艾滋病严重疾病期合并中性粒细胞减少症与再感染的关系
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摘要
目的研究艾滋病严重疾病期患者接受抗病毒治疗(HAART)前后中性粒细胞减少症与发生机会性感染的关系。方法回顾性分析138例已经确诊为艾滋病严重疾病期的患者,所有患者的机会性感染均已得到控制而进入机会性感染的二级预防及HAART阶段。患者按HAART前基线的血常规检测,分为中性粒细胞绝对数≤2×10~9/L组77例(低下组)和中性粒细胞绝对数>2×10~9/L组61例(正常组)。接受HAART6个月后,对比两组患者再感染率及平均抗生素使用天数,分析患者基线中性粒细胞计数水平与抗生素使用天数、再感染次数的相关性。结果经过6个月的观察,低下组患者的再感染率为59.7%,正常组患者的再感染率为34.4%,两者差异有统计学意义(χ~2=8.732,P<0.05)。患者的基线中性粒细胞数值与患者再感染次数存在负相关(r_s=-0.31,P<0.05),与抗生素使用天数存在负相关(r_s=-0.299,P<0.05)。结论合并中性粒细胞减少症可使艾滋病严重疾病期患者在抗病毒治疗早期出现再感染的危险性增加,监测患者中性粒细胞水平,及时发现并治疗再感染,具有重要临床意义。
Objective To study the relationship between neutropenia and opportunistic infection in severe-stage AIDS patients before and after receiving highly active antiretroviral therapy(HAART). Methods We retrospectively analyzed 138 patients diagnosed with severe-stage AIDS. All the patients' opportunistic infections were controlled and entered the secondary prevention and HAART stage. According to the blood routine test of pre-HAART baseline, the patients were divided into the low neutrophil group(neutrophil absolute count ≤ 2×10~9/L, n=77) and the normal group(neutrophil absolute count >2×10~9/L, n=61). Six months after receiving HAART, we compared the reinfection rate and average days of antibiotic use between the two groups, and analyzed the correlation of baseline neutrophil count with days of antibiotic use and reinfection. Results Observation continued for a 6-month period. The reinfection rate in the low neutrophil group and the normal group was 59.7% and 34.4% respectively, and the difference was statistically significant(χ~2=8.732, P<0.05). The patients' baseline neutrophil count was negatively correlated with their reinfection frequency(r_s=-0.31, P<0.05) and days of antibiotic use(r_s=-0.299, P<0.05). Conclusions In the early stage of HAART, severe-stage AIDS complicated with neutropenia can increase the patients' risk of reinfection. It is therefore of great clinical significance to monitor the level of neutrophils in the patients and timely detect and treat their reinfections.
Objective To study the relationship between neutropenia and opportunistic infection in severe-stage AIDS patients before and after receiving highly active antiretroviral therapy(HAART). Methods We retrospectively analyzed 138 patients diagnosed with severe-stage AIDS. All the patients' opportunistic infections were controlled and entered the secondary prevention and HAART stage. According to the blood routine test of pre-HAART baseline, the patients were divided into the low neutrophil group(neutrophil absolute count ≤ 2×10~9/L, n=77) and the normal group(neutrophil absolute count >2×10~9/L, n=61). Six months after receiving HAART, we compared the reinfection rate and average days of antibiotic use between the two groups, and analyzed the correlation of baseline neutrophil count with days of antibiotic use and reinfection. Results Observation continued for a 6-month period. The reinfection rate in the low neutrophil group and the normal group was 59.7% and 34.4% respectively, and the difference was statistically significant(χ~2=8.732, P<0.05). The patients' baseline neutrophil count was negatively correlated with their reinfection frequency(r_s=-0.31, P<0.05) and days of antibiotic use(r_s=-0.299, P<0.05). Conclusions In the early stage of HAART, severe-stage AIDS complicated with neutropenia can increase the patients' risk of reinfection. It is therefore of great clinical significance to monitor the level of neutrophils in the patients and timely detect and treat their reinfections.
引文
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[13] Kestens L,Seddiki N,Bohjanen PR.Immunopathogenesis of immune reconstitution disease in HIV patients responding to antiretroviral therapy[J].Curr Opin HIV AIDS,2008,3(4):419-424.
[2] 蔡卫平,陈谐捷,李惠琴,等.国家免费艾滋病抗病毒药物治疗手册[M].第4版.北京:人民卫生出版社,2016:16-18.
[3] 郑武,张薇,汤恒,等.湖北省接受艾滋病HAART患者CD4+T淋巴细胞变化趋势及影响因素[J].实用预防医学,2018,25(11):1325-1328.
[4] Hunt P,Deeks S,Rodriguez B,et al.Continued CD4 cell count increases in HIV-infected adults experiencing 4 years of viral suppression on antiretroviral therapy[J].AIDS,2003,17(3):1907-1915.
[5] Moore DA,Benepal T,Partsmouth S,et al.Etiology and natural history of neutropenia in human immunodeficiency virus diseaes :a prospective study[J].Clin Infect Dis,2001,32(3):469-476.
[6] 赵勤,张会芬,李丽华.40例艾滋病患者外周血细胞及骨髓细胞异改变 [J].实用医技杂志,2007,14(34):4682-4683.
[7] 张团庆,覃善芳,吕青.艾滋病患者外周血象及骨髓象的临床研究[J].中国医学创新,2013,10(14):142-143.
[8] Martin-Davila P,Fortun J,Lopez-Velez R,et al.Transmission of tropical and geographically restricted infections during solid-organ transplantation[J].Clin Microbiol Rev,2010,21(1):60-96.
[9] 葛均波,徐永健.内科学[M].第8版.北京:人民卫生出版社,2013:618-620.
[10] 张政,王福生.AIDS的免疫重建和免疫治疗[J].传染病信息,2009,22(6):325-329.
[11] Appay V,Sauce D.Immune activation and inflammation in HIV-1 infection:causes and consequences[J].J Pathol,2008,214(2):231-241.
[12] Grossman Z,Meier-Sehellersheim M,Paul WE,et al.Pathogenesis of HIV infection:what the virus spares is as important as what it destroys[J].Nat Med,2006,12(3):289-295.
[13] Kestens L,Seddiki N,Bohjanen PR.Immunopathogenesis of immune reconstitution disease in HIV patients responding to antiretroviral therapy[J].Curr Opin HIV AIDS,2008,3(4):419-424.