HIV/AIDS患者机会性感染与CD_4~+T淋巴细胞间的关联性
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摘要
目的研究人免疫缺陷病毒(HIV)感染者及艾滋病(AIDS)患者发生机会性感染的概率与自身CD_4~+T淋巴细胞之间的关系,为HIV患者机会性感染的防治提供参考。方法以2016年6月至2017年6月我院400例HIV患者为研究对象,回顾性分析不同CD_4~+T淋巴细胞计数HIV患者发生机会性感染的情况。结果 400例HIV患者发生机会性感染178例,总感染率为44.5%。CD_4~+T淋巴细胞计数≤50个/μL的患者机会性感染发生率(86.67%)最高,与其他各组比较差异有统计学意义(P<0.05)。随着CD_4~+T淋巴细胞计数的减少,HIV患者机会性感染率升高。178例机会性感染者中,单一感染82例,2部位感染52例,3部位感染28例,4部位以上感染16例。感染病原体检测显示,细菌感染84例(47.19%),结核杆菌感染36例(20.22%),病毒感染30例(16.85%,包括巨细胞病毒感染18例、单纯疱疹病毒感染12例),真菌感染77例(43.25%,包括假丝酵母感染35例,肺孢子菌感染20例,马尔尼菲青霉菌感染12例,新型隐球菌感染10例),未明确病原体性质34例(19.10%),复合感染多见。结论 CD_4~+T淋巴细胞水平与HIV患者继发机会性感染的概率关系密切。HIV患者CD_4~+T淋巴细胞水平的监测对其继发机会性感染的防控具有重要临床意义。
Objective To explore the correlation between opportunistic infection and CD_4~+T lymphocytes in patients with HIV infection or acquired immunodeficiency syndrome(AIDS)and provide reference for the prevention and treatment of opportunistic infections in HIV patients.Methods 400 HIV infected patients in our hospital from June 2016 to June 2017 were selected as the subjects.The incidences of opportunistic infections in HIV patients with different CD_4~+T lymphocyte counts were analyzed retrospectively.Results There were 178 cases of opportunistic infections in the 400 HIV patients;the overall infection rate was 44.5%.The incidence of opportunistic infections in the patients with CD_4~+T lymphocyte count≤50/μL was the highest,reaching up to 86.67%,significantly higher than the other groups(Ps<0.05).With the decrease of CD_4~+T lymphocyte count,the incidence of opportunistic infections in HIV patients increased.In the 178 cases of opportunistic infections,82 cases were single infections,52 cases were double site infections,28 cases were triple site infections,and 16 cases were multiple(more than four sites)infections.The pathogen detection showed that 84 cases were bacterium infection(47.19%),36 cases were Tuberculosis bacilli infection(20.22%),30 cases were virus infection(16.85%,including 18 cases of cytomegalovirus infections and 12 cases of herpes simplex virus infections),77 cases were fungal infection(43.25%,including 35 cases of Candida infection,20 cases of Pneumocystisinfections,12 cases of Penicillium marneffyinfection,and 10 cases of Cryptococcus neoformans infection),and 34 cases(19.10%)were unidentified pathogen infections.Complex infections were common.Conclusion The level of CD_4~+T lymphocytes was closely related to the probability of secondary opportunistic infections in HIV infected patients.The monitoring on the CD_4~+T lymphocyte level in HIV infected patients has important clinical significance for the prevention of secondary opportunistic infections.
