HIV/AIDS-TB患者抗结核药物治疗强化期红细胞系的变化
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摘要
目的分析接受抗逆转录病毒治疗(ART)及不同ART方案联合抗结核药物治疗的人类免疫缺陷病毒/艾滋病合并结核分枝杆菌感染(HIV/AIDS-TB)患者在强化期内血液学红细胞系的变化情况。方法选取2014—2017年某传染病专科医院确诊为HIV/AIDS-TB的患者,分为在ART基础上接受抗结核药物联合治疗组(A组),抗结核药物治疗8周内开始ART联合治疗组(B组),抗结核药物治疗8周后开始ART治疗组(C组);检测并比较治疗前基线(0周)和治疗后1、2、4、8周等红细胞系参数红细胞(RBC)、血红蛋白(HGB)、红细胞平均体积(MCV)和红细胞分布宽度(RDW-CV)变化的差异。结果共选取180例HIV/AIDS-TB患者,其中A组71例、B组75例、C组34例;共85.00%(153例)的患者发生轻度贫血,其中A、B、C组分别为84.51%(60/71)、85.33%(64/75)和85.29%(29/34)。抗结核药物治疗后,A、B和C组患者RBC绝对值增减差异均无统计学意义(均P>0.05);治疗4周后,B组患者HGB增加均高于基线(均P<0.05);A、B和C组患者MCV和RDW-CV在治疗后均较基线上升(均P<0.05),但C组治疗8周时RDW-CV恢复至基线水平。A、B两组患者中TDF/3TC/EFV方案在联合抗结核药物治疗4周时,HGB均较基线增高(均P<0.05),其他方案均无统计学意义(均P>0.05)。结论HIV/AIDS-TB患者在抗结核药物治疗后应尽快启动ART治疗,最好8周内开始ART治疗,不同ART方案联合抗结核治疗患者的红细胞系参数变化有差异,TDF治疗方案效果较为理想。
Objective To analyze changes in hematological erythrocyte lineage in patients with HIV/AIDS and Mycobacterium tuberculosis infection(HIV/AIDS-TB)during intensive period of antiretroviral therapy(ART)and different ART regimens combined with anti-tuberculosis drugs.Methods Patients who were confirmed with HIV/AIDS-TB in an infectious disease hospital from2014 to 2017 were selected and divided into three groups:group A received combination therapy of anti-tuberculosis drugs on the basis of ART,group B started ART within 8 weeks of anti-tuberculosis drug therapy,group C started ART after 8 weeks of anti-tuberculosis drug therapy;changes in parameters of erythrocyte lineage,such as red blood cell(RBC),hemoglobin(HGB),mean corpuscular volume(MCV),and RBC distribution width(RDW-CV)before therapy(baseline,at 0 week)and1,2,4,and8 weeks after therapy were detected and compared.Results A total of 180 patients with HIV/AIDS-TB were enrolled,group A,B,and C were 71,75,and34 cases respectively;85.00%(n=153)of patients developed mild anemia,84.51%(60/71),85.33%(64/75),and 85.29%(29/34)were in group A,B,and C respectively.After anti-tuberculosis drug therapy,changes in absolute value of RBC in group A,B,and C had no significant difference(all P>0.05);after 4 weeks of therapy,increase of HGB in patients in group B was higher than baseline(P<0.05);MCV and RDW-CV in group A,B,and C after therapy were all higher than baseline(all P<0.05),but RDW-CV in group C recovered to baseline level at 8 weeks of therapy.HGB of group A and B at 4 weeks of TDF/3 TC/EFV regimen combined anti-tuberculosis drug therapy were both higher than that of baseline(both P<0.05),but there was no significant difference in other regimens(all P>0.05).Conclusion Patients with HIV/AIDS-TB should start ART as soon as possible after anti-tuberculosis drug therapy,preferably within 8 weeks,changes in erythrocyte parameters in patients treated with different ART regimens combined with anti-tuberculosis therapy are different,effect of TDF therapy is ideal.
