动态监测HIV患者CD4+T细胞的意义
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摘要
目的分析梧州地区新发现HIV患者的流行病特征,同时探讨动态监测新发现HIV患者CD4+T淋巴细胞的临床意义。方法选取2014年4月至2016年12月梧州市皮肤病防治院实验室送检的36例HIV感染患者作为研究对象。收集并分析其流行病资料,同时动态监测CD4+T淋巴细胞,根据连续4次监测后1个月是否出现机会性感染分为机会性感染组(n=8)及非机会性感染组(n=20)对比分析两组4次重复测量CD4+T细胞数量、△1、△2、△3、△1%、△2%、△3%,同时进行ROC曲线分析。结果新发现HIV感染者,仍以男性居多,年龄较以往呈现年轻化趋势,但仍以30<年龄≤60岁段居多,初中及以下的文化程度为主要人群,这类人群更多是无业或者务农为主。动态检测结果发现,机会性感染组在第3次及第4次测量的CD4+T细胞数量显著低于非机会性感染组,差异具有统计学意义(P<0.05)。机会性感染组的△1、△2、△3、△1%、△2%、△3%均显著高于非机会性感染组,差异均具有统计学意义(均P<0.05),ROC曲线分析结果△2、△3、△1%、△2%、△3%的ROC曲线面积较大,同时特异度和灵敏度均较高。结论应加强对文化程度偏低,无业或务农人员艾滋病相关知识的健康教育,同时,对新发现HIV感染者进行动态监测HIV感染患者CD4+T淋巴细胞数量改变情况,若有发现CD4+T淋巴细胞数量突然下降幅度较大,很有可能提示HIV感染者免疫功能受到破坏,有大概率会发生机会性感染,需积极干预治疗。
Objective To analyze the epidemiological characteristics of newly discovered HIV patients in Wuzhou, and to explore the clinical significance of dynamic monitoring of CD4 + T lymphocytes in newly discovered HIV patients. Methods A retrospective analysis of 36 laboratory-confirmed HIV infections from April 2014 to December 2016 was carried out. Epidemiological data were collected and analyzed. CD4 + T lymphocytes were monitored dynamically. According to whether opportunistic infections occurred a month after 4 consecutive surveillances, they were divided into opportunistic infections group(n=8) and non-opportunistic infections group(n=20). The number of CD4 + T cells, ROC curves were also analyzed. Results Of the 36 HIV patients, the majority was male at the age of 30 to 60 years old. In terms of educational level, the majority was junior high school and below, mostly unemployed and fame workers. The number of CD4 + T cells measured at the 3~(rd) and 4~(th) time in the opportunistic infections group was significantly lower than that in the non-opportunistic infections group, with statistically significant differences(P<0.05). The levels of △1,△2,△3,△1%,△2% and △3% in the opportunistic infections group was significantly higher than those in the non-opportunistic infections group, with statistically significant differences(all P<0.05). Areas under the ROC curve of △2,△3,△1%,△2% and △3% were larger in the opportunistic infections group with high specificity and sensitivity. Conclusions Health education on AIDS-related knowledge among low-educated, unemployed or farm workers should be strengthened, and the number of CD4+T lymphocytes in newly discovered HIV-infected patients should be dynamically monitored. If the number of CD4+T lymphocytes is found to drop sharply, it is likely that the immune function of HIV-infected people is damaged, with a great chance of opportunistic infection, so active intervention should be conducted.
Objective To analyze the epidemiological characteristics of newly discovered HIV patients in Wuzhou, and to explore the clinical significance of dynamic monitoring of CD4 + T lymphocytes in newly discovered HIV patients. Methods A retrospective analysis of 36 laboratory-confirmed HIV infections from April 2014 to December 2016 was carried out. Epidemiological data were collected and analyzed. CD4 + T lymphocytes were monitored dynamically. According to whether opportunistic infections occurred a month after 4 consecutive surveillances, they were divided into opportunistic infections group(n=8) and non-opportunistic infections group(n=20). The number of CD4 + T cells, ROC curves were also analyzed. Results Of the 36 HIV patients, the majority was male at the age of 30 to 60 years old. In terms of educational level, the majority was junior high school and below, mostly unemployed and fame workers. The number of CD4 + T cells measured at the 3~(rd) and 4~(th) time in the opportunistic infections group was significantly lower than that in the non-opportunistic infections group, with statistically significant differences(P<0.05). The levels of △1,△2,△3,△1%,△2% and △3% in the opportunistic infections group was significantly higher than those in the non-opportunistic infections group, with statistically significant differences(all P<0.05). Areas under the ROC curve of △2,△3,△1%,△2% and △3% were larger in the opportunistic infections group with high specificity and sensitivity. Conclusions Health education on AIDS-related knowledge among low-educated, unemployed or farm workers should be strengthened, and the number of CD4+T lymphocytes in newly discovered HIV-infected patients should be dynamically monitored. If the number of CD4+T lymphocytes is found to drop sharply, it is likely that the immune function of HIV-infected people is damaged, with a great chance of opportunistic infection, so active intervention should be conducted.