Objective To explore the correlation between opportunistic infection and CD_4~+T lymphocytes in patients with HIV infection or acquired immunodeficiency syndrome(AIDS)and provide reference for the prevention and treatment of opportunistic infections in HIV patients.Methods 400 HIV infected patients in our hospital from June 2016 to June 2017 were selected as the subjects.The incidences of opportunistic infections in HIV patients with different CD_4~+T lymphocyte counts were analyzed retrospectively.Results There were 178 cases of opportunistic infections in the 400 HIV patients;the overall infection rate was 44.5%.The incidence of opportunistic infections in the patients with CD_4~+T lymphocyte count≤50/μL was the highest,reaching up to 86.67%,significantly higher than the other groups(Ps<0.05).With the decrease of CD_4~+T lymphocyte count,the incidence of opportunistic infections in HIV patients increased.In the 178 cases of opportunistic infections,82 cases were single infections,52 cases were double site infections,28 cases were triple site infections,and 16 cases were multiple(more than four sites)infections.The pathogen detection showed that 84 cases were bacterium infection(47.19%),36 cases were Tuberculosis bacilli infection(20.22%),30 cases were virus infection(16.85%,including 18 cases of cytomegalovirus infections and 12 cases of herpes simplex virus infections),77 cases were fungal infection(43.25%,including 35 cases of Candida infection,20 cases of Pneumocystisinfections,12 cases of Penicillium marneffyinfection,and 10 cases of Cryptococcus neoformans infection),and 34 cases(19.10%)were unidentified pathogen infections.Complex infections were common.Conclusion The level of CD_4~+T lymphocytes was closely related to the probability of secondary opportunistic infections in HIV infected patients.The monitoring on the CD_4~+T lymphocyte level in HIV infected patients has important clinical significance for the prevention of secondary opportunistic infections.
引文
[1]LIU Pengtao,XING Hui,LIAO Lingjie,et al.Relationship between low viral load resistance and CD+4T lymphocyte count in HIV antiviral treatment[J].Chin J Prevent Med,2018,11(3):277-281.(in Chinese)刘鹏涛,邢辉,廖玲洁,等.HIV抗病毒治疗者低病毒载量耐药与CD+4T淋巴细胞计数水平间关系的研究[J].中华预防医学杂志,2018,11(3):277-281.
[2]ZHANG Zining,HU Siwen,XU Junjie,et al.Changes of CD+4,CD+25Foxp3+regulatory T lymphocytes in early HIV infection in China[J].Chin J Lab Med,2011,9(8):712-716.(in Chinese)张子宁,胡斯文,徐俊杰,等.中国HIV早期感染者CD+4CD+25Foxp3+调节性T淋巴细胞变化研究[J].中华检验医学杂志,2011,9(8):712-716.
[3]WU Xiaoying,XUN Yunhao,LYU Tiefeng,et al.Clinical analysis of 112cases of HIV/AIDS combined sputum smearnegative pulmonary tuberculosis[J].Chin J Exp&Clin Virol,2017,16(5):450-453.(in Chinese)吴晓瑛,荀运浩,吕铁峰,等.HIV/AIDS合并痰抗酸菌涂片阴性肺结核112例临床分析[J].中华实验和临床病毒学杂志,2017,16(5):450-453.
[4]ZHENG Jinlei,PAN Xiaohong,MA Qiaoqin,et al.Relationship between baseline CD4levels of HIV/AIDS in MSM population and antiviral treatment efficacy of HIV[J].J Prevent Med,2017,1(12):1189-1198.(in Chinese)郑锦雷,潘晓红,马瞧勤,等.MSM人群HIV/AIDS基线CD4水平与艾滋病抗病毒治疗效果的关系研究[J].预防医学,2017,1(12):1189-1198.
[5]Teeraananchai S,Bunupuradah T,Puthanakit T,et al.Firstline antiretroviral treatment outcomes and durability in HIV-infected children treated through the universal coverage health program in thailand[J].J Acquir Immune Deficien Syndr,2017,75(2):219-225.
[6]YU Qiuyan,WANG Fanglin,XU Peng,et al.Epidemic characteristics of non-commercial heterosexual transmission of noncommunicable HIV in Miao and Dong Autonomous Prefecture of Southeast Guizhou Province[J].Chin J Prevent Med,2017,5(11):977-981.(in Chinese)俞秋嫣,王方林,徐鹏,等.黔东南苗族侗族自治州HIV经非婚非商业异性性传播流行特征[J].中华预防医学杂志,2017,5(11):977-981.