Objective To analyze changes in hematological erythrocyte lineage in patients with HIV/AIDS and Mycobacterium tuberculosis infection(HIV/AIDS-TB)during intensive period of antiretroviral therapy(ART)and different ART regimens combined with anti-tuberculosis drugs.Methods Patients who were confirmed with HIV/AIDS-TB in an infectious disease hospital from2014 to 2017 were selected and divided into three groups:group A received combination therapy of anti-tuberculosis drugs on the basis of ART,group B started ART within 8 weeks of anti-tuberculosis drug therapy,group C started ART after 8 weeks of anti-tuberculosis drug therapy;changes in parameters of erythrocyte lineage,such as red blood cell(RBC),hemoglobin(HGB),mean corpuscular volume(MCV),and RBC distribution width(RDW-CV)before therapy(baseline,at 0 week)and1,2,4,and8 weeks after therapy were detected and compared.Results A total of 180 patients with HIV/AIDS-TB were enrolled,group A,B,and C were 71,75,and34 cases respectively;85.00%(n=153)of patients developed mild anemia,84.51%(60/71),85.33%(64/75),and 85.29%(29/34)were in group A,B,and C respectively.After anti-tuberculosis drug therapy,changes in absolute value of RBC in group A,B,and C had no significant difference(all P>0.05);after 4 weeks of therapy,increase of HGB in patients in group B was higher than baseline(P<0.05);MCV and RDW-CV in group A,B,and C after therapy were all higher than baseline(all P<0.05),but RDW-CV in group C recovered to baseline level at 8 weeks of therapy.HGB of group A and B at 4 weeks of TDF/3 TC/EFV regimen combined anti-tuberculosis drug therapy were both higher than that of baseline(both P<0.05),but there was no significant difference in other regimens(all P>0.05).Conclusion Patients with HIV/AIDS-TB should start ART as soon as possible after anti-tuberculosis drug therapy,preferably within 8 weeks,changes in erythrocyte parameters in patients treated with different ART regimens combined with anti-tuberculosis therapy are different,effect of TDF therapy is ideal.
引文
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[8]Deressa T,Damtie D,Workineh M,et al.Anemia and thrombocytopenia in the cohort of HIV-infected adults in northwest Ethiopia:a facility-based cross-sectional study[J].EJIFCC,2018,29(1):36-47.
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[12]中国疾病预防控制中心性病艾滋病预防控制中心.国家免费艾滋病抗病毒药物治疗手册[M].4版.北京:人民卫生出版社,2016:64-65.
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[15]韩丹,潘建玲,储文功,等.上海市872例抗病毒药物治疗艾滋病患者的不良反应分析[J].中国医院药学杂志,2015,35(22):2038-2041.
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[17]王倩,陈津红,韩琴,等.441例抗结核药引起血液系统不良反应文献分析[J].中国药房,2008,19(5):376-377.
[18]朱敏,刘亚东,赵茜,等.警惕抗结核药物引起血液系统的异常[J].中国防痨杂志,2004,26(6):338-340.
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[20]中华医学会结核病学分会.肺结核诊断和治疗指南[J].中华结核和呼吸杂志,2001,24(2):70-74.
[21]沈银忠.艾滋病合并结核病患者的抗结核治疗[J].上海医药,2009,30(1):8-11.
[22]王承,吴鹏,王学文.人免疫缺陷病毒感染的血液学特征[J].医学研究生学报,2000,13(5):331-334.
[23]Steele RH,Keogh GL,Quin J,et al.Mean cell volume(MCV)changes in HIV-positive patients taking nucleoside reverse transcriptase inhibitors(NRTIs):a surrogate marker for adherence[J].Int J STD AIDS,2002,13(11):748-754.
[24]Owiredu WK,Quaye L,Amidu N,et al.Prevalence of anaemia and immunological markers among ghanaian HAART-na6ve HIV-patients and those on HAART[J].Afr Health Sci,2011,11(1):2-15.
