愛滋病住院病人伺機性感染的相關因素

Factors That Related to Opportunistic Infections Among Inpatients With Acquired Immunodeficiency Syndrome

郭逸羚(Yi-Ling Kuo)

指導教授 ： 高家常

義守大學/醫學院/護理學系/碩士(2018年)

摘要

背景：愛滋病感染者有年輕化的趨勢，而伺機性感染為人類免疫缺乏病毒感染者後天免疫缺乏症候群感染者住院期間的主要死因。服用愛滋病藥物治療者雖可控制愛滋病病毒量及提高cluster of differentiation 4 receptor (CD4)，但仍有機會發生伺機性感染。伺機性感染感染會促使病情嚴重、增加住院天數及提高醫療費用。
目的：本研究目的是了解伺機性感染疾病發生率以及人口屬性、疾病相關因素在伺機性感染之間的差異性。
方法：採描述性相關性研究設計，病歷回溯及醫院資料庫進行次級資料分析。樣本收集的條件為:診斷為愛滋病或人類免疫缺乏病毒感染住院者。使用SPSS統計套裝軟體分析，使用描述性分析及卡方檢定說明人口屬性、疾病相關因素及伺機性感染。
結果：年齡、教育程度、職業，身體質量指數、性傾向及婚姻與伺機性感染有達到顯著差異；人口屬性與CD4只有婚姻達統計顯著差異，部分未達顯著意義；CD4與伺機性感染的肺囊蟲肺炎達統計顯著差異；病毒量與伺機性感染中的肺囊蟲肺炎及其他感染疾病呈顯著差異；呼吸、神經、腸胃系統及其他臨床表徵與伺機性感染的肺結核、肺囊蟲肺炎、隱球菌感染及其他感染疾病有顯著差異，其餘變項皆未達統計意義。
結論與建議：愛滋病發生率年輕化及發病臨床表徵以多系統呈現，甚至以伺機性感染就醫住院才診斷為愛滋病感染者，期望透過此研究結果提供臨床醫療人員對愛滋病臨床表徵警覺性，提早診斷及治療以減少住院天數及醫療費用。

關鍵字

愛滋病 ； 伺機性感染 ； 病毒量

並列摘要

Background: Patients with acquired immunodeficiency syndrome (AIDS) tends to be younger. Opportunistic infections (OIs) are the leading death in patients with human immunodeficiency virus/AIDs during hospitalizations. Although highly active antiretroviral therapy may control the viral load and increase Cluster of Differentiation 4 receptors (CD4), however, OIs is still out of control. OIs can deteriorate disease and increase the length of hospital stays and medical costs.
Aim: The purpose of the study was to understand the incidence rate of OIs and demographics and clinical factors differences in OIs incidence in patients with human immunodeficiency virus/AIDS.
Method: A cross-sectional design with secondary data analysis using hospital’s data bank was conducted. A total of 163 inpatients with human immunodeficiency virus/AIDS (by frequency) from 2012 to 2015 of the databank was included the analysis. Analytic variables included demographics and clinical factors. Analytic strategies included descriptive and Chi-squares.
Results: Subjects who were younger, college education, non-service occupation, lowest BMI, homosexuality, and single status had higher/the highest percentages of OIs than their counterparties. Single subjects had lower CD4 than those of married. CD4 and viral load were differences in Pneumocystis jiroveci pneumonia and level of viral load difference in undifferentiated OIs. Chronic diseases、admission of symptoms in respiratory、neurology、and gastrointestinal systems were differences in Tuberculosis、Pneumocystis jiroveci pneumonia、cryptococcus meningitis, and undifferentiated OIs.
Conclusion and recommendation: Once the personal attritions and clinical factors differences in OIs have examined. The results may provide more insight of characteristics of clinical features of HIV / AIDS into healthcare professionals for early diagnosis and treatments and then reduce the length of hospital stays and medical expenses.

並列關鍵字

human immunodeficiency virus / HIV ； Acquired immunodeficiency syndrome ； AIDS ； Opportunistic infection ； cluster of differentiation 4 receptors ； viral load

參考文獻

3.林德宇、王甯祺(2013)．未服用愛滋病治療藥物的新患者感染抗藥性愛滋病毒的趨勢．感控雜誌，23，191-199。

1.李政益、吳宛真、楊祥麟、劉定萍(2015)．臺灣2014年愛滋病毒感染流行病學分析．衛生福利部．疫情報導，31(23)，579-584。

4.陳美妏、張夙娟、張靜雯(2015)．愛滋病患者併發伺機性感染後之心理衝擊與照護．榮總護理，32(2)，185-192。

12.戴君惜、余思華、李素芬、林詩萍、林育蕙(2016)．愛滋病毒急性感染期之案例探討．台灣醫檢會報，31(4)，57-63。

4. Centers for disease control and prevention (2001). First report of AIDS. Morbidity and Mortality weekly report, 50(21). Retrieved from https://www.cdc.gov/mmwr/pdf/wk/mm5021.pdf