引文
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[15] 王印,李在村,代丽丽.HIV感染的诊断、治疗及预防[J].中国血液净化,2017,16(10):651-653,671.
[16] 罗文明,张硕,黄幼娜.罗定市2014年新发现HIV感染者首次CD_4～+T淋巴细胞检测情况分析[J].中国实用医药,2015,10(13):286-288.
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[19] 彭庭海,詹发先,褚小刚,等.湖北省健康青少年及成人外周血T淋巴细胞正常值研究[J].中国艾滋病性病,2007(5):414-416.
[2] 中国疾病预防控制中心.2016年第3季度全国艾滋病性病疫情[J].中国艾滋病性病,2016(11):849-849.
[3] Qian S,Guo W,Xing J,et al.Diversity of HIV/AIDS epidemic in China:A result from hierarchical clustering analysis and spatial autocorrelation analysis[J].AIDS,2014,28 (12):1805-1813.
[4] 王学燕,张振开,韦兴强,等.广西两市2014—2015年新发现HIV/AIDS病例的流行病学研究[J].中国热带医学,2018,18(4):365-369.
[5] 刘佼.山西省HIV/AIDS感染与流行状况调查及不同人群T淋巴细胞亚群的研究[D].太原:山西医科大学,2010.
[6] 贺智英,刘亚东,田红英.HIV、HBV共感染患者HIV病毒载量与HBV病毒载量及细胞免疫功能的相关性[J].标记免疫分析与临床,2015,22(9):876-878.
[7] 白一春,李骁,夏仁兴.司他夫定联合拉米夫定与奈韦拉平抗病毒方案治疗对艾滋病患者免疫功能的影响及其安全性分析[J].临床和实验医学杂志,2018,17(1):63-67.
[8] 李山,沈德才,李若林,等.两种筛查HIV(1+2)抗体试验的性能比较[J].标记免疫分析与临床,2009,16(2):123-124.
[9] 国杰,张婷,桂萍,等.北京某医院2012～2016年无偿献血者血液感染性指标检测结果分析[J].标记免疫分析与临床,2017,24(9):964-966,981.
[10] 齐伟亮,刘杰.2450例患者输血前感染性指标检测结果分析[J].标记免疫分析与临床,2017,24(8):852-855.
[11] 康银花,顾觉奋.基于跨膜蛋白gp41为作用靶点的抗HIV-1药物研究进展[J].抗感染药学,2018(7):1105-1111.
[12] 王学顺.新型多酚类HIV-1 RNase H抑制剂的设计、合成与活性评价[D].济南:山东大学,2018.
[13] 林兆森,王卫军.HIV-1耐药性相关研究进展[J].微生物学免疫学进展,2018,46(4):76-80.
[14] 李敬云.HIV耐药的现状趋势与应对[J].中国艾滋病性病,2018,24(6):635-638,642.
[15] 王印,李在村,代丽丽.HIV感染的诊断、治疗及预防[J].中国血液净化,2017,16(10):651-653,671.
[16] 罗文明,张硕,黄幼娜.罗定市2014年新发现HIV感染者首次CD_4～+T淋巴细胞检测情况分析[J].中国实用医药,2015,10(13):286-288.
[17] 楚承霞,徐艳声,李婕,等.昆明市2011年新发现HIV感染者首次CD4～+T淋巴细胞检测情况分析[J].实用预防医学,2013,20(6):705-707.
[18] 谢静,李太生.HIV感染的CD4～+T淋巴细胞损伤机制[J].中国病毒病杂志,2011,1(3):167-170.
[19] 彭庭海,詹发先,褚小刚,等.湖北省健康青少年及成人外周血T淋巴细胞正常值研究[J].中国艾滋病性病,2007(5):414-416.