АНАЛИЗ ПРИЧИН СМЕРТИ, СТРУКТУРЫ ВТОРИЧНОЙ И СОПУТСТВУЮЩЕЙ ПАТОЛОГИИ ВИЧ-ИНФИЦИРОВАННЫХ ПАЦИЕНТОВ ГОМЕЛЬСКОЙ ОБЛАСТИ
Аннотация
Актуальность. Анализ спектра причин смерти, связанных с ВИЧ-инфекцией, представляет некоторые трудности, так как значительное число случаев смерти ВИЧ-инфицированных пациентов напрямую не связано с манифестацией иммунодефицита. Цель – определить спектр вторичных заболеваний, непосредственные и основные причины смерти, а также органы-мишени для оппортунистических инфекций и заболеваний ВИЧ-инфицированных пациентов Гомельской области. Материал и методы. Изучены истории болезни, данные кабинета инфекционных заболеваний и протоколы патологоанатомических вскрытий ВИЧ-инфицированных пациентов Светлогорского района Гомельской области за 2012-2018 гг. Результаты. Среди ВИЧ-инфицированных умерших пациентов преобладают мужчины (более 60%), в возрасте от 35 до 44 лет (около 50%). Уменьшается количество умерших пациентов со стажем инфицирования от 1 года до 12 лет и увеличивается – от 13 лет до 21 года (28,4%). Средняя продолжительность жизни после инфицирования ВИЧ составляет 10,5±4,9 года. Среди ВИЧ-инфицированных умерших пациентов, имевших показатели иммунного статуса, содержание CD4+ лимфоцитов менее 200 клеток было у 63,8% пациентов, у 23,3% количество CD4+ клеток на момент смерти – менее 50. Вирусная нагрузка у 22,4% умерших на момент смерти превышала 500000 копий/мкл, большинство (89,2%) умерших имели 4-ю клиническую стадию ВИЧ-инфекции. Выводы. У 74,6% пациентов ВИЧ-инфекция была основным заболеванием и основной причиной смерти. Среди спектра вторичных заболеваний, ставших причиной смерти, выявлены: пневмоцистная пневмония, прогрессирующая мультифокальная лейкоэнцефалопатия, криптококковая инфекция, токсоплазмоз головного мозга, туберкулез, лимфомы, ЦМВ-инфекция, генерализованный кандидоз, атипичный микобактериоз, аспергиллез легких и другие. В 25,4% случаев ВИЧ-инфекция была расценена как сопутствующая, а не основная патология, среди которой преобладали циррозы печени и иная патология: острое нарушение мозгового кровообращения, ишемическая болезнь сердца, хроническая ревматическая болезнь сердца, дилатационная кардиомиопатия, хроническая алкогольная болезнь и другие. Увеличение числа вскрытий и постоянный мониторинг причин смерти умерших от ВИЧ-инфекции и связанных с ней оппортунистических инфекций и заболеваний повысят качество и ускорят сроки прижизненной диагностики разного рода патологии у ВИЧ-инфицированных пациентов.
Литература
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