AIDS病人脑脊液与血液HIVRNA病毒载量相关性及影响因素
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摘要
目的研究分析艾滋病病人脑脊液与血液艾滋病病毒(HIV)核糖核酸(RNA)病毒载量的相关性及影响因素。方法对68例艾滋病病人脑脊液及血液中HIV RNA病毒载量检测结果以及相关影响因素进行回顾性分析。结果 68例病人中,脑脊液HIV RNA病毒载量Log值高于或等于血液HIV RNA病毒载量Log值的20例(29.4%),低于血液HIV RNA病毒载量Log值的,或与血液HIV RNA病毒载量均低于检测下限的48例(70.6%)。单因素Logistic回归分析结果显示,中枢神经系统感染、脑脊液压力、脑脊液蛋白水平是脑脊液高HIV RNA病毒载量的危险因素,脑脊液葡萄糖是脑脊液高HIV RNA病毒载量的保护因素。多因素Logistic回归分析结果显示,脑脊液葡萄糖具有统计学意义[P=0.019,比值比(OR)=0.455],是脑脊液高HIV RNA病毒载量的保护因素,在其他因素不变的情况下,脑脊液葡萄糖浓度升高1个单位(mmol/L),病人脑脊液HIV RNA病毒载量Log值不低于血HIV RNA病毒载量Log值的风险下降为原来的0.455倍。结论脑脊液葡萄糖是脑脊液高HIV RNA病毒载量的保护因素。
Objective To study the correlation and influence factors of AIDS cerebrospinal fluid(CSF)and blood HIVRNA viral load of AIDS patients.Methods A retrospective study was made based on the HIVRNA viral load test results and related influence factors in CSF and blood of the 68 HIV/AIDS.Results All of the cases showed that their cerebrospinal fluid HIVRNA viral load were higher than or equal to the blood HIVRNA viral load(20 cases,29.4%),and lower than blood HIVRNA viral load or with blood HIVRNA viral load both lower than the detection limit(48 cases,70.6%).The univariate logistic regression analysis indicated that the central nervous system infection,CSF pressure,CSF protein levels were risk factors and CSF glucose was protection factor for high HIVRNA viral load in CSF.Multivariate logistic regression analysis showed that CSF glucose was statistically significant(P=0.019,OR=0.455).In case of other factors unchanged,CSF glucose concentration increased by one unit(mmol/L),cerebrospinal fluid HIVRNA viral load was not less than the blood HIVRNA viral load in a decreased risk for the original 0.455 times.Conclusion CSF glucose is the protection factor for high HIVRNA viral load in CSF.
Objective To study the correlation and influence factors of AIDS cerebrospinal fluid(CSF)and blood HIVRNA viral load of AIDS patients.Methods A retrospective study was made based on the HIVRNA viral load test results and related influence factors in CSF and blood of the 68 HIV/AIDS.Results All of the cases showed that their cerebrospinal fluid HIVRNA viral load were higher than or equal to the blood HIVRNA viral load(20 cases,29.4%),and lower than blood HIVRNA viral load or with blood HIVRNA viral load both lower than the detection limit(48 cases,70.6%).The univariate logistic regression analysis indicated that the central nervous system infection,CSF pressure,CSF protein levels were risk factors and CSF glucose was protection factor for high HIVRNA viral load in CSF.Multivariate logistic regression analysis showed that CSF glucose was statistically significant(P=0.019,OR=0.455).In case of other factors unchanged,CSF glucose concentration increased by one unit(mmol/L),cerebrospinal fluid HIVRNA viral load was not less than the blood HIVRNA viral load in a decreased risk for the original 0.455 times.Conclusion CSF glucose is the protection factor for high HIVRNA viral load in CSF.
引文
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[13]Kumar A,Abbas W,Herbein G.HIV-1latency in monocytes/macrophages[J].Viruses,2014,6(4):1837-1860.
[14]温春燕,冯理智,胡凤玉,等.HIV-1病毒储存库的清除策略研究进展[J].国际流行病学传染病学杂志,2016,43(3):203-206.
[15]Van Lelyveld SFL,Nijhuis M,Baatz F,et al.Therapy failure following selection of enfuvirtide-resistant HIV-1in cerebrospinal fluid[J].Clinical infectious diseases,2010,50(3):387-390.
[16]Liu L,Zhao Q,Wei F,et al.Genetic analysis of HIV type 1env gene in cerebrospinal fluid and plasma of infected Chinese paid blood donors[J].AIDS research and human retroviruses,2012,28(1):106-109.
[2]Michael Carter.HIV detectable in CSF of 10%of patients taking successful antiretroviral treatment[J].Journal of Infectious Diseases,2010,11(3):107-108.
[3]Giancola ML,Lorenzini P,Cingolani A,et al.Virological response in cerebrospinal fluid to antiretroviral therapy in a large Italian cohort of HIV-infected patients with neurological disorders[J].AIDS Research and Treatment,2012,13(7):37-38.
[4]中华医学会感染病学分会艾滋病学组.艾滋病诊疗指南[J].3版.中华传染病杂志,2015,33(10):577-593.
[5]Christo PP,Greco DB,Aleixo AW,et al.HIV-1RNA levels in cerebrospinal fluid and plasma and their correlation with opportunistic neurological diseases in a Brazilian AIDS reference hospital[J].Arq Neuropsiquiatr,2005,63(4):907-913.
[6]刘远志,陈兵刚,张玉林,等.合并中枢神经系统机会性感染病人的中枢HIV-1载量和变异性增高[J].首都医科大学学报,2014,35(1):81-86.
[7]Gras G,Kaul M.Molecular mechanisms of neuroinvasion by monocytes-macrophages in HIV-1infection[J].Retrovirology,2010,7:30.
[8]李太富,连铁,王开俊,等.血糖水平对脑脊液葡萄糖含量的影响[J].临床麻醉学杂志,2003,19(9):567.
[9]李宁,李太生.HIV-1病毒储存库及检测方法的研究进展[J].中国医师杂志,2014,16(1):51-55.
[10]Eisele E,Siliciano RF.Redefining the viral reservoirs that prevent HIV-1eradication[J].Immunity,2012,37(3):377-388.
[11]Tyagi M,Bukrinsky M.Human immunodeficiency virus(HIV)latency:the major hurdle in HIV eradication[J].Mol Med,2012,18:1096-1108.
[12]Chun TW,Justement JS,Murray D,et al.Rebound of plasmaviremia following cessation of antiretroviral therapy despite profoundly low levels of HIV reservoir:implications for eradication[J].AIDS,2010,24(18):2803-2808.
[13]Kumar A,Abbas W,Herbein G.HIV-1latency in monocytes/macrophages[J].Viruses,2014,6(4):1837-1860.
[14]温春燕,冯理智,胡凤玉,等.HIV-1病毒储存库的清除策略研究进展[J].国际流行病学传染病学杂志,2016,43(3):203-206.
[15]Van Lelyveld SFL,Nijhuis M,Baatz F,et al.Therapy failure following selection of enfuvirtide-resistant HIV-1in cerebrospinal fluid[J].Clinical infectious diseases,2010,50(3):387-390.
[16]Liu L,Zhao Q,Wei F,et al.Genetic analysis of HIV type 1env gene in cerebrospinal fluid and plasma of infected Chinese paid blood donors[J].AIDS research and human retroviruses,2012,28(1):106-109.