[25]Armitage AE,Moran E.HIV-associated tuberculosis:does the iron-regulatory hormone hepcidin connect anemia with poor prognosis?[J].J Infect Dis,2016,213(1):3-5.
[26]王一淳.MCV和RDW在贫血疾病诊断与鉴别中的应用探析[J].临床检验杂志(电子版),2018,7(1):9-10.
[27]Morris CD,Bird AR,Nell H.The haematological and biochemical changes in severe pulmonary tuberculosis[J].Q JMed,1989,73(272):1151-1159.
[28]胡晓战,弓显凤,杨卫民.抗结核药物导致巨幼红细胞性贫血2例[J].中国防痨杂志,2002,24(1):58.
[29]Abed M,Towhid ST,Shaik N,et al.Stimulation of suicidal death of erythrocytes by rifampicin[J].Toxicology,2012,302(2-3):123-128.
[30]吴念宁,黄绍标,陈万,等.艾滋病合并结核病患者抗结核治疗中肝损伤情况调查[J].临床肺科杂志,2012,17(3):461-462.
[31]陈悦,李慕军,曾雅畅.抗逆转录病毒药物暴露对子代造血及免疫系统和生长发育的潜在影响[J].中国医药科学,2014,4(7):31-34.
[32]王晗,赵丽丽,耿伟,等.人类免疫缺陷病毒阳性患者经高效抗逆转录病毒治疗血液学指标变化[J].解放军医学院学报,2015,36(8):786-788,793.
[33]陈隽,杨瑜浩,董德琼.肺结核继发血液学3系异常86例临床分析[J].实用临床医药杂志,2012,16(17):138-140.
[34]Kutiyal AS,Gupta N,Garg S,et al.A study of haematological and haemostasis parameters and hypercoagulable state in tuberculosis patients in northern India and the outcome with anti-tubercular therapy[J].J Clin Diagn Res,2017,11(2):OC09-OC13.
[35]Eyuel K,Bamlaku E,Aschalew G,et al.Effect of anti-tuberculosis drugs on hematological profiles of tuberculosis patients attending at University of Gondar Hospital,Northwest Ethiopia[J].BMC Hematol,2016,16:1.
[36]Tang LL,Jin CZ,Wu LJ,et al.The impact of highly active antiretroviral treatment on the blood profiles of patients with acquired immune deficiency syndrome[J].J Int Med Res,2011,39(4):1520-1528.
[37]Melese H,Wassie MM,Woldie H,et al.Anemia among adult HIV patients in Ethiopia:a hospital-based cross-sectional study[J].HIV AIDS(Auckl),2017,9:25-30.
[38]Zemenu T,Jemal A,Aster T.Anemia among HIV infected individuals taking art with and without zidovudine at Addis Ababa,Ethiopia[J].Ethiop J Health Sci,2018,28(1):73-82.
[39]Chow FP,Hamburger AW.In vivo evaluation of the anemia induced by azidothymidine(AZT)in a murine model of AIDS[J].Eur J Haematol,1991,47(2):91-97.
[40]Falguera M,Perez-Mur J,Puig T,et al.Study of the role of vitamin B12 and folinic acid supplementation in preventing hematologic toxicity of zidovudine[J].Eur J Haematol,2010,55(2):97-102.
[41]向信春,丁芳,李佳豫.8例艾滋病患者进行依非韦伦、拉米夫定和替诺福韦治疗的生化指标分析[J].中国医药指南,2015,13(12):157-158.
[2]Nagu TJ,Aboud S,Mwiru R,et al.Tuberculosis associated mortality in a prospective cohort in Sub Saharan Africa:Association with HIV and antiretroviral therapy[J].Int J Infect Dis,2017,56:39-44.
[3]周林,陈磊,赖钰基,等.TB/HIV双重感染患者抗结核治疗药物不良反应分析[J].中国防痨杂志,2011,33(2):77-81.
