中国真菌学杂志

目的 分析HIV合并马尔尼菲篮状菌感染特征及预后不良相关因素。方法 回顾性分析河池市人民医院2020年2月—2023年12月106例HIV合并马尔尼菲篮状菌病的一般人口特征、合并症与预后的相关性。结果 壮族与其他民族在HIV-TSM感染恶化进展上有统计学差异(P<0.05)。合并症中脓毒血症、代谢性酸中毒、血小板减少在好转组和恶化组的构成比中有显著性统计学差异(P<0.001);采用单因素Cox比例风险回归分析中代谢性酸中毒、血小板减少、脓毒血症与恶化特征有相关性；多因素Cox比例风险回归分析血小板减少是恶化的独立风险因素(HR=2.955,95%CI=1.304～6.699;P=0.009),代谢性酸中毒是恶化的独立风险因素(HR=6.219,95%CI=2.740～14.116;P<0.001)。Kaplan-Meier分析提示血小板减少与HIV-TSM恶化预后相关(Log-Rand,χ²=11.511,P<0.001),代谢性酸中毒与HIV-TSM恶化预后相关(Log-Rand,χ²=44.847,P<0.001);受试者工作特征曲线分析血小板减少联合代谢性酸中毒AUC为0.794 (P<0.001,95%CI:0.690～0.892)。结论 广西西北部壮族人群与其他民族相比在HIV-TSM感染预后不良上具有统计学差异，血小板减少和代谢性酸中毒是HIV-TSM感染预后不佳的独立风险因素。

Objective To analyze the characteristics of HIV positive cases with Talaromyces mameffei infection and the associated factors of poor prognosis.Methods A retrospective analysis was performed to analyze the general characteristic,clinical comorbidities and prognostic correlation of 106 cases of HIV positive cases complicated with Talaromyces mameffei infection from February 2020 to December 2023 in The People's Hospital of Hechi.Results There were statistical differences in the progression of HIV-TSM infection between Zhuang and other ethnic groups(P<0.05). The comorbidities of sepsis,metabolic acidosis and thrombocytopenia showed significantly different composition ratio between the improved group and the deteriorating group(P<0.001). In univariate Cox analysis,metabolic acidosis,thrombocytopenia and sepsis were correlate-d with severe symptoms. In multivariate Cox analysis,thrombocytopenia was as an independent risk factor for severe disease(HR = 2.955,95%CI = 1.304～6.699;P= 0.009),metabolic acidosis was an independent risk factor for severe disease (HR=6.219,95%CI=2.740～14.116;P<0.001). Kaplan-Meier analysis suggested that thrombocytopenia was associated with HIV-TSM prognosis(Log-Rand,χ²=11.511,P<0.001),and metabolic acidosis was associated with HIV-TSM prognosis(Log-Rand, χ²=44.847,P<0.001). The area under ROC curve predicted by thrombocytopenia combined with metabolic acidosis was 0.794(P<0.001,95%CI:0.690～0.892). Conclusion Compared with other ethnic groups,Zhuang population in northwestern Guangxi has a significant difference in the poor prognosis of HIV-TSM infection,thrombocytopenia and metabolic acidosis are independent risk factors for the poor prognosis of HIV-TSM infection.