[7]HUANG Lei,TU Bo,JIN Lei,et al.Study on the expression of CD160in HIV-specific T-lymphocytes and their subsets in HIV-infected asymptomatic patients[J].Chin J Exp&Clin Virol,2017,2(5):387-391.(in Chinese)黄磊,涂波,金磊,等.HIV感染无症状者外周血中HIV特异性T细胞及其亚群表达CD160情况的研究[J].中华实验和临床病毒学杂志,2017,2(5):387-391.
[8]RAO Heping,YAN Changzhong,JIN Xiangning,et al.Effects of different HAART regimens on liver function and HIV load in HIV-infected children with HCV[J].Chongqing Med J,2017,10(15):2045-2047.(in Chinese)饶和平,靳昌忠,金祥宁,等.不同HAART方案对HIV合并HCV感染患儿肝功能和HIV载量的影响[J].重庆医学,2017,10(15):2045-2047.
[9]Thobakgale C,Naidoo K,Mckinnon LR,et al.Interleukin 1-Beta(IL-1β)Production by innate cells following TLR stimulation correlates with TB recurrence in ART-treated HIV-infected patients[J].J Acquir Immune Deficien Syndr,2017,74(2):213-220.
[10]LI Yao,HU Siwen,JIANG Yongjun,et al.Study on the expression of B and T lymphocyte attenuation factors on regulatory T cells of HIV-infected patients[J].Chin J Immunol,2017,20(7):1053-1056.(in Chinese)栗瑶,胡斯文,姜拥军,等.HIV感染者调节性T细胞表面B、T淋巴细胞衰减因子的表达研究[J].中国免疫学杂志,2017,20(7):1053-1056.
[11]FU Xiangdong,LIU Shuiteng,LI Wenlang,et al.Study on the immune function of CD+4cells in patients with HIV-associated tuberculosis latent infection[J].J Clin Pulmon Med,2015,16(7):1212-1214.(in Chinese)傅向东,刘水腾,李文郎,等.HIV合并结核潜伏感染患者CD+4细胞免疫功能影响的研究[J].临床肺科杂志,2015,16(7):1212-1214.
[12]LIU Shuiteng,YANG Guilin,YAO Hongyan,et al.The role of CD+4CD+25 regulatory T cells in HIV/AIDS patients and its correlation with HIV viral load[J].Chin J Exp&Clin Virol,2006,21(4):364-366.(in Chinese)刘水腾,杨桂林,姚红艳,等.CD+4CD+25调节性T细胞在HIV/AIDS患者中的作用及其与HIV病毒载量的相关性研究[J].中华实验和临床病毒学杂志,2006,21(4):364-366.
[13]Kaufmann DE,Kavanagh DG,Pereyra F,et al.Upregulation of CTLA-4by HIV-specific CD+4T cells correlates with disease progression and defines a reversible immune dysfunction[J].Nat Immunol,2007,8(11):1246-1254.收稿日期修回日期本文编辑
[2]ZHANG Zining,HU Siwen,XU Junjie,et al.Changes of CD+4,CD+25Foxp3+regulatory T lymphocytes in early HIV infection in China[J].Chin J Lab Med,2011,9(8):712-716.(in Chinese)张子宁,胡斯文,徐俊杰,等.中国HIV早期感染者CD+4CD+25Foxp3+调节性T淋巴细胞变化研究[J].中华检验医学杂志,2011,9(8):712-716.
[3]WU Xiaoying,XUN Yunhao,LYU Tiefeng,et al.Clinical analysis of 112cases of HIV/AIDS combined sputum smearnegative pulmonary tuberculosis[J].Chin J Exp&Clin Virol,2017,16(5):450-453.(in Chinese)吴晓瑛,荀运浩,吕铁峰,等.HIV/AIDS合并痰抗酸菌涂片阴性肺结核112例临床分析[J].中华实验和临床病毒学杂志,2017,16(5):450-453.
[4]ZHENG Jinlei,PAN Xiaohong,MA Qiaoqin,et al.Relationship between baseline CD4levels of HIV/AIDS in MSM population and antiviral treatment efficacy of HIV[J].J Prevent Med,2017,1(12):1189-1198.(in Chinese)郑锦雷,潘晓红,马瞧勤,等.MSM人群HIV/AIDS基线CD4水平与艾滋病抗病毒治疗效果的关系研究[J].预防医学,2017,1(12):1189-1198.
[5]Teeraananchai S,Bunupuradah T,Puthanakit T,et al.Firstline antiretroviral treatment outcomes and durability in HIV-infected children treated through the universal coverage health program in thailand[J].J Acquir Immune Deficien Syndr,2017,75(2):219-225.
[6]YU Qiuyan,WANG Fanglin,XU Peng,et al.Epidemic characteristics of non-commercial heterosexual transmission of noncommunicable HIV in Miao and Dong Autonomous Prefecture of Southeast Guizhou Province[J].Chin J Prevent Med,2017,5(11):977-981.(in Chinese)俞秋嫣,王方林,徐鹏,等.黔东南苗族侗族自治州HIV经非婚非商业异性性传播流行特征[J].中华预防医学杂志,2017,5(11):977-981.
[7]HUANG Lei,TU Bo,JIN Lei,et al.Study on the expression of CD160in HIV-specific T-lymphocytes and their subsets in HIV-infected asymptomatic patients[J].Chin J Exp&Clin Virol,2017,2(5):387-391.(in Chinese)黄磊,涂波,金磊,等.HIV感染无症状者外周血中HIV特异性T细胞及其亚群表达CD160情况的研究[J].中华实验和临床病毒学杂志,2017,2(5):387-391.
[8]RAO Heping,YAN Changzhong,JIN Xiangning,et al.Effects of different HAART regimens on liver function and HIV load in HIV-infected children with HCV[J].Chongqing Med J,2017,10(15):2045-2047.(in Chinese)饶和平,靳昌忠,金祥宁,等.不同HAART方案对HIV合并HCV感染患儿肝功能和HIV载量的影响[J].重庆医学,2017,10(15):2045-2047.
[9]Thobakgale C,Naidoo K,Mckinnon LR,et al.Interleukin 1-Beta(IL-1β)Production by innate cells following TLR stimulation correlates with TB recurrence in ART-treated HIV-infected patients[J].J Acquir Immune Deficien Syndr,2017,74(2):213-220.
[10]LI Yao,HU Siwen,JIANG Yongjun,et al.Study on the expression of B and T lymphocyte attenuation factors on regulatory T cells of HIV-infected patients[J].Chin J Immunol,2017,20(7):1053-1056.(in Chinese)栗瑶,胡斯文,姜拥军,等.HIV感染者调节性T细胞表面B、T淋巴细胞衰减因子的表达研究[J].中国免疫学杂志,2017,20(7):1053-1056.
[11]FU Xiangdong,LIU Shuiteng,LI Wenlang,et al.Study on the immune function of CD+4cells in patients with HIV-associated tuberculosis latent infection[J].J Clin Pulmon Med,2015,16(7):1212-1214.(in Chinese)傅向东,刘水腾,李文郎,等.HIV合并结核潜伏感染患者CD+4细胞免疫功能影响的研究[J].临床肺科杂志,2015,16(7):1212-1214.
[12]LIU Shuiteng,YANG Guilin,YAO Hongyan,et al.The role of CD+4CD+25 regulatory T cells in HIV/AIDS patients and its correlation with HIV viral load[J].Chin J Exp&Clin Virol,2006,21(4):364-366.(in Chinese)刘水腾,杨桂林,姚红艳,等.CD+4CD+25调节性T细胞在HIV/AIDS患者中的作用及其与HIV病毒载量的相关性研究[J].中华实验和临床病毒学杂志,2006,21(4):364-366.
[13]Kaufmann DE,Kavanagh DG,Pereyra F,et al.Upregulation of CTLA-4by HIV-specific CD+4T cells correlates with disease progression and defines a reversible immune dysfunction[J].Nat Immunol,2007,8(11):1246-1254.收稿日期修回日期本文编辑