[4]Lawn SD,Wood R.Incidence of tuberculosis during highly active antiretroviral therapy in high-income and low-income countries[J].Clin Infect Dis,2005,41(12):1783-1786.
[5]Karo B,Haas W,Kollan C,et al.Tuberculosis among people living with HIV/AIDS in the German ClinSurv HIV Cohort:long-term incidence and risk factors[J].BMC Infect Dis,2014,14:148.
[6]Yuan YH,Zhao SS,Wang XL,et al.HIV-1 p55-gag protein induces senescence of human bone marrow mesenchymal stem cells and reduces their capacity to support expansion of hematopoietic stem cells in vitro[J].Cell Biol Int,2017,41(9):969-981.
[7]Brastianos PK,Swanson JW,Torbenson M,et al.Tuberculosis-associated haemophagocytic syndrome[J].Lancet Infect Dis,2006,6(7):447-454.
[8]Deressa T,Damtie D,Workineh M,et al.Anemia and thrombocytopenia in the cohort of HIV-infected adults in northwest Ethiopia:a facility-based cross-sectional study[J].EJIFCC,2018,29(1):36-47.
[9]邓岚兰,杨新婷,贾俊楠,等.2012-2016年北京市胸科医院肺结核合并症患者的回顾性分析[J].疾病监测,2018,33(4):320-323.
[10]Hella J,Cercamondi CI,Mhimbira F,et al.Anemia in tuberculosis cases and household controls from Tanzania:Contribution of disease,coinfections,and the role of hepcidin[J].PLoS One,2018,13(4):e0195985.
[11]Dai G,Xiao J,Gao G,et al.Anemia in combined antiretroviral treatment-naive HIV-infected patients in China:A retrospective study of prevalence,risk factors,and mortality[J].Biosci Trends,2016,10(6):445-453.
[12]中国疾病预防控制中心性病艾滋病预防控制中心.国家免费艾滋病抗病毒药物治疗手册[M].4版.北京:人民卫生出版社,2016:64-65.
[13]Takuva S,Maskew M,Brennan AT,et al.Anemia among HIV-Infected patients initiating antiretroviral therapy in South Africa:improvement in hemoglobin regardless of degree of immunosuppression and the initiating ART regimen[J].J Trop Med,2013:162950.
[14]Woldeamanuel GG,Wondimu DH.Prevalence of anemia before and after initiation of antiretroviral therapy among HIVinfected patients at Black Lion Specialized Hospital,Addis Ababa,Ethiopia:a cross sectional study[J].BMC Hematol,2018,18:7.
[15]韩丹,潘建玲,储文功,等.上海市872例抗病毒药物治疗艾滋病患者的不良反应分析[J].中国医院药学杂志,2015,35(22):2038-2041.
[16]Woodward CL,Hall AM,Williams IG,et al.Tenofovir-associated renal and bone toxicity[J].HIV Med,2010,10(8):482-487.
[17]王倩,陈津红,韩琴,等.441例抗结核药引起血液系统不良反应文献分析[J].中国药房,2008,19(5):376-377.
[18]朱敏,刘亚东,赵茜,等.警惕抗结核药物引起血液系统的异常[J].中国防痨杂志,2004,26(6):338-340.
[19]Jam S,Ramezani A,Sabzvari D,et al.A cross-sectional study of anemia in human immunodeficiency virus-infected patients in Iran[J].Arch Iran Med,2009,12(2):145-150.
[20]中华医学会结核病学分会.肺结核诊断和治疗指南[J].中华结核和呼吸杂志,2001,24(2):70-74.
[21]沈银忠.艾滋病合并结核病患者的抗结核治疗[J].上海医药,2009,30(1):8-11.
[22]王承,吴鹏,王学文.人免疫缺陷病毒感染的血液学特征[J].医学研究生学报,2000,13(5):331-334.
