南方地区低CD4~+T淋巴细胞艾滋病病人筛查马尔尼菲蓝状菌抗原和隐球菌荚膜抗原的临床意义
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摘要
目的探讨我国南方地区低CD4~+T淋巴细胞(简称CD4细胞)艾滋病病人接受高效抗反转录病毒治疗(HAART)前筛查马尔尼菲蓝状菌抗原和隐球菌荚膜抗原(CrAg)的临床意义。方法以广州市第八人民医院236例艾滋病病毒1型阳性且CD4细胞<100个/μL的初诊病人为研究对象,检测其外周血马尔尼菲蓝状菌特异性甘露糖蛋白(Mp1p)和半乳甘露聚糖(GM)及CrAg,分析这些检测抗原的临床意义。结果 236例病人,男194例,女42例,平均年龄(41.21±13.13)岁,CD4细胞计数均<100个/μL,中位数24个/μL。检测Mp1p阳性者46例(19.49%),GM阳性38例(16.10%),CrAg阳性8例(3.39%)。CD4细胞计数<50个/μL组与≥50个/μL组比较,有临床症状组与无症状组比较,其外周血Mp1p和GM抗原阳性率更高(P均<0.05),但CrAg抗原检出率无明显差异(P均≥0.05)。共44例Mp1p阳性、38例GM阳性及8例CrAg阳性病人接受病原检测,分别97.73%(43/44)、78.95%(30/38)发现马尔尼菲蓝状菌,62.50%(5/8)发现新型隐球菌。共131例Mp1p阴性、137例GM阴性及167例CrAg阴性病人接受病原检测,分别4.58%(6/131)与13.87%(19/137)发现马尔尼菲蓝状菌,无一例发现新型隐球菌。Mp1p阳性组和CrAg阳性组1年时的死亡率明显高于阴性组(P均<0.05),但外周血GM阳性组和阴性组12周及1年时的死亡率无明显差异(P均≥0.05)。结论我国南方低CD4细胞艾滋病病人接受HAART前筛查马尔尼菲蓝状菌抗原和CrAg,有助于早期诊断和治疗,降低死亡率。
Objective To explore the clinical significance of screening serum talaromyces marneffei(T.marneffei)antigen and cryptococcus neoformans capsule antigen in AIDS patients with low CD4+T cell count in southern China.Methods 236 HIV-1infected HAART-naive patients with CD4<100cells/μL were recruited as study subjects from Guangzhou eighth people's hospital to assay the serum mannoprotein(Mp1p)and galactomannan(GM)of T.marneffei,along with cryptococcal antigen(CrAg).Results 236 patients included 194 males and42females,with average age of(41.21±13.13)and low CD4count<100cell/μL(median 24cells/μL).The number of patients with positive Mp1 p,GM or CrAg were 46(19.49%),38(16.10%)or 8(3.08%)separately.The positive rates of Mp1 p and GM were higher in patients with CD4count<50cells/μL than those with CD4count≥50cells/μL(P<0.05).However,the positive rates of CrAg were not statistically different between the two groups(P≥0.05).The positive rates of Mp1 p and GM were also higher in symptomatic patients than asymptomatic patients(P<0.05).But the positive rates of CrAg were not significantly different between the two groups(P ≥0.05).Totally,97.72%(43/44)patients with positive Mp1 p,78.95%(30/38)patients with positive GM,and62.5%(5/8)patients with positive CrAg were confirmed T.marneffei or Cryptococcus neoformans infection by pathogen detection.Meanwhile,4.58%(6/131)patients with negative Mp1 p and 13.87%(19/137)patients,with negative GM were found T.marneffei infection by pathogen detection,but no cryptococcus neoformans were detected in cases with negative CrAg.Furthermore,the mortality of cases with positive Mp1 p or CrAg was obviously higher than those with negative Mp1 p or CrAg in one year follow-up(P<0.05),but no significant difference of the mortality were shown between cases with positive GM and those with negative GM at the 12 th week and one year follow-up(P≥0.05).Conclusion In southern China,screening serum T.marneffei and CrAg for AIDS patients with low CD4 cell count before highly active antiretroviral therapy(HAART)will benefit for early diagnosis and treatment,and reduction of the mortality.
