COPD(n＝99)	未合并COPD(n＝251)	χ²/t/F值	P值
体重	48.42±19.73	57.31±12.62	－2.56	0.030
吸烟史	67	32	7.72	0.000
CD4^＋	99.61±96.76	174.59±148.67	－4.11	0.000
CD8^＋	448.18±154.08	560.14±229.89	－2.16	0.040
IL-6	41.25±93.73	47.11±96.10	0.36	0.720
肺孢子菌肺炎	48	61	4.28	0.040
肺真菌病	37	35	9.16	0.000
肺结核	39	44	5.50	0.020
马尔尼菲蓝状菌	6	2	5.22	0.030
弓形虫感染	3	1	2.57	0.110
年均住院≥2次	37	28	15.13	0.000
FEV₁	1.28±0.50	1.66±0.53	5.32	0.000
FVC	1.30±0.53	1.71±0.59	23.57	0.000
FEV₁/FVC	42.62±9.13	72.01±8.01	19.57	0.000
弥散正常	0	48	21.94	0.000
轻度弥散障碍	2	38	12.07	0.000
中度弥散障碍	19	73	3.59	0.060
重度弥散障碍	78	140	16.00	0.000

表3 AIDS合并COPD多因素回归分析

影响因素	SE	Wald	P值	β	OR	95%CI
体质量	0.036	11.478	0.001	－0.144	0.991	1.074~1.248
吸烟史	0.405	13.445	0.000	1.524	4.798	1.875~6.392
CD4^＋	0.002	10.127	0.003	－0.007	0.911	0.975~0.997
CD8^＋	0.007	0.063	0.914	0.001	1.024	0.124~1.857
肺孢子菌肺炎	0.527	0.182	0.761	0.268	1.219	0.521~4.278
肺结核	0.738	0.165	0.824	0.321	0.978	0.423~4.027
肺真菌病	0.539	0.057	0.997	－0.172	0.827	0.339~3.879
马尔尼菲蓝状菌	0.047	0.002	0.108	0.002	1.027	0.921~1.025
年均住院≥2次	0.226	10.26	0.000	0.724	2.061	1.325~3.212
弥散正常	0.299	0.105	0.746	－0.097	0.908	0.505~1.630
中度弥散障碍	0.306	0.122	0.727	－0.107	0.899	0.493~1.637
重度弥散障碍	0.276	12.94	0.000	0.993	2.699	1.571~4.637

表3 AIDS合并COPD多因素回归分析

影响因素	SE	Wald	P值	β	OR	95%CI
体质量	0.036	11.478	0.001	－0.144	0.991	1.074~1.248
吸烟史	0.405	13.445	0.000	1.524	4.798	1.875~6.392
CD4^＋	0.002	10.127	0.003	－0.007	0.911	0.975~0.997
CD8^＋	0.007	0.063	0.914	0.001	1.024	0.124~1.857
肺孢子菌肺炎	0.527	0.182	0.761	0.268	1.219	0.521~4.278
肺结核	0.738	0.165	0.824	0.321	0.978	0.423~4.027
肺真菌病	0.539	0.057	0.997	－0.172	0.827	0.339~3.879
马尔尼菲蓝状菌	0.047	0.002	0.108	0.002	1.027	0.921~1.025
年均住院≥2次	0.226	10.26	0.000	0.724	2.061	1.325~3.212
弥散正常	0.299	0.105	0.746	－0.097	0.908	0.505~1.630
中度弥散障碍	0.306	0.122	0.727	－0.107	0.899	0.493~1.637
重度弥散障碍	0.276	12.94	0.000	0.993	2.699	1.571~4.637

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Risk factors analysis of chronic obstructive pulmonary disease in patients with acquired immunodeficiency syndrome

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Risk factors analysis of chronic obstructive pulmonary disease in patients with acquired immunodeficiency syndrome