[23]Steele RH,Keogh GL,Quin J,et al.Mean cell volume(MCV)changes in HIV-positive patients taking nucleoside reverse transcriptase inhibitors(NRTIs):a surrogate marker for adherence[J].Int J STD AIDS,2002,13(11):748-754.
[24]Owiredu WK,Quaye L,Amidu N,et al.Prevalence of anaemia and immunological markers among ghanaian HAART-na6ve HIV-patients and those on HAART[J].Afr Health Sci,2011,11(1):2-15.
[25]Armitage AE,Moran E.HIV-associated tuberculosis:does the iron-regulatory hormone hepcidin connect anemia with poor prognosis?[J].J Infect Dis,2016,213(1):3-5.
[26]王一淳.MCV和RDW在贫血疾病诊断与鉴别中的应用探析[J].临床检验杂志(电子版),2018,7(1):9-10.
[27]Morris CD,Bird AR,Nell H.The haematological and biochemical changes in severe pulmonary tuberculosis[J].Q JMed,1989,73(272):1151-1159.
[28]胡晓战,弓显凤,杨卫民.抗结核药物导致巨幼红细胞性贫血2例[J].中国防痨杂志,2002,24(1):58.
[29]Abed M,Towhid ST,Shaik N,et al.Stimulation of suicidal death of erythrocytes by rifampicin[J].Toxicology,2012,302(2-3):123-128.
[30]吴念宁,黄绍标,陈万,等.艾滋病合并结核病患者抗结核治疗中肝损伤情况调查[J].临床肺科杂志,2012,17(3):461-462.
[31]陈悦,李慕军,曾雅畅.抗逆转录病毒药物暴露对子代造血及免疫系统和生长发育的潜在影响[J].中国医药科学,2014,4(7):31-34.
[32]王晗,赵丽丽,耿伟,等.人类免疫缺陷病毒阳性患者经高效抗逆转录病毒治疗血液学指标变化[J].解放军医学院学报,2015,36(8):786-788,793.
[33]陈隽,杨瑜浩,董德琼.肺结核继发血液学3系异常86例临床分析[J].实用临床医药杂志,2012,16(17):138-140.
[34]Kutiyal AS,Gupta N,Garg S,et al.A study of haematological and haemostasis parameters and hypercoagulable state in tuberculosis patients in northern India and the outcome with anti-tubercular therapy[J].J Clin Diagn Res,2017,11(2):OC09-OC13.
[35]Eyuel K,Bamlaku E,Aschalew G,et al.Effect of anti-tuberculosis drugs on hematological profiles of tuberculosis patients attending at University of Gondar Hospital,Northwest Ethiopia[J].BMC Hematol,2016,16:1.
[36]Tang LL,Jin CZ,Wu LJ,et al.The impact of highly active antiretroviral treatment on the blood profiles of patients with acquired immune deficiency syndrome[J].J Int Med Res,2011,39(4):1520-1528.
[37]Melese H,Wassie MM,Woldie H,et al.Anemia among adult HIV patients in Ethiopia:a hospital-based cross-sectional study[J].HIV AIDS(Auckl),2017,9:25-30.
[38]Zemenu T,Jemal A,Aster T.Anemia among HIV infected individuals taking art with and without zidovudine at Addis Ababa,Ethiopia[J].Ethiop J Health Sci,2018,28(1):73-82.
[39]Chow FP,Hamburger AW.In vivo evaluation of the anemia induced by azidothymidine(AZT)in a murine model of AIDS[J].Eur J Haematol,1991,47(2):91-97.
[40]Falguera M,Perez-Mur J,Puig T,et al.Study of the role of vitamin B12 and folinic acid supplementation in preventing hematologic toxicity of zidovudine[J].Eur J Haematol,2010,55(2):97-102.
[41]向信春,丁芳,李佳豫.8例艾滋病患者进行依非韦伦、拉米夫定和替诺福韦治疗的生化指标分析[J].中国医药指南,2015,13(12):157-158.