Objective To explore the clinical significance of screening serum talaromyces marneffei(T.marneffei)antigen and cryptococcus neoformans capsule antigen in AIDS patients with low CD4+T cell count in southern China.Methods 236 HIV-1infected HAART-naive patients with CD4<100cells/μL were recruited as study subjects from Guangzhou eighth people's hospital to assay the serum mannoprotein(Mp1p)and galactomannan(GM)of T.marneffei,along with cryptococcal antigen(CrAg).Results 236 patients included 194 males and42females,with average age of(41.21±13.13)and low CD4count<100cell/μL(median 24cells/μL).The number of patients with positive Mp1 p,GM or CrAg were 46(19.49%),38(16.10%)or 8(3.08%)separately.The positive rates of Mp1 p and GM were higher in patients with CD4count<50cells/μL than those with CD4count≥50cells/μL(P<0.05).However,the positive rates of CrAg were not statistically different between the two groups(P≥0.05).The positive rates of Mp1 p and GM were also higher in symptomatic patients than asymptomatic patients(P<0.05).But the positive rates of CrAg were not significantly different between the two groups(P ≥0.05).Totally,97.72%(43/44)patients with positive Mp1 p,78.95%(30/38)patients with positive GM,and62.5%(5/8)patients with positive CrAg were confirmed T.marneffei or Cryptococcus neoformans infection by pathogen detection.Meanwhile,4.58%(6/131)patients with negative Mp1 p and 13.87%(19/137)patients,with negative GM were found T.marneffei infection by pathogen detection,but no cryptococcus neoformans were detected in cases with negative CrAg.Furthermore,the mortality of cases with positive Mp1 p or CrAg was obviously higher than those with negative Mp1 p or CrAg in one year follow-up(P<0.05),but no significant difference of the mortality were shown between cases with positive GM and those with negative GM at the 12 th week and one year follow-up(P≥0.05).Conclusion In southern China,screening serum T.marneffei and CrAg for AIDS patients with low CD4 cell count before highly active antiretroviral therapy(HAART)will benefit for early diagnosis and treatment,and reduction of the mortality.
引文
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[13]Wang YF,Xu HF,Han ZG,et al.Serological surveillance for penicillium marneffei infection in HIV-infected patients during2004-2011in Guangzhou,China[J].Clin Microbiol Infect,2015,1(5):484-489.
[14]Huang YT,Hung CC,Hsueh PR.Aspergillus galactomannan antigenemia in penicilliosis marneffei[J].AIDS,2007,21(14):1990-1991.
[15]何凯茵,冯理智,梁志伟,等.血清半乳甘露聚糖试验在诊断艾滋病合并马尔尼菲青霉菌病中的价值探讨[J].广州医科大学学报,2016,44(3):21-24.
[16]Longley N,Jarvis JN,Meintjes G,et al.Cryptococcal Antigen Screening in Patients Initiating ART in South Africa:A Prospective Cohort Study[J].Clin Infect Dis,2016,62(5):581-587.
[2]李凌华,唐小平,蔡卫平.101例艾滋病合并马尔尼菲青霉病的临床研究[J].中国艾滋病性病,2008,14(1):12-14.
[3]Limper AH,Adenis A,Le T,et al.Fungal infections in HIV/AIDS[J].Lancet Infect Dis,2017,17(11):e334-e343.
[4]Jarvis JN,Govender N,Chiller T,et al.Cryptococcal antigen screening and preemptive therapy in patients initiating antiretroviral therapy in resource-limited settings:aproposed algorithm for clinical implementation[J].J Int Assoc Physicians AIDS Care(Chic),2012,11(6):374-379.
[5]Temfack E,Kouanfack C,Mossiang L,et al.Cryptococcal Antigen Screening in Asymptomatic HIV-Infected Antiretroviral Na6ve Patients in Cameroon and Evaluation of the New Semi-Quantitative Biosynex CryptoPS Test[J].Front Microbiol,2018(9):409.
[6]Beyene T,Zewde AG,Balcha A,et al.I nadequacy of High-Dose Fluconazole Monotherapy Among Cerebrospinal Fluid CryptococcalAntigen(CrAg)-Positive Human Immunodeficiency Virus-Infected Persons in an Ethiopian CrAgScreening Program[J].Clin Infect Dis,2017,65(12):2126-2129.
[7]WHO.Rapid advice:Diagnosis,prevention and management of cryptococcal disease in HIV-infected adults,adolescents and children[R].Geneva:World Health Organization,2011.
[8]黄丽芬,唐小平,蔡卫平,等.广东地区762例住院人类免疫缺陷病毒感染病人机会性感染分析[J].中华内科杂志,2010,49(8):653-656.
[9]中华医学会感染病学分会艾滋病学组.艾滋病诊疗指南(2015版)[J].中华传染病杂志,2015,8(5):385-401.
[10]Centers for Disease Control and Prevention.1993revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults[J].MMWR Recomm Rep,1992,41(RR-17):1-19.
[11]中国疾病预防控制中心性病艾滋病预防控制中心性病控制中心.2017年第3季度全国艾滋病性病疫情[J].中国艾滋病性病,2017,23(11):981.
[12]毛立超,张志坤,魏学前,等.唐山市HIV/AIDS病人抗病毒治疗1年后CD4+T淋巴细胞计数变化情况[J].中国艾滋病性病,2017,23(10):969-970.
[13]Wang YF,Xu HF,Han ZG,et al.Serological surveillance for penicillium marneffei infection in HIV-infected patients during2004-2011in Guangzhou,China[J].Clin Microbiol Infect,2015,1(5):484-489.
[14]Huang YT,Hung CC,Hsueh PR.Aspergillus galactomannan antigenemia in penicilliosis marneffei[J].AIDS,2007,21(14):1990-1991.
[15]何凯茵,冯理智,梁志伟,等.血清半乳甘露聚糖试验在诊断艾滋病合并马尔尼菲青霉菌病中的价值探讨[J].广州医科大学学报,2016,44(3):21-24.
[16]Longley N,Jarvis JN,Meintjes G,et al.Cryptococcal Antigen Screening in Patients Initiating ART in South Africa:A Prospective Cohort Study[J].Clin Infect Dis,2016,62(